One Year After Rhinoplasty, Pretty Unhappy with Results. Should I Elect for a Revision Procedure? (photo)

I had my rhino/septoplasty on 12/15/2011 to fix a deviated septum and to define/turn up the tip of my nose. A year after the surgery my nose is still crooked, my nostrils are uneven, my bridge is still too high for my taste, dents have formed on either side of my nose under my bridge, and my tip points downward when I smile and looks exactly like it did pre-op. This is purely cosmetic, but do you think a revision procedure can help achieve my desired, more straight and up-turned results?

Doctor Answers 5

Revision rhinoplasty for minor changes is certainly possible!

Hello bostonrhino,

Sorry to hear you are disappointed with your results.  With regards to your question about the possibility of revision rhinoplasty, I would have to say that you should do your homework first.  The most important thing is that you must have very realistic expectations for what is possible.  Trying to copy someone else's nose is impossible but to use their picture as a guide to help your surgeon understand your wishlist is very helpful.  I love Kate Beckinsale but her nose would not fit on the face of most people.  You have very angular features so it is reasonable to consider wanting a more angular nose.  Here are my thoughts on your various concerns:

1. "my nose is still crooked" - on the worm's eye view photo you can see the deflection to the left side of your face.  But, you have cheekbone asymmetry that is adding to this problem.  Without going overboard, it is possible to change the deflection of the base of your nose back to the right side but do not expect straight-as-an-arrow results.

2. "my nostrils are uneven" - this is a result of the problem in #1 above.

3. "my bridge is still too high for my taste" - a conservative dorsal reduction complemented by a cartilage graft at the tip can give you the appropriate supratip break to mimic the nose you see on Kate Beckinsale's face.

4. "dents have formed on either side of my nose under my bridge" - post-operative contour irregularities can be improved by camouflage cartilage grafting during revision rhinoplasty or use of injectible filler, such as Restylane or Juvederm.  Also, the position of the upper lateral cartilages must be checked to make sure they haven't slipped down after septoplasty.

5. "my tip points downward when I smile and looks exactly like it did pre-op" - the tip will always depress when smiling because of muscles activate during the smile process and pull down on the tip.  You can use Botox on these muscles to provide temporary improvement in tip droop, or the muscles can be resected to weaken tip droop during smile.  Also, mild cartilage resection at the base of the nose can rotate the tip up a bit more to create a more pleasing position.

I hope this helps.

Good luck,

Dr. Shah

Denver Plastic Surgeon
4.8 out of 5 stars 56 reviews

Need for Revision Rhinoplasty

I'm sorry, but I cannot bring up your pictures. However, with the problems you describe and your obvious dissatisfaction I strongly recommend that you consult with a revision specialist.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 39 reviews

Revision Rhinoplasty

   A revision may be in order for a few of your concerns, but you must realize that achieving someone else's nose is never possible.  The dorsum can be reduced slightly and the nasal depressor septi can be released to help with tip droop during animation.  Nostril asymmetry is the rule in human anatomy, but this may be improved.  Good luck.

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 496 reviews

Should i have revision

I'm sorry for your frustration. however based on the photos you sent and what you are seeking I would recommend against further surgery at this time. See how things continue to settle over the next year.

Michael L. Schwartz, MD
West Palm Beach Facial Plastic Surgeon
4.8 out of 5 stars 12 reviews

Need for revision rhinoplasty?

I agree with your assessment. The  postoperative changes to the nose are small, other than raising the tip, and the shape could still be improved.  The changes to be made are small, but  definitely achievable..   Your nose has been shortened already, and I would not shorten it further.  The tip will always drop a bit when you smile.  Revision rhinoplasty is best done by a surgeon experienced in revisions. 

Thomas A. Mustoe, MD, FACS
Chicago Plastic Surgeon
4.8 out of 5 stars 97 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.