Why is my nose changing so much after primary rhinoplasty? 20 months post op now (photos)

Question

I am 20 months post op and I feel that my nose is getting worse with time. I am experiencing a dip in the middle of my nose, uneven nostrils and retraction, a bulbous tip and unaesthetic dorsal aesthetic lines. I feel like the bridge of my nose is also not even and I can see and feel asymmetry especially in photos. How can this be fixed and why is this happening now? I have thick skin and have received 3 steroid shots at 6,9 and 12 months. My surgeon won’t tell me why this is happening !

Eric M. Joseph, MD · Answer

Based on your photos, you appear to have an indentation just above your tip, and there may also be nostril retraction on both sides. I believe you are seeing this because all of your swelling has now dissipated. Depending on your examination, microdroplet Silikon-1000 injections maybe considered for filling the indent along your bridge on profile, and for lowering your lower nostril margins for a less operated nasal appearance. I hope this is helpful. Sincerely, Dr Joseph

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photographs, you are a great candidate for a revision rhinoplasty. Maneuvers for your surgery would include dorsal hump reduction, tip refinement, placement of alar contour grafts to correct alar retraction 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

Best wishes and good luck.

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

Ronald J. Edelson, MD · Answer

The nose continues to change after even 3 years. Overall your result is good but your tip could benefit from refinement that the steroid shots were unable to produce.

Oakley Smith, MD, FRCSC · Answer

Hi, It is better for you to consult with your facial plastic surgeon who can examine you and give you opinion based on examination. Surgery technique, healing process, and complications all can play a role.

Zoran Potparic, MD · Answer

Some patients may need longer time for postoperative scars to mature and settle. The fact that you had several corticosteroid injections tells that you are within that group of patients who react with prolonged and excessive scaring. This type of  reaction may change initial result after surgery to a certain degree; that  is not something that surgeon has a full control off! You should wait until result is mature and then address the issues with revision surgery. However, have in mind that the same process of excessive scarring may happen after next surgery. Good luck.

Selcuk Yazan, MD · Answer

Hello,
The changes you observe after a primary rhinoplasty are part of the natural healing process and are influenced by several factors, both intrinsic and extrinsic. These changes can occur gradually over the months and even years following surgery as the tissues settle and heal.
What you see on the operating table or immediately after cast removal is not your final result. During surgery, tissues are manipulated and swollen, and the shape seen at this time reflects temporary conditions such as intraoperative edema and overcorrections made by the surgeon to anticipate post-operative changes.
The healing process lasts up to 1–2 years, and during this time, swelling resolves, tissues contract, and the nasal framework stabilizes. Swelling typically persists longer in the tip of the nose, especially in thicker-skinned patients.
Every surgeon employs specific techniques tailored to the patient’s unique anatomy and goals. Some results may appear “overdone” immediately post-op to account for anticipated tissue relaxation and settling. This is especially common in structural rhinoplasty, where certain modifications are made to ensure long-term stability and aesthetic balance. It’s crucial to communicate openly with your surgeon about your goals and understand their approach to achieve those goals.
As for patient-specific factors it’s important to note, thicker skin tends to retain swelling longer and may mask finer details of the underlying structure. Conversely, thinner skin may reveal irregularities more prominently, which can also influence how the nose appears over time. 
Compromised blood flow or excessive scar tissue formation can also lead to unexpected changes. Factors like smoking, high blood pressure, or inadequate post-operative care can contribute to complications such as prolonged swelling or fibrosis.
Following your surgeon’s instructions is critical to minimizing swelling and avoiding complications. Factors such as sleeping position, avoiding strenuous activities, and keeping your blood pressure controlled can significantly impact your outcome. Excessive swelling during recovery can lead to the formation of scar tissue or fibrosis, altering the intended result. Maintaining a healthy recovery environment through optimal care and communication with your surgeon can help mitigate these risks.
It’s just as important to select a surgeon based on their experience, aesthetic judgment, and ability to achieve results that align with your goals&mdash;not just on simulation images or intraoperative photos. Remember, photos taken immediately after surgery do not reflect the final result, as every nose “drops” and refines over time.
It’s also essential to avoid fixating on photos of other noses or relying solely on simulation results. A nose that looks perfect on someone else may not harmonize with your facial features, skin type, or ethnic background. An ideal surgeon prioritizes balance and proportion over replicating a specific photo. Understanding that the nose must suit your entire face, not exist as an isolated structure, is key to achieving long-term satisfaction.

Sean Fisher, MD · Answer

post-operative changes are highly dependent individual patient healing and the techniques employed from previous surgery. Patients having varying degrees of scar formation/fibrosis which can affect post-operative outcomes. Long term changes may also depend on the techniques used and the structural integrity of the deeper structures of the nose. I typically advise patients to wait at least 1 year after primary rhinoplasty before considering revisionary surgery.

Joseph Shvidler, MD · Answer

It’s understandable to be concerned about the appearance of your nose after rhinoplasty. Here’s a general timeline and what you can expect as your healing progresses:
First Few Days to Weeks:

1. Swelling and Bruising: It’s common to have significant swelling and bruising around the eyes and nose. The tip of your nose might look turned up or distorted due to the swelling.

2. Splint and Packing:If you had a splint or nasal packing, it will typically be removed within the first week. This can significantly change the appearance of your nose.

3. Initial Healing: The first week to ten days is crucial for initial healing. During this time, your nose may look quite different from its final shape. The tip being turned up might be due to acute postoperative swelling.

One Month:

1. Reduction in Swelling: Most of the initial swelling will start to subside, but some residual swelling, particularly at the tip, may remain. This can affect the final appearance of the tip.

2. Changing Appearance: As swelling decreases, you may notice that the tip of your nose is still not settling into its final position. This is normal.

Three to Six Months:

1. Continued Swelling Reduction: Swelling will continue to diminish over the next several months. The tip of your nose should start to settle into a more natural position as the swelling reduces.

2. Healing Progress:The nose's appearance will gradually improve, and the tip should begin to soften and assume a more natural shape. Almost all the swelling should be gone from the nasal bridge at this point.

One Year:

1. Final Results:The majority of the swelling should be resolved, and the final shape of your nose will be more apparent. Full healing and final results can sometimes take up to a year, especially in the tip area.

Beyond One Year:

1. The skin soft tissue envelope may continue to shrink-wrap around the new nasal structure and sometimes certain irregularities may appear such as lumps bumps and slight saddling in the supratip.  A small revision may be necessary in a small percentage of patients who experience these changes and would like to further refine the nasal appearance

Mats Hagstrom, MD (license on probation) · Answer

To make a quality assessment regarding the outcome of any plastic surgery procedure we need to see a complete set of proper before and after pictures.
If you don’t have it before, and after pictures, then ask your surgeon to forward the pictures they took.
At 20 months, your results should be considered final and they will not change in any meaningful way by waiting further.
If you’re not happy with the outcome, then talk to your provider.
If you’re not getting the care you need then consider scheduling an in person, second opinion consultation.
 For second opinion consultations come prepared to bring with you a complete set of proper before and after pictures and a copy of your operative report.
These are all part of your medical records that you can request from your current provider by simply asking for them.
 Best,
Mats Hagstrom MD