Do I need a revision because nearly 3 after rhinoplasty my tip still points down?

Question

I had a rhinoplasty almost 3 years ago. I loved my nose when the cast first came off. However I experienced a lot of swelling after that. I think it's finished swelling but now I see the top still points down long, which is why I had a rhinoplasty to stop that. Do I need a revision? Is it likely to improve after this long?

Steven M. Denenberg, MD · Answer

I see how your nose is still long, with the tip pointing down. The good news is that elevating the tip of the nose should be one of the more predictable changes to make in a rhinoplasty, even in a revision.
The woman in the short video that I posted with this answer had the tip of her nose elevated significantly in her revision operation.How *much* to elevate the tip? And what else should be done to the nose at the same time (you only posted frontal views)? 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 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 always 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 only the surgeon has that information and judgment. Another aside: I also recommend that you not show morphs made by one surgeon to a different surgeon. If a surgeon makes his *own* morphs, you get to see whether he understands the important issues of your nose, and how your nose should be changed. But if you show the surgeon someone else's morphs, and he says "Of course I can make your nose look like that," then you don't really know if he fully understands, or even recognizes, the important changes shown in those morphs. And you don't know if he can make those changes during surgery.)
Remember, too,  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 -- revision work on the tip cartilages that are holding the tip down -- require advanced techniques, and skill that most plastic surgeons don't possess with expertise. For most noses, 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 for those who have had previous surgery, it also discusses how to tell whether your first surgeon should be performing your revision. And it also discusses how to take photos that are best for online evaluations.
Your nose is also a perfect example of why computer imaging is mandatory in rhinoplasty. You need to know exactly what the surgeon is planning to accomplish -- what features he thinks he can change, and by how much he thinks he can change them. I always email morphs to my online rhinoplasty consultations. When you see the surgeon's goals in the morphs, you'll know whether he has an eye for an attractive nose, and whether he shares your opinion of what constitutes an attractive nose. You'll also know whether the changes he proposes are large enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. How would you ever get that figured out without the morphs?

Eric M. Joseph, MD · Answer

The feasibility of revision rhinoplasty would require an examination. In general, if you want your tip elevated, surgery would be necessary. Consider consulting with your surgeon or another rhinoplasty specialist to discuss your concerns. Thank you. Dr Joseph

Waleed Ezzat, MD, FACS · Answer

Thank you for your question. The best way to answer this question would be to seek out a board certified specialist with extensive experience in revision rhinoplasty.  In most cases, there are things that can be done to reposition your tip. However, only a full clinical examination and review of your history can answer that definitively.Good luck!Dr. E

Thomas Trevisani, MD · Answer

Nobody needs Cosmetic Rhinoplasty - it is an elective procedure. Only the patient can decide if she/he wants to go ahead with surgery. In order to evaluate accurately -especially when it comes to revision Rhinoplasty -in person exam is essential, evaluation of pre-op and post op photos- all views, and reading the op-report. Based on limited frontal views, in the right hands your nose can be improved through a closed technique. I suggest that you seek an experienced Board Certified PS with extensive Rhinoplasty experience

Richard Mark Winters, MD · Answer

early on after rhinoplasty, it is common for swelling and early scarring to buoy structures and hide imperfections.... your late photos seem to reveal over-resected tip cartilages which likely exacerbated poor tip supportthe only solution to secondary rhinoplasty deformities like yours is to restore structure in a revision rhinoplastygood luck

Do I need a revision because nearly 3 after rhinoplasty my tip still points down?

Answers (6)

Answer: Do I need a revision because nearly 3 after rhinoplasty my tip still points down?

Answer: Do I need a revision because nearly 3 after rhinoplasty my tip still points down?

Answer: Lack of tip support...

Answer: Lack of tip support...

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Do I need a revision because nearly 3 after rhinoplasty my tip still points down?

Answers (6)

Answer: Do I need a revision because nearly 3 after rhinoplasty my tip still points down?

Answer: Do I need a revision because nearly 3 after rhinoplasty my tip still points down?

Answer: Lack of tip support...

Answer: Lack of tip support...

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Recommended reading

Everything you need to know about Revision Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.