Upturned Nose After 4th Surgery: Will a 5th Revision Rhinoplasty Fix the Problem?

Dear Doctors, 5 days ago I did my 4th rhinoplasty and I still have a very upturned nose (more than 110 degree and I am a male). I got this upturned nose after the 2nd surgery which was very agressive and the 3rd and the 4th didn't fix the problem. The last doctor used an ear graft as well. Could it be that my nose cannot be de-turned? I am ready to do a 5th surgery.

Doctor Answers 6

Over-rotated nose

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As others have pointed out early post-op swelling will make the nose look up-turned.  Having said that if after a few  weeks it is still up-turned it will likely remain so.  At that point consider a rib graft.

Seattle Facial Plastic Surgeon
4.7 out of 5 stars 231 reviews

Yes your nose should be able to be rotated downward with Revision Rhinoplasty

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 I'd have to see you, or pictures of your nose to make specific comments and recommendatiuons but after performing Rhinoplasty and Revision Rhinoplasty for over 20 years, yes IMHO, your tip should be able to be rotated downward...or lengthened.  Placing an ear graft to the front, of the nose, is often not an adequate means to decrease tip rotation.  Most often, there is columellar show that must be addressed as well.  You will have to wait 6-12 months nefore having any revision, based on what is deicided for the Revision Rhinoplasty and what was done during this last Rhinoplasty.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Upturned nose following multiple revision rhinoplasty procedures.

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Without photos and only 5 days following your 4th rhinoplasty it is hard to tell exactly what the issues are.  You will need to let the swelling subside and the tissues to completely remodel before considering revision rhinoplasty, if indeed that is the advisable thing to do.  Typically the waiting period is 9-12 months. 

I agree that swelling in the early postoperative period can cause a temporary up-rotation of the nasal tip.  If, things have not changed down the line, then you need to consider the pros and cons of further surgery.  From your description of an aggressive rhinoplasty procedure it is very likely that your nose is now to short in addition to being up-rotated.

If rhinoplasty is considered the most challenging facial plastic surgery procedure, then lengthening the short nose following prior surgery is definitely the most challenging rhinoplasty.  To successfully elongate the overly-resected nose requires attention be given to lengthen all 3 of the nasal layers: 

  1. The internal mucosal lining - this can be achieved by rearranging the internal lining in the form of local mucosal grafts or by using composite (skin plus cartilage) grafts from the ear.
  2. The middle cartilage framework - this can be lengthened with extensive extension grafts to the nasal septum, the lower lateral lateral cartilages and the nasal tip.  In multiple revision cases one typically needs to turn to the rib grafts because the nose and the ear have been depleted of cartilage.
  3. The outer skin cover -  In some cases, the skin cover has responded to prior surgery with severe scarring and shortening which has undone the placement of cartilage grafts in the middle support layer.  Unfortunately, not much can be done about this.  It is possible to achieve some loosening of the skin cover by removing and weakening the internal scar, but this is often inadequate in cases of severe skin contracture.  In these cases, the only way to obtain adequate skin release is to use local flaps or grafts which will add their own stamp on the final appearance and to some patients will be unacceptable.  In cases where severe skin contracture is the main culprit, it may not be advisable to consider further surgery.                                   

Mario J. Imola, MD, DDS
Denver Facial Plastic Surgeon
4.9 out of 5 stars 124 reviews

Upturned Nose after 4th Surgery

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It is difficult to evaluate your nose 5 days after surgery; swelling can distort your appearance at this time. Wait  6-12 months and then submit pictures to Real Self physicians if you're not satisfied and want another opinion.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

Fixing upturned nose

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It's hard to assess the outcome of your recent surgery so soon after the procedure was completed. swelling at the base of the nose can cause your nose to temporarily become more upturned.

Without seeing your nose it's hard to say whether further surgery would help.

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
4.9 out of 5 stars 22 reviews

Upturned Nose After Rhinoplasty

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Lengthening the nose is one of the most difficult things in rhinoplasty.  Most of the time it requires the use of either septal cartilage (if present) or costal cartilage.  Early on, the swelling from the nose will make it appear shorter than the final result.  The rate limiting steps in lengthening the nose are skin mobility and the amount of skin available. Contracted scarred skin moves less and may make it harder to lengthen the nose.  Preoperative massage can be helpful to loosen the skin in these circumstances.

Anil R. Shah, MD
Chicago Facial Plastic Surgeon
4.8 out of 5 stars 177 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.