Upturned Pig-like Nose After Rhinoplasty

I had my Rhinoplasty surgery done 3 days ago and am very concerned about my nose now. I had a downward turned tip, which I asked to be corrected. but now when i look at it, it seems to have gone totally opposite and now looks upturned like a pig's nose. I am very concerned as I have so many events to go to and i feel it's a drastic change and not a subtle one. I trusted the doctor and asked him to work with it to suit my face, but now I'm very very worried and feel people will comment. Can this still be corrected? I think I'm going to need revision surgery, but I am also very worried about it being made worse and people laughing at me. I wish I had not done this now.

Doctor Answers 68

Tip rotation after rhinoplasty

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The upturned tip you are describing three days out from rhinoplasty is perfectly normal. The swelling at the base of the nose and upper lip as well as the tape and splint are contributing to this "upturned" look. Once the splint comes off (around day 6 or 7) and the majority of the swelling resolves (around day 10), your nose will look significantly different. We usually recommend giving the nose a full year to settle down before even considering any sort of revision surgery. Do not fret! Regards, Dr. Mehta

Bay Area Facial Plastic Surgeon
4.7 out of 5 stars 52 reviews

Upturned Nose After Rhinoplasty

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My colleagues are right - 3 days is too early to judge your final results. Swelling, sutures, taping and splints can alter the initial shape. It is not uncommon for the tip to drop during the healing process. After 8 to 12 weeks, if you are still not happy with the tip rotation, discuss a possible revision with your surgeon.

Daniel Reichner, MD
Newport Beach Plastic Surgeon
4.9 out of 5 stars 50 reviews

Rhinoplasty and Upturned Tip

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New Lady, I would just try and be very patient with the healing process. First off, as others have noted here, your bandages should still be in place that would preclude you from even seeing what your nose looks like underneath. I normally leave rhinoplasty bandages in place for about 5-6 days. Even without bandages, your nose is expected to be quite swollen and probably over-corrected in terms of the tip position. In rhinoplasty cases where we are elevating the nasal tip, most rhinoplasty surgeons will position the tip slightly higher than where it will ultimately sit. This is done because your tip will likely drop down during the healing process. This is why your nose should look upturned at this time. Be patient and trust in your surgeon.

John M. Hilinski, MD
San Diego Facial Plastic Surgeon
4.7 out of 5 stars 44 reviews

"Piggy Nose" after Rhinoplasty

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Thank you for your question.

The technical term for the "pig nose" that you describe is tip rotation - this is usually an intentional outcome early after rhinoplasty.  As you heal, the tissues will begin to relax and gravity will pull your nose down.  It's important to "over-correct" tip rotation during surgery to account for these effects - otherwise, if it looks perfect immediately after surgery, it will look droopy a year later.

I tell my patients that you won't see the final result of your surgery until about 1 1/2 to 2 years afterwards - approximately 60% of the swelling is gone at 1 month, 70% at 2 months, 80% at 3 months, and 90% at 6 months.  By 6 months, the only people who will notice any swelling will be you, your surgeon, and your mother.  Specifically with regards to tip rotation, by 1-2 months, you'll find that your tip position will be very close to your long-term outcome and only you and your surgeon will notice the continued evolution of your nose from there on.

If you're considering any type of revision, I recommend that you wait at least a year to see how your healing evolves - you may find that by then, you're surprised by how nice it turned out.  in any case, you should discuss your concerns with your surgeon, since that person knows exactly what was done during the operation and can give you a more concrete answer regarding the timeline.

Exagerrated upturned nose and deformities after rhinoplasty can be corrected with advanced grafting techniques

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Unfortunately you are in good company. Most rhinoplasty patients out there are very unhappy with their results in 1-2 years. The explanation for this is very simple: Most surgeons performing rhinoplasty do not have advanced training or experience, they perform the rhinoplasty of 50 years ago. Decades ago thought process of rhinoplasty was to remove cartilage to refine the shape of the nose and perform it through an open approach. An open approach makes it easy for neophyte surgeons to access visualize and manipulate the structures but also unnecessarily destroys two arteries and veins that are important for nasal vascularity. The open approach thus ensures that patients have 1-2 years of risidual swelling which hides the final result. Most rhinoplasties out there I consider cartilage robbing thus when the swlling resolves there is inadequate structure to provide aesthetic appearance and fight the cicatriacial forces or the continued scarring that results from the lowered oxygen tension and fibrosis of tissues. One additional problem it that most rhinoplasty surgeons out there inadvertently break the connection between the bony nose and the cartilagenous nose. this can cause irregular narrowing and what we calll "the inverted V deformity" which means the outline of the nasal bone becomes visible through the skin particularly in flash photography under certain lighting conditions.

In my opinion, an expert level rhinoplasty is always performed in a closed technique and ALWAYS involves grafting to add to the structural integrity of the nose. The act of opening the nose even under the closed technique causes healing and some contraction, thus for a long term beautiful result the nose must be left more structurally sound than it was found. This is missed upon most rhinoplasty surgeons.

In secondary cases such as yours it is even more crucial that sound grafting techniques are used. It sounds like at a minimum you will need bilateral spreader grafts a. Is sounds like your surgeon is on the right track. Definitely do not consider any rhinoplasty procedure that does not include grafting preferably by an experienced Plastic and reconstructive training with ddition fellowship level craniofacial and aesthetic training. Of course this is my bias because it is my training but I think this level of training is very necessary for success in secondary and tertiary rhinoplasty because there is delicate nuance involved and every patient requires different maneuvers. Improtantly if possible you should wait 6 months for closed rhinoplasty and one year after open to start evaluating revision unless aesthetics are completely intolerable.  I hope this helps!

All the best,

Rian A. Maercks M.D.

Upturned "Pig Nose" Following Rhinoplasty

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Taping the nose in an over-corrected, over-rotated position during the first week following rhinoplasty is expected, as the surgeon is compensating for the inevitable strong force of gravity that will be pulling your tip back down after the splint comes off. Gravity can continue to pull the tip down even out to 5 months or so, although most of the downward movement will occur in the first 2 months

Richard Parfitt, MD
Madison Facial Plastic Surgeon
4.4 out of 5 stars 36 reviews

Unhappy 3 days following rhinoplasty.

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At this point, I presume you still have an external stent on the nose.  This combined with all the swelling will make it very difficult to accurately assess the result.  Usually, at three to six months it will become apparent whether a revision will be necessary which should be delayed until 1 year following the original surgery.

Mario J. Imola, MD, DDS, FRCSC.

Mario J. Imola, MD, DDS
Denver Facial Plastic Surgeon
4.9 out of 5 stars 124 reviews

Too Soon to Judge!

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Your concern is completely reasonable, it's just way too soon to judge!

In the first few days, the tip will look too high more often than not, due to the interaction of swelling, taping and the splint. The tip will often relax within minutes of removing the splint and tape.

Paul C. Zwiebel, MD
Denver Plastic Surgeon
4.7 out of 5 stars 45 reviews

Upturned nose after rhinoplasty

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Hello and thank you for the question. This is perhaps the greatest amount of distress for my younger rhinoplasty patients during the first 1-2 weeks after surgery. I try to tell all my patients to turn the mirrors around for the first three weeks (try to limit the selfies too!). The reason being is that one's nose undergoes a wide variety of swelling on a day-to-day basis for really the first 6 weeks after rhinoplasty. During the first 10 days there are massive amounts of swelling in the lip, cheeks and nose which cause there to be an upturned look. In addition, the nose is taped a certain way (often turned up) because we know the natural tendency is for the tip to drop with time. Be patient, give it time. Hope this information helps. 

Giancarlo Zuliani, MD
Rochester Facial Plastic Surgeon
5.0 out of 5 stars 71 reviews

Rhinoplasty healing timeframe

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3 days is much too soon to begin judging the results of your surgery.  In fact, 3 months is too soon.  The tip will begin to drop after the tape, splints, and any intranasal packing are removed.  

Clyde Mathison, MD
Knoxville Facial Plastic Surgeon
5.0 out of 5 stars 10 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.