Swelling years after revision rhinoplasty - can this be improved? (Photos)

Thanks Charming657132 for your question! It's understandable that you're feeling discouraged and experiencing low self-esteem after two rhinoplasty procedures have not yielded the results you hoped for.
Swelling after rhinoplasty, particularly revision rhinoplasty, can last a long time. While the majority subsides within the first year, some residual swelling, especially in the tip, can linger for several years. This is due to the complex nature of healing, particularly when dealing with prior scar tissue and altered anatomy from previous surgeries. Fluctuations in swelling can occur due to various factors, including diet (high sodium), activity levels, and even weather. It's possible a significant portion of what you're experiencing is indeed persistent fluid and inflammation.
Revision rhinoplasty often involves working through existing scar tissue from the initial surgery. While the surgeon aimed to remove scar tissue, the body's natural healing response can lead to the formation of new scar tissue. Excessive or unpredictable scar tissue can contribute to increased size and firmness, sometimes giving the appearance of a larger or less refined nose. The second surgery involved "more septal work" and potentially removing more from your tip. While intended to improve the shape, these changes, combined with healing and scar tissue, could have led to unforeseen structural support issues or contours that contribute to the perception of increased size.
The healing process after any surgery, especially revision rhinoplasty, is highly individual and not always entirely predictable. The way your tissues responded to the trauma of two surgeries could be a factor in the current outcome.
Given your history and dissatisfaction, seeking a second opinion from another qualified plastic surgeon, particularly one specializing in complex revision rhinoplasty, is highly recommended. A new surgeon will evaluate your nose and surgical history with a fresh perspective. They may identify factors or potential approaches that your previous surgeon did not consider or feel comfortable undertaking.
Revision rhinoplasty is significantly more challenging than primary rhinoplasty. Surgeons have varying levels of experience and expertise with different techniques for addressing issues like persistent swelling, scar tissue, and structural support in previously operated noses. A surgeon who specializes even more narrowly in complex revisions might have solutions or strategies that could be beneficial.
Prioritize finding a surgeon with extensive experience specifically in revision rhinoplasty and a strong track record of managing challenging cases. Look at their before and after photos of revision patients and have a very open and detailed conversation about your concerns and their assessment of what might be possible. It really takes at least 12 -24 months for healing to complete itself after Revision rhinoplasty.
Hope this was helpful!
Best wishes,
Dr Ali Sajjadian

I would not look at this one photo and conclude that there's nothing you can do. You need an expert to feel the nose, assess where the cartilages lie, see how the cartilages are controlling what the nose looks like now, how much of the size is swelling, or scar, or cartilage, whether modifying the positions of the cartilages could help, and how that could help, and by how much, and what are the chances of success.

It'd be rare for a lot of what you're seeing right now to be true swelling; swelling eventually tends to go away, almost no matter what else is happening in the nose.

There may be other considerations, too. For example, the after photo you posted has you in a big smile, which does tend to distort the nose, but even in the middle photo, the nose looks long-ish to me. If your current nose would benefit from being shortened, that change might address part of how the nose looks wide to you, because a nose that is smaller overall tends to bug us less, and it might change the proportions so you don't interpret what you see as too wide. Boy, I'm even confusing *myself* right now. I think the next step would be a good set of photos, and some morphs made by the surgeon, under your direction, and then of course an exam in person. An honest and skilled surgeon would tell you whether he would go ahead with surgery, if the nose were on *his* face. But giving up now, without another try at evaluation, especially considering how much it bothers you, doesn't seem at all to be necessary.

Hi and thanks for the question. Sorry to hear about the difficulty you’ve had with your nose. It does look like your tip is still bulbous in the photos. The scar tissue and edema should be treatable with Kenalog injections… I use these commonly in my practice. The tip shape can also be improved by reshaping the lower lateral cartilages with modern suture techniques and removing some of the soft tissue directly. It may be that the current tip grafts are a bit wide and thick. Assessment of your tip could best be done with an in-person consultation, to assess how much of the issue is cartilage vs. swelling/scar tissue.
All the best!
Dr. Mehta

Hello and thank you for your question. Based on your photographs, you may benefit from another revision rhinoplasty. Maneuvers for your surgery could include tip refinement, nasal tip deprojection, tip elevation, among other maneuvers. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon