Is straightening my tip possible after three previous rhinoplasty surgeries? (photos)

Question

I've had three previous rhinoplasty operations (2006, 2007 & 2018). None of the surgeons have been successful in straightening my tip. Could there be a reason why? I'm happy with my profile, I'd just like the tip straight. I'll upload two images; one of how it is currently and one is what I'd like. Also, if this is possible, would it be the cost of a standard rhinoplasty? Any advice would be much appreciated :)

Philip Michael, MBBCh, FRACS, FRCS(Ed) · Answer

Many thanks for your enquiry. Generally, a tip twist can be improved but the inherent forces arising in healing owing the memory of the underlying structure can pull things back to their pre-operative position. However, using grafts that have enough structural integrity together with addressing any associated septal deviation can aid in reducing the degree to retwisitng. Any further surgery though should be undertaken by someone who has significant experience in performing revision surgery.
Best Wishes

Nima Shemirani, MD · Answer

Hi @VictoriaKlaus11. Thank you for sharing you photos. I recommend seeing an expert revision rhinoplasty specialist for an in person examination. There are options for you that can be determined after examination

Best of luck,

Dr. Nima

Best of luck,

Dr. Nima

Jonathan Kulbersh, MD · Answer

Hello and thank you for your question. In the majority of cases, a twisted tip can be corrected. However, the procedure may take longer than the initial rhinoplasty. To correct the deviation in your tip, an experienced facial plastic surgeon may use a cartilage graft from your rib. Cartilage has memory, so it may start to shift back into its original position throughout the healing process. Replacing the deviated septum with rib cartilage may be the only way to prevent the tip from returning to its original position. As for cost, revision rhinoplasty is almost always more costly than the original procedure because it’s more difficult to perform. I highly recommend scheduling a consultation with a reputable board-certified facial plastic surgeon to ensure your procedure is performed safely and correctly.

Marc Polacco, MD · Answer

Thank you for your question. Fixing a crooked or twisted nose is one of the biggest challenges for any rhinoplasty surgeon. The issue is that cartilage has memory, so your septum is going back to the same side after surgery. In cases like this, sometimes it is best to remove the crooked septum entirely, and replace it with cartilage that is straight, often from rib. Typically the cost of this procedure will be more than a standard rhinoplasty because it takes much longer. I hope this information is helpful, and all the best!
-Dr. P

Samuel Lin, MD, FACS · Answer

Thank you for your question-- in revisional cases the first steps that I review are essentially what was performed previously in surgery-- after which a plan may be formed.  It may be possible to further straighten a nasal tip after previous surgeries all depending on a patient's anatomy..

Akshay Sanan, MD, FACS · Answer

Dear VictoriaKlaus11,
Thank you for uploading photos and the insightful question. A potential reason why your tip is still not crooked is because the nose cartilage has memory and it is curving to the left. Since this is your 4th nose surgery, there is scar tissue and the skin quality is not as good as if you never had surgery. This increases the risk of your rhinoplasty. In order to get the tip straighter, it will require firm cartilage, and I prefer to use rib cartilage for this case. Because it is a multiple revision operation and requires rib cartilage, it takes more time and expertise, and the price is more than a standard rhinoplasty.
All the best,Dr. Sanan, MDLos Angeles, CA

Cem Altindag, MD - Account Suspended · Answer

Hi Victoria, thank you for your question. Your expectations are normal. It would be difficult surgery. A fourth (revision) rhinoplasty also may be planned although it has risks. It appears that; Rib cartilage graft (your own) would be ideal graft material. Regards. OprDr. Cem Altindag The Nose Clinic Istanbul TR

Is straightening my tip possible after three previous rhinoplasty surgeries? (photos)

Answers (7)

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