I am 12 months post op rhinoplasty and I'm really disappointed with the results. (Photo)

Question

My nose looks uneven from the front and the right profile looks bigger than the left. I still feel like my nose is big. The front really bothers me because when I smile it looks even more uneven and misshapen. My surgeon says this may be swelling but it has been 12 months. I had wanted a thin, defined nose but it still looks bulbous. Can I have some professional opinions on whether my nose has been 'botched' and if a revision is needed. Thank you.

Steven M. Denenberg, MD · Answer

Click on the "Learn more" link, just below my response, or go here:
FacialSurgery.com/RealSelf/RealSelf_alexy21.html
I made a computer morph of your nose, and an animation of the morph, to show the changes that are possible for your nose in truly expert hands.I elevated the tip of your nose, rather substantially actually, and I brought the tip of your nose back closer to your face. Even in the frontal views, it seemed to me that your nose looks long. The tip cartilages hold a nose long, and hold it out away from the face, so if they are still strong enough to make those two features, they're probably strong enough to make the tip look wide, too.
See if you think the morph captured what you're looking for. When I'm considering shortening a nose in a revision, I like to make as big a change as the patient would appreciate, so there's enough of an improvement to make the operation worthwhile. The woman in the short video that I posted with this answer had the tip of her nose elevated in a revision operation.
You should understand that the changes I demonstrated in the morph require advanced techniques, techniques that most plastic surgeons cannot handle.  Be sure to read the section in the "Learn more" link on how to stay out of trouble while searching for a rhinoplasty surgeon, and read the essay on how to tell whether your previous surgeon should be performing your revision. Rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. 
I'd love to hear what you think of the morph. Did it seem to address your main concerns? I could modify the morph to your taste if you wish.
Your nose is also a good example of why computer imaging is mandatory in rhinoplasty. You need to know exactly what the surgeon is planning to accomplish -- what features he thinks he can change, and by how much he thinks he can change them. When you see his goals, you'll know whether he has an eye for an attractive nose, and whether he shares your opinion of what constitutes an attractive nose. You'll also know whether the changes he proposes are enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. How would you ever get that figured out without the morphs?! But remember, you're not hiring him for his skills with the computer. The doctor must then show you his before and after photos to prove that he can actually accomplish what he draws on the computer.
In your case in particular, you need to find a surgeon who understands all of the issues I mentioned, and how they fit together, and who can actually accomplish them in surgery.

John Michael Thomassen, MD · Answer

At 12 months the swelling should be resolved. You will know if you have full tip sensation and the tip feels soft and supple.  You would benefit from further reduction of your tip cartilages to refine your tip and a reduction in tip projection to better match your dorsal bridge profile.

Robert Brobst, MD · Answer

Thank you for sharing your questions and photos.  On frontal view you have some asymmetry mainly in the nasal bones and middle vault.  Without your original photographs, it is difficulty to know if this is better, worse, or the same as before your operation.  As for looking big, swelling can take a long time to improve completely.  This is especially true if you had a reduction in nasal size and the overlying skin is still shrinking/ redrawing over the smaller cartilage framework. This usually takes the longest in the lower portions of the nose.  The slowest part of healing, and the part that takes the most patience, is waiting for the swelling to resolve completely.   Discuss you concerns with your surgeon and allow him to keep watching you closely for improvement.  Since you are at the end of the first year, you will have a pretty good idea of what your shape will look like in most instances, but swelling/size is still a factor and may take longer patients. If he determines all the swelling is resolved, you may consider a revision if the result is not consistent with your overall goals. I hope this helps. Take care

I am 12 months post op rhinoplasty and I'm really disappointed with the results. (Photo)

Answers (3)

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