Rhinoplasty failure… but why & what now? My nose looks the same as before (Photos)

Question

My rhinoplasty is a failure. It's been a year, nose looks the same as before. I wanted the tip reduced (refined) and upturned. It looked amazing a few days after surgery. I followed all post-op instructions and was seen every month by the surgeon - whom I made aware of these concerns at month 5+6. I was told more time was needed, put on oral steroids and instructed to tape my nose again. Please, help me, what went wrong? What now? Blessings to all and thank you.

Andrew Miller, MD · Answer

Based on your photos, you appear to be a candidate for revision rhinoplasty since your tip still appears droopy. The tip should be able to be made smaller as well. Be sure to see a couple of different rhinoplasty experts with your preop photos and op note to see what can be done. Computer imaging can be done at the same time.

Eric M. Joseph, MD · Answer

We have met many patients over the last 25 years who have come to our office looking ridiculously close to how they started, even though they were over a year after rhinoplasty surgery. The best way to answer your question would be to procure a copy of your operative report and before and after photos. This data may be reviewed by another reputable rhinoplasty specialist to see what may have happened. As I mentioned in the title of this post, an under-operated nose may lead to a more predictable outcome than a nose that has been made to small. Simply put, removing a persistent dorsal hump along with tip narrowing and tip rotation should be something attainable in the right hands. I hope this is helpful and I appreciate your question. Sincerely, Dr. Joseph

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photographs, will benefit from a Revision Rhinoplasty. Careful selection of a revision surgeon is needed to here. I highly recommend that my patients focus much more on real longterm before and after photographs rather than 3D imaging.   I encounter so many patients in my practice who see me for revision rhinoplasty who previously had surgery elsewhere who feel like they were mislead into surgery by surgeons who relied heavily on 3D imaging without adequate real before and after pictures to back it up.  Photoshop is easy but real surgery is very different.

I always recommend that you carefully evaluate your surgeon’s online before and after gallery on their website for both quality and quantity of results. Make sure that there are hundreds of real before and after pictures which demonstrate long-term follow up results. If your surgeon is posting mostly on table results without real long-term follow up results, that is usually a major red flag.  If a surgeon is posting mostly just splint removal day videos without longterm follow-up pictures, that can also be a red flag.   Long-term results are much more meaningful than on table results or 1 week post-op results.  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

Jeffrey H. Spiegel, MD · Answer

Rhinoplasty is a complicated procedure where many variables are at play.  The thickness of your skin, the way you heal, and the shape of your cartilage all influence the final outcome.
However, this should be readily improved.  Particularly so when we know you are prone to this.

Steven M. Denenberg, MD · Answer

I'd like to see the tip narrowed and elevated quite significantly, and perhaps the bridge lowered a bit more. I can't tell what's going on with the forward projection of the nose because you didn't post a true profile.

The good news is that, in expert hands, these changes are rather predictable to accomplish, even in a revision. I wouldn't bother with taping or steroids. At this point, neither can make the changes that your nose needs, at all.

How *much* to elevate the tip, or narrow the tip, or lower the bridge, or make other changes? We figure that out with morphs, well before surgery. I'd love for you to see some excellent professionally-designed morphs of what could possibly be done with your nose. Morphs could also help you identify better just what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. Profile and three-quarter views would be particularly important in morphing your nose. (Side note: in my opinion, morphs should really be done by the surgeon, or he should direct an assistant as she makes the morphs. Morphs should be made with a constant eye to what actually *can* be done in surgery, for that particular nose, and the surgeon has that information and judgment best.)

Finally, remember that rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The changes that your nose needs require advanced techniques, and skill that most plastic surgeons don't possess with expertise. It's much better to not have surgery than to have inexpertly-performed surgery. Read my essay on how to stay out of trouble while selecting a rhinoplasty surgeon. And it also discusses how to take photos that are best for online evaluations.

And for those who have had previous surgery, it also discusses how to tell whether your first surgeon should be performing your revision.

William Portuese, MD · Answer

A full set of current facial photographs from all angles that are in focus are required to make a determination about how best to proceed. In addition, copy of the operative report would be helpful to find out what was accomplished in the first procedure. Revision rhinoplasty is more difficult than a primary rhinoplasty, so choose your second surgeon wisely based on extensive experience producing natural results

Rhinoplasty failure… but why & what now? My nose looks the same as before (Photos)

Answers (6)

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