I had a pointy downward nose. I had rhinoplasty. My nose is very long and still pointing downward. What can be done? (Photo)

Question

How long do I have to wait to have a second rhinoplasty I had ask doctor to raise my tip and round it out but nose is still too big and pointy

Thomas A. Mustoe, MD, FACS · Answer

You have a common outcome of rhinoplasty where the dorsum was lowered (easy) bit the tip was not deprojected which many surgeons find more difficult.   You need to wait 12-18 months before  revision for optimal results, and choose a surgeon who can show you before and after pictures of noses similar to yours.   Also rely on reviews credentials and ample examples of experience with revision rhinoplasty.

Ronald J. Edelson, MD · Answer

If your nose starts off too long there are strategies to shorten it which are pretty simple. Your nose was either not shortened enough or dropped down over time. In either case the solution is surprisingly simple and doesn’t involve redoing the entire job. Cartilage and nasal lining need to be removed from the lower end of the septum. This sometimes either not done or done too conservatively. An easy correction.

Jonathan Kulbersh, MD · Answer

The standard waiting period before considering revision rhinoplasty is one full year after your initial procedure. If you are unhappy with your results at that point, I advise you to find a board-certified facial plastic surgeon with extensive experience in performing revision procedures. The second surgery is often much more complex than the first, and requires a tremendous degree of expertise and artistry to produce the best possible result.

Thomas A. Lamperti, MD · Answer

In general we recommend waiting 1 year after your prior surgery before having a revision. This allow the nose to heal more and for the internal scar tissue to soften.You'd want to get a fully nasal assessment to determine your best options, but it should be possible to raise your tip a bit compared to where it is now.You can learn about droopy tip repair at my web reference link below.

Stephen J. Pincus, MD · Answer

Yes, it appears that your tip still needs to be raised and rotated. Without lateral views, it's hard to say if the bridge needs to be raised, but it certainly looks like the bony bridge was reduced. Since the bridge is a minor support structure for the nasal tip, it is easy to see that reducing it could make it more difficult for the tip to remain raised. Otherwise, there are several powerful techniques that we use to raise, rotate and stabilize the tip. And making it less angular and rounder is also pretty straightforward.

Toby Mayer, MD · Answer

Revision rhinoplasty for the insufficient tip elevation and Supra tip excess cartilage etc. This is what you need based on my 46 years of revision rhinoplasty. Look at the revision rhinoplasty results of revision rhinoplasty surgeons and don’t rely on imaging.

Steven M. Denenberg, MD · Answer

Your nose is still "long," which means the tip is hanging down. As is typical, we see it most the three-quarter views that you posted. Elevating the tip, I think, would go a long way toward making you happier with your nose. 
The good news is that elevating the tip, in expert hands, is one of the more predictable changes to make, even in a revision. In less expert hands, failure to elevate the tip is a common cause for a revision.
The woman in the short video that I posted with this answer had the tip of her nose elevated substantially in her revision operation.
Not in love with your profile morph. I'd like to see the tip elevated a little more, and also brought back a little closer to your face.
So how *much* to elevate the tip, or make any 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 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 also 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. 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 by the operating surgeon 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?When to do it? We usually say you need to wait about a year after the first operation. What does "about" mean? Well, it means that 10 or 11 months is usually fine, depending on how the nose healed, but 7 or 8 months is too early. That should give you a feel for it.

William Portuese, MD · Answer

Its acceptable to undergo revision Rhinoplasty after one year to allow full healing. In the meantime, best to follow up with the operative surgeon  for steroid shots placed in a supratip  area of the nose to reduce the poly beak deformity

Mats Hagstrom, MD (license on probation) · Answer

A secondary rhinoplasty is complex and your nose is not an easy one.
The limited outcome of your first procedure should tell you that.
To be well prepared for a secondary rhinoplasty the first thing you need is proper before and after pictures and your operative report.
The new plastic surgeon needs to accurately understand what changes were made during the first procedure.
This is critical in planning out how to do your revision.
The most important thing for you is to find the best rhinoplasty surgeon that you have access to.
With so much self-promotion among plastic surgeons that may be so much challenging.
I suggest committing to having in person consultations with many more certified plastic surgeons.
Look for plastic surgeons will have a minimum of 10 years but preferably 20 or more years of experience.
Look for board-certified plastic surgeons whose career has evolved to focus on facial aesthetics especially rhinoplasty surgery.
This can also include physicians who have a background in facial plastic surgery(typically ENT doctors with a different type of training than plastic surgeons).
And experienced plastic surgeon will have many hundreds of before and after pictures of previous rhinoplasty surgeries including revision rhinoplasty surgery.
Someone with sufficient experience should be able to find previous examples of patients with very similar nose anatomy to your own. Bring with you the before and after pictures and the operative report from your previous surgery. If you don’t have this information and ask your previous provider to forward them to you. They’re your medical records and you have a right to on your medical records.
In your case I suggest scheduling 5 to 10 consultations to start with.
Rhinoplasties become substantially more complicated each time you have surgery.
The anatomy is distorted and virgin tissues are replaced by scar tissue.
The key is to find the right plastic surgeon the first time. In your case it will need to be the second time.
Rhinoplasty surgery is difficult business. An expert rhinoplasty surgeon may very well have a handful of patients they were unhappy with the outcome. The number of negative reviews should be limited though.
Feel free to drop me a line if you want me to forward the names of the talented surgeons in your area.
Most plastic surgeons will recommend waiting one year before having a second rhinoplasty. 
Best, 
Mats Hagstrom MD

I had a pointy downward nose. I had rhinoplasty. My nose is very long and still pointing downward. What can be done? (Photo)

Answers (9)

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