Will this supratip fullness resolve, or will I need a revision rhinoplasty? (Photo)

I had a rhinoplasty about 6.5 months ago. It still feels somewhat swollen, but I'm getting concerned about a bump above my tip. It looks alright when I'm in repose, but when I smile, making blowing/kiss faces, etc, it becomes somewhat prominent. Could this be scar tissue that might flatten out over time? Or will I need a revision to address this?

Doctor Answers 8

Considering revision rhinoplasty 6.5 months after plastic surgery

Thank you for your question and photographs. Your nose will continue to change with time, but your specific concern may or may not change. Plastic surgeons generally don't consider revision rhinoplasty until at least a year has passed from the original surgery. It's difficult to determine based on the photographs alone without knowing anything else about your original rhinoplasty. The tip of the nose naturally moves with facial expressions and smiling. Sometimes this movement may be reduced with surgery, if appropriate. If you haven't already, then speak with your plastic surgeon regarding any concerns you have.

Dr. Chaboki

Washington DC Facial Plastic Surgeon
4.9 out of 5 stars 85 reviews

Probably a revision, sorry. But it looks like the length of your nose is the real problem.

The view with your face in repose is the important one, because that's how your nose looks most of the time. Even in that view, your nose perhaps looks rather long, and of course when you smile, it gets longer, besides showing the bump.

See the "Web reference" link, below. I rotated the image so that your head is in a neutral position, and then I made a computer modification, and an animation, showing elevating the tip of your nose, bringing it back closer to your face, and then taking down the rest of the hump.

Are those the kind of changes you would be looking for?

If you have a revision, it's very very important that the doctor doesn't *just* fix the little bump, but that he addresses *everything* that still bugs you about the nose. You don't want to do a partial job and then be looking for a third operation later!

You should understand that these proposed changes require advanced techniques on the tip of the nose, techniques that most plastic surgeons cannot handle. You must see lots of revision before and after photos of your surgeon's work before deciding to use him for your operation.

Steven M. Denenberg, MD
Omaha Facial Plastic Surgeon
4.8 out of 5 stars 41 reviews

Revision Rhinoplasty

Thank you for your question.  I would wait a year and see. Please consult your plastic surgeon. Best of luck on your future cosmetic endeavors.

Howard N. Robinson, MD (retired)
Miami Plastic Surgeon
4.7 out of 5 stars 62 reviews

Septal issue

This looks like a doral septa issue toward the lower region right by your tip cartilage. You will likely nee da revision if it bothers you.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Will I need a revision rhinoplasty

At 6 months out you can still see changes in swelling, but in your case the supratip swelling appears to be mostly cartilage, with an underprojecting tip in relation to the supratip area.  It is very likely that you will benefit from a revision, but that it is best deferred for a full year after your first procedure.  Because your nose has a lot of projection, the major goal of revision surgery would be to lower your supratip, but your tip would also benefit from increased support.  I would discuss your situation with your surgeon, and make sure your are comfortable with the plan for revision, and that your surgeon is experienced with revision rlhinoplasty.

Thomas A. Mustoe, MD, FACS
Chicago Plastic Surgeon
4.8 out of 5 stars 96 reviews

Supratip deformity more than 6 months after rhinoplasty

Based on these photos I would plan for a revision.  The bump above your tip is not going to resolve over time since it appears to be part of a poorly resected and poorly balanced dorsal cartilage edge.  For best results consult a surgeon certified by the American Board of Plastic Surgery who has a lot of revision rhinoplasty experience.  You will want to wait for a few more months for all scar tissue to mature and soften.

Daniel Greenwald, MD
Tampa Plastic Surgeon
5.0 out of 5 stars 46 reviews

Supratip fullness

Based on your photos, the high spot appears to be the anterior septal angle.  The part of the septum where the bridge starts.  When you smile or pucker, your depressor septi muscle pulls the tip down just enough to reveal the immobile anterior septal angle. This is a common issue of tip support after rhinoplasty.  Unfortunately, I don't think this will get better.  You should discuss this with your surgeon. 

Matthew Bridges, MD
Richmond Facial Plastic Surgeon
5.0 out of 5 stars 24 reviews

Supratip Fullness.

A supratip fullness either develop as a result of the excessive scar tissue formation above the tip or because of inadequate tip projection. From the pictures that you have posted it seem that you have inadequate tip projection. Unfortunately this means that you will need a revision surgery. There are a variety ways of augmenting the tip projection and in your case if a columella strut is used it will accomplish two goals at the same time. It will produce more projection and will resist the forces of the muscles that pulls your tip down when you smile.

Bahman Guyuron, MD
Cleveland Plastic Surgeon
4.7 out of 5 stars 21 reviews

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