Upturned Pig-like Nose After Rhinoplasty

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

Hello and thank you for your question. At three days postop, your nose is extremely swollen. This will likely improve with time. However, depending on the surgical techniques used by your surgeon, it may remain overly rotated. Give it a lot more time and eventually if it does not derotate, then you may want to seek experts for opinions regarding a revision. For now, I recommend that you maintain close follow-up with your surgeon who can evaluate you in person.

Best wishes and good luck.

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

I am so terribly sorry that your surgeon did not spare you this worry by explaining to you how the nose will look postoperatively! In my practice, we explain in detail that having an upturned nose at day three is perfectly normal. If I were in your position and nobody had explained this to me, I would be as nervous as you. So rest assured, please know that it is very common for the tip to be temporarily elevated due to swelling, and due to the sponges that help reduce swelling. It will settle into a lower postoperative position. As a specialist in rhinoplasty and rhinoplasty revision, I even have my staff give you a detailed explanation (written on paper, no less!) about what to expect to spare you this nervousness. Being a good surgeon is not only about producing excellent results, but is also about honoring the emotional process that the patient experiences.

As you have raised this question only three days after your surgery, it was too early to have an idea how the nose would settle. At this point I would advise patients not to be concerned, there is still major swelling and the splint should be kept on the nose until the first post-op appointment, which usually takes place 10-12 days after the surgery, however this always depends on the surgeon's instructions. If the concerns persist, I would advise to discuss the procedure as well as the outcome and recovery on your first post-op follow up with the surgeon, who would be able to advise and reassure you.

I appreciate your concern, but I assure you it is far too early to begin worrying about your results. The nose takes a significant amount of time to heal after this surgery, and most patients will not see their full results for a year. I encourage you to take a breath, follow your surgeon's instructions to the letter, and discuss your concerns at your next follow-up appointment. My guess is you will begin to see the improvements in your nose in the upcoming weeks and months, which will give you a better idea whether your surgery was successful. Most surgeon won't even talk about revision surgery until patients hit the one-year mark for this very reason.

It is expected that at cast removal after rhinoplasty the tip appears more upturned. The reasons behind this impression are the swelling at the base of the columella and the swelling over the tip. If from the front view the nostrils appear relatively similar to before the surgery, you can expect the tip to "drop". This is usually the result of swelling coming down which allows you to see the actual shape of the support. There is also some genuine downward tip rotation, possibly as a result of traction from the surrounding muscles.If in the early stages after surgery the nostril show from the front is significantly increased, there is less chance of natural improvement

This is normal to some degree so don't worry. There is usually a lot of swelling in the upper lip and base of the nose (columella) which gives the appearance that the tip is too turned up. It will look better and hopefully disappear in a few weeks. As the nose heals over the next 6 months the tip often comes down due to scar tissue contraction especially with an open approach. I anticipate that and usually over compensate with my Rhinoplasties and probably your surgeon did the same thing. Don't worry and be patient.

It is not uncommon for the nose to look a little upturned in the first few days and weeks after rhinoplasty. This is often because of the way the plaster was applied and in any case the tip usually drops a little with time. 
It is also quite common for patients to have some anxiety about their appearance immediately after surgery as it is a big change to their face that can take some time to get used to. Patients often worry about what others may think but in reality this is usually unfounded anxiety  
Clearly it is difficult to advise without seeing how things are but I would urge to be wait and be patient and hopefully things will settle with time  
Do discuss your concerns with your surgeon - if the nose is too upturned for your liking, there may be ways of dealing with this early dependent on the technique used. Sometimes removing stitches placed to rotate the tip can help reverse things but it does depend on what was done  
In the worst case scenario if the tip heals fully into a position with looks overrrotated there are options for corrction of this too - but definitely not worth considering until the nose has fully healed. 
I hope things settle with time!

Up-turend (over-rotated) nose is a very common concern/issue for patients seeking revision rhinopalsty. In general it is one of the stigmas of "surgical nose" from the old days of rhinoplasty in the 60s and 70s before the advances of the structural grafting era. There are a variety of techniques available in revision rhinoplasty to change projection and rotation of the tip. The decision on choosing the technique is based on many factors including the other features of the nose and also their relation to the rest of the face.
As far as the timing for such assessments, most experts believe roughly one year should be given before the results are considered "settled". In the first few weeks, such assessments can not be made due to significant swelling and lack of adequate contraction which can change the projection and rotation of the nose. In most cases, at around 3-4 months postoperatively a reasonable sense of the outcome can be perceived by both the patient and the surgeon. The caveat is that such timing on each case can be different based on many factors such as the quality and thickness of the skin, and the extent of the work and the types of grafts used.

Nasal tip support, elevation and refinement, are an important part of the rhinoplasty operation. It can take several months for the final shape and position of the nasal tip to be appreciated. Immediately after rhinoplasty the tip may appear over-rotated or upturned because of upper lip swelling and the postoperative splint. Gradually, over several months the swelling will subside and the tip will settle into its final position.
Best of luck,
Dr. Kaniff

At 72 hours, or even several weeks after a cosmetic rhinoplasty it is vital to focus on optimal healing and trust in your surgeons commitment to your result.