Nose Upturned During Rhinoplasty Without Consent

My nose was turned up "slightly" without my consent during my Rhinoplasty 7 weeks ago. The doctor admitted to this recently. It has been a "drastic" change as it's very turned up. As time passes, the tip is turning up even more. My nose is very short and it's not coming back down as swelling settles. Why would a surgeon decide to do this if we agreed not to (as my angle between tip and lip was around 100 plus degrees)? The treatment was to only correct small hump. I would appreciate a surgeon's advice on how I should address this? With him? Thank you.

Doctor Answers 8

Rhinoplasty; Unwanted Upturn of Nasal Tip

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Hi Nurse B,

The best way to address you concerns are directly. Schedule a consultation with your surgeon to discuss what his thought process was. Hopefully there were not any maneuvers to actively increase the rotation of your tip, and over time it will settle.

Sorry to hear of your unsatisfactory experience thus far, but it does emphasize the importance of clear communication between patient and surgeon before surgery.

I hope that you nose settles to your liking. Be well.

Dr. P

Encino Facial Plastic Surgeon
4.8 out of 5 stars 36 reviews

Give some time

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First, the tip should fall with time. Once the swelling diminishes, it will drop a bit. It may not drop enough to make you happy, but there will be a change.

Second, after 6-9 months f you are still unhappy with your nose, speak to your surgeon and discuss your options for revision/correction. It would be wise for you to get a second opinion to help your decision making at that time. Seeing someone else right now will likely not change the outcome since they would want you to wait for at least 6-9 months before considering an evaluation for revision. Good luck.

Sirish Maddali, MD
Portland Plastic Surgeon

Your nasal tip will drop in 6-12 months

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The most common problem with rhinoplasty is caused by the drop of the nasal tip which happens in almost every rhinoplasty. When the tip drops the bump or hump on the dorsum of the nose returns and patients are always unhappy.

Because of this most surgeons elevate the tip at the time of surgery to compensate for the expected drop of the tip over time.

Be patient wait 6-8 months and your tip will be lower.

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Upturned Nose After Rhinoplasty

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If you have seen your nose to turn up more over the last month, then it is unlikely that it will drop down again.

Tip position in regards to rotation is a dynamic issue determined by many variables. Even a hump reduction by itself can cause uprotation of the tip. In addition, small refinements of the tip can turn up the nose even further. Certainly, noses that are already up-turned are prone to more rotation with most rhinoplasty maneuvers; noses with droopy tips need to be forced up if this is to last... After all, this is only one reason why rhinoplasty is the most challenging facial plastic procedures!

I would explore with your surgeon how he could correct this issue in the future. Certainly, I would recommend to wait (minimum 9 months) before entertaining a revision procedure.

Frank P. Fechner, MD
Worcester Facial Plastic Surgeon
4.6 out of 5 stars 51 reviews

It will change but.....

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First off as time passes over the next 3-6 months the tip SHOULD drop down some. This is due to resolution of swelling and softening of tip support.

However, if you think its actually turning up more at the 2 month post op point then thats not a good sign. The question you need to ask him now is what did he do to make it turn up? Did he resect cartilage from the "caudal septum?" Did he do a "cephalic trim" of your tip cartilages? Did he place permanent sutures to rotate the tip upward? If he did not do any of these then time should correct it. You can help it by downward massage of the tip.

As far as why did he do it: Tough to know without asking him. Had he done computer imaging at the consult? Had you specifically told him not to rotate the tip further? Had he told you that the tip may rotate with some of the maneuvers he is going to do?

The fact is that many plastic surgeons do have a "standard rhinoplasty" that they perform and over rotation and shortening of the nose is a very common error. Moreover, each plastic surgeon has a different taste for the final outcome and that is wh computer imaging is so very crucial before surgery to make sure you and your surgeon agree on the type of nose BEFORE undergoing surgery.

At this point what is done is done. Massage and time should help. Dialogue with your surgeon in a calm fashion without emotions would be the most productive approach. After a year passes, if you are unhappy then you can consider a revision with the same surgeon or another.

Good luck.

Gravity will help your nose turn down after Rhinoplasty.

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 The tip of the nose almost always drops with time. You're only 7 weeks post-op, and you should expect further improvement in your appearance.

Best regards.

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 430 reviews

Upturned nose

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 Initially post-op, the nose becomes a bit upturned.  It may eventually fall a bit as time goes by. You have to give it some time probably 6 months to a year.  This is something that you will have to work out with your doctor and follow-up.

Wait for 6-12 months.

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 The elevation may drop with the time above. If it does not, you should discuss this with your surgeon and see what he proposes to do. If you are not satisfied seek a second opinion from an experienced revision rhinoplasty expert.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 36 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.