Revision rhinoplasty - How to lengthen the nose so it appears longer when I smile? (Photos)

I used to have a beautiful long nose when I smiled. I also liked that the tip dropped. I am trying to be very specific about what I want from a revision and I am curious if these sound realistic: 1) I would like to remove the collumelar strut so the tip drops again when I smile. 2) Slightly rotate the tip down 3) taller bridge 4) increase the forward projection hoping to get a longer nose again. Or what could create long bridge again when I smile? I attached pictures of my old nose as well. Thanks

Doctor Answers 3

Realistic results with a revision rhinoplasty

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Since you have already had a rhinoplasty procedure with significant alterations to the normal nasal anatomy, it may be  Very difficult, if not impossible to accomplish all of your goals.  It is possible to slightly rotate the tip downward.  The columellar strut can be removed, but is very difficult to predict what the dynamic  action will be of the nose once it is removed.  It is also important to make sure that the depressor septi ligament has not been cut  during the primary rhinoplasty which pulls the tip down when smiling. It is also very difficult to give added projection to the nose without turning it upwards which is counterproductive.  The bridge of the nose could be built up, but it is important to know how much cartilage is left on the inside of the nose for potential grafting purposes. Most importantly is to have realistic expectations about what can and cannot be accomplished with a difficult revision rhinoplasty procedure and look natural. Your current nose looks quite nice, and the  risk may outweigh the benefit.

Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 reviews

Revision Rhinoplasty?

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Your pre-operative photos show significant dorsal asymmetry involving both bone and cartilage, a bulbous tip, and hanging columella. In your post-operative photos, each of these is well-corrected, and the nasal tip projection appears quite good. I believe that your surgeon did a fine job in correcting a very difficult nasal shape.

Revision rhinoplasty is always more difficult, and risks causing or accentuating asymmetries. Scar tissue formation is unpredictable, and can defeat our best intentions. As always, I would discuss your concerns at length with your operative surgeon. However, I do not see anything 'glaring' that would warrant or outweigh the risks of revision rhinoplasty. 

Michael F. Bohley, MD
Portland Plastic Surgeon
4.9 out of 5 stars 20 reviews

Revision rhinoplasty

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thank you for your question

I reviewed a your photos from pre and post op it appears that there are dorsum was slightly higher and your nose was slightly more projecting.  I would first ask you how long it has been since initial surgery.?   It sometimes takes a while for a patient to get used to there "new appearance".  Certainly, another procedure can be done . An examination  of ear nose would be necessary to determine whether or not a tip graft  or removal of the columellar strut would be advisable.  Imaging can be done at that time and although this is not a guarantee , it can certainly give you an idea as to whether revision surgery would be advisable. Initially ,  I would speak with your surgeon . Of course,  If you elect to  see another surgeon it would be someone with vast experience with revision rhinoplasty.


Dave LaPatka,M.D.,F.A.C.S.

David F. LaPatka, MD
Santa Barbara Facial Plastic Surgeon
5.0 out of 5 stars 2 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.