Revision Rhinoplasty for Tip Irregularities and Deprojection

I had a primary rhinoplasty with another doctor in...

I had a primary rhinoplasty with another doctor in 2008 to fix a deviated septum and deproject my nose. This left me with an asymmetric tip. Although my nose is still prominent, I am choosing to stay on the conservative side and only fix the tip, as I am satisfied with the length of my nose (especially compared to my original nose). I am scheduled for surgery on Dec. 22 and am very anxious and excited! I have done a lot of research in choosing a surgeon and finally decided to choose Dr. Kim in SF. Thank you to everyone on realself for the worthwile and supportive interactions! :)


The consultation with Dr. Kim went well. He listened to all my questions and explained the procedure in detail with schematic images of the nose. Upon request, he showed me before and after photos of a couple patients with severe bossae. Also, he did 3D morphs, which he later sent to me via email. Dr. Kim's mannerisms and overall attitude was very pleasant and understanding. The staff (Nanette, Natalie and Autumn) were all very nice and patient with me.

Day after my surgery

Hi everyone! Yesterday was my big day! I have to admit I was insanely nervous (both the night before and the morning of my surgery), but the staff at the surgery center were so cheerful and comforting that I started to feel better.

Dr. Kim was very reassuring, confident and realistic (reminding me that my nose will not be perfect). He listened to my concerns and desires. We agreed that if there was enough septal cartilage, to go ahead and insert thin spreader grafts and reduce the height by a couple mm, but if there wasn't enough septal cartilage to just fix the tip.

Upon waking up, Dr Kim told me that there was plenty septal cartilage, so he inserted the thin spreader grafts and reduced the height. He showed me photos of my nose right after surgery (without the cast) and from what I remember they looked great.

Alicia, a lady recommended by Dr. Kim's office, took amazing care of me at my hotel. She was genuinely concerned for my physical and mental state, and told me comforting stories. I had no nausea or discomfort after I got to my hotel.

Today, I feel pressure in my nose... Other than that, I feel well. No bruising or swelling. Mentally, I'm also feeling quite positive. Just watching movies and eating soft food :).

Unfortunately, I forgot my camera-computer cord at home, so I won't post photos until I get back in a week (not like there's much to see anyway). Thanks for all your support and I will keep you updated!

Pictures with cast

1 and 2 days post-op. I had a bit of swelling, but no bruising. No nausea or vomiting. Recovery with my cast went smoothly, except for digestive troubles due to the antibiotics. One night I had pretty bad cramps and sweats (small fever perhaps?) due to the gut pain, but felt better during the day.

Cast off!!

The first 2 pics are right after cast removal and cleaning. Removing the stitches wasn't very painful (uncomfortable and weird seeing sharp objects going into my nose), but removing the internal splints was very uncomfortable and a bit painful (especially the second one). Had a burning sensation for several minutes after. Although not THAT painful, I would recommend taking a couple painkillers prior to going in for splint removal. Natalie (the nurse) was very careful and nice about everything.

The next 3 pics are 10 days after (today) compared to what my nose looked like prior to the revision. I tried to get the sizes and orientations to match.

I LOVE the difference in the profile and am so thankful that I decided that it was a good idea to get it reduced and the spreader grafts inserted. Dr. Kim was right when he said the tip would look better and more continuous if the bridge is shortened in height. Also, (when my nose is clear) I can breathe better than I've ever been able to breathe!!! Amazing!!

I can't wait for the swelling to go down. So far I am thrilled with my results! I'm still in disbelief :).

20 days post op

Swelling has gone down quite a bit. My nose is still sore and it hurts to touch it or move it, but my smile is almost back. I've been reintroducing a little bit of alcohol and sodium back into my diet without more-than-usual swelling in the morning. Everything is fine and I'm feeling quite happy :).

1 month post op!!

My nose is still stiff, but my smile is completely back. My nose is only sore if bumped, but not when touched. I still don't blow my nose or wash my face normally (I use cotton balls to wash my nose). My diet is back to terms of salt (although I don't tend to eat a high sodium diet anyway).

I had a follow up appointment with Dr. Kim yesterday. I'm on track in terms of healing :). I asked about the grafts that were used, as many have inquired, so here's a summary of what was used/done (shortened from the operative notes):
- 2.5-mm dorsal reduction
- spreader grafts
- clocking sutures to repair nasal middle vault & reposition the anterior septal angle
- septal extension graft with splinting grafts
- elevated the columella and lowered the domes
- lateral crural reconstruction
- crushed cartilage (note: different from diced cartilage)

3 months post op

Hi everyone! So it's been three months since my surgery. My nose is still stiff, although moving it around doesn't hurt as much. I still can't really blow my nose, but washing my face is pretty close to normal (just with care not to bump it).

I visited the cold midwest where it was snowing and I LOVED not having to worry about my nose (in my previous nose, parts of my tip would whiten where the cartilage pushed against the skin while the rest of my nose would redden).

A few weeks ago, my mother (who doesn't know about the surgery) said, "Your nose looks shorter and smoother, and all the angles are gone. Did you do something? I won't be upset if you did -- it looks great." I mumbled something and changed the subject (gleeing on the inside). :-)

I'm very happy with the changes, although I know it's not a small nose and it's a bit wider than my original and post-primary nose. And the stresses and anxieties of everyday life is still there, but it's great to not have to worry/fret over my nose. I love looking in the mirror now, seeing features that are in harmony and not detracting. Financially, it's been rough, but I know that it was worth it :).

Best of luck to everyone in your nose journey. Stay positive!


Last edited by elisa90 on August 16, 2015

8 months post op!

I can't believe it's been 8 months since my revision! I thought I was still at 6 months :P.

Anyway, everything is going well. My nose is no longer sore or numb, which means I can blow my nose and wash my face totally normally. The tip is starting to soften up and is starting to move more naturally as well, although it's a bit stiffer than before surgery. The tip is a little bit fuller (rounder) than I'd like, but I still very much like the result. It fits me, even if it isn't a small, modelesque nose. I asked for a subtle change to fix the irregularities and a reduction in bridge height -- and that's what I got! The surgery itself wasn't easy and required reconstruction of my tip, and yet it still looks like me. No one, except for my mom, noticed the difference, which was a huge relief :).

I posted a few photos that show my nose from an angle. Unfortunately I couldn't find any before close ups from those angles, but at least you can see what it looks like right now.

I sometimes have nightmares/visions that my nose will fall apart or deform with time. Not an unreasonable fear, but my goal is to part with "nose anxiety." :) I'd like to not think about my nose on a daily basis and just live freely, finally.

I hope everyone is doing well. Take care everyone and thank you again for your support!
Bay Area Facial Plastic Surgeon

I spent several months researching revision rhinoplasty specialists. At first, I wanted to stay in my home town, but decided that it was worth traveling even if it meant spending a week in a hotel. This opened up my search to the top doctors in the US, which of course made the search even more difficult. I chose Dr. Kim because of his natural results, credentials, before/afters and positive reviews. I understand how stressful it can be choosing a rhinoplasty doctor, especially for a revision. So here I am sharing my positive experience. I can breathe better than I have ever been able to in my life, and I finally can say that I love my nose! I don't think about it when I talk to people and I don't worry about them seeing my nose in a certain angle or under unfavorable lighting. It's a great feeling :).

5 out of 5 stars Overall rating
5 out of 5 stars Doctor's bedside manner
5 out of 5 stars Answered my questions
5 out of 5 stars After care follow-up
4 out of 5 stars Time spent with me
5 out of 5 stars Phone or email responsiveness
5 out of 5 stars Staff professionalism & courtesy
5 out of 5 stars Payment process
5 out of 5 stars Wait times
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