Is my Nose Tip Too pointy after my Rhinoplasty?

I feel like the tip of my nose is too pointy after my rhinoplasty. What are my options with a revision? Do I just go back to my doctor and ask them to fix it? Will it cost extra money? I have nothing left in my savings to pay for anything. I am really not happy with the results here.

NadaDeNada

F, 32, California

Nasal surgery is one of the most challenging facial plastic surgery procedures to perform. A nose job requires excellent surgical technique, artistic skill, and expert knowledge of nasal anatomy. Unfortunately, even in the hands of the most accomplished surgeon, patients can still be dissatisfied with their new nose. The postoperative recovery period can be unpredictable, and excess scar tissue, weak cartilage, or thin skin can lead to inferior or unexpected aesthetic results. Different skin types heal differently over the framework of the nose and can distort it somewhat from the outcome the surgeon intended. Thin nasal skin shows up small irregularities, and thicker skin veils the effects of surgery somewhat.

Before you consider a second surgical procedure, give your nose time to settle into its new shape. Revision surgery cannot be scheduled too soon after the initial procedure as rhinoplasty recovery takes time, with most plastic surgeons advising their patients to wait at least six months but preferably a year before they consider another procedure.

Sutures, tapes, and nasal splints all distort the shape of your nasal tip in the immediate postoperative period. Swelling can last for up to 12 months with the tip of the nose the last part of the nose to settle. During this time, you may notice the size or pointiness of your tip starting to decrease as the swelling resolves and tip definition begins to appear. The tip also often begins to descend slightly, and may rotate downwards, making it less prominent.

However, if sufficient time has passed and you are still dissatisfied with your nose, revision rhinoplasty is definitely an option. Five to 10% of rhinoplasty patients undergo secondary nose surgery to make small adjustments or correct aesthetic issues they are unhappy with. Talk to the surgeon who carried out your surgery to inform him or her that you are unhappy with your results, and to see what they can offer you. Most surgeons will stand by their work and charge an additional fee for a revision procedure, which can be as costly or sometimes more expensive than the initial nose job.

If you feel that you would be happier with a different surgeon performing the revision surgery, do some research and find a board-certified facial plastic surgeon who specializes in revision rhinoplasty. Revision rhinoplasty is a challenging surgery in its own right and often considered more difficult than the primary procedure. It also usually takes longer and can be more costly, so finding the right surgeon to perform the second rhinoplasty is essential.

I am sorry to hear you are unhappy with the results of your surgery. Unfortunately, compared to other cosmetic procedures, rhinoplasty surgery tends to have a lower patient satisfaction rate, with some studies showing that approximately 15% of patients are dissatisfied with the results of their surgery. This is in part because some patients have unrealistic expectations of what surgery can achieve, and also because rhinoplasty is one of the most difficult cosmetic surgery procedures for surgeons to perform. Even subtle changes in the shape of the nose can profoundly affect the balance of the other facial features, so the operation requires great skill, care, aesthetic awareness, and accuracy.

Plastic surgeons performing rhinoplasty require a sophisticated understanding of the anatomy of the nose and its mobile soft tissue, cartilage, and small nasal bones. The nose cannot be simply sculpted into a new shape but must be disassembled, reshaped, repositioned, and then reconstructed while maintaining airflow and olfactory senses. Expert knowledge and experience are required as errors can result in permanent disfigurement. Cosmetic surgeons therefore often tend to err toward the conservative.

You didn't mention in your question when your rhinoplasty was performed. The most significant bruising and swelling will decrease after a month. However, in most cases, the recovery time for rhinoplasty is a year before the final results are apparent. Rhinoplasty patients are often surprised by the fact that the healing process can take so long, but swelling can linger and fluctuate for up to 12 months while your nose settles into its new shape. If your surgery was performed a few months ago or less, I would suggest allowing for some more time as you move past the postoperative period into your long-term recovery. It may be that the sensitive nasal tip is still swollen -- the tip is typically the last part of the nose to settle in the recovery process. Most surgeons refuse to perform revision rhinoplasty procedures until a year has passed and the nose has properly healed.

If your surgery was performed a while ago, and the results are still troubling you, then revision surgery is worth considering. During your initial consultations with your plastic surgeon, an understanding should have been reached regarding your surgeon's obligations and your obligations with respect to revision procedures.

Most likely, the revision procedure will be your financial responsibility, however, you should still notify your surgeon that you are unhappy with the results. Most plastic surgeons want their patients to leave their clinics satisfied, as it is both better for the surgeon and for the patient. He or she may be able to sit down with you and talk over your concerns, and develop a plan to address the pointy nasal tip.

However, it is also important for you to know that revision rhinoplasty can be more challenging than the initial procedure, even though secondary surgeries are quite common. Revising a rhinoplasty means working around scar tissue as well correcting the problem, and can take longer than the initial procedure. It is often advisable to seek out a board-certified surgeon with specialization in revision procedures so that you know you are in the best possible hands.

Thanks for the question. From the frontal view in your profile picture it looks like your nose looks quite natural. Usually the first step is to discuss your reasons for concern with your original surgeon and see what his/her thoughts are. You should have received information about revision surgery financial policies before you had your procedure; did you? Most of the time when a revision is required, there are fees for the facility and anesthesia. The surgeon may choose, but is not obliged to, waive the surgeon fee for the procedure. Many of us do that in select cases. We use surgical simulation software called Crisalix in our office which is PHENOMENAL for looking at potential outcomes of rhinoplasty surgery (as well as breasts and body). I usually don't suggest revision for 12 months after the first procedure except if there is a super early issue with the tip being overrotated.

Happy to help!

http://www.crisalix.com/timsayedmd

http://www.timsayedmd.com/facial-plastic-surgery-newport-beach/rhinoplasty-nose/


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Your nose looks quite good to me, but if you have concerns you should of course discuss it with your own surgeon.  Each office has their own policies with regards to whether or now you will have to pay for touch-ups, so be sure to ask about your surgeon's policies.

Thank you for sharing your question.  I am sorry to hear that you are unhappy with your results.  I think your nose looks just fine.  If you wish to have revision surgery you may need to wait at least a year for the nose to heal and swelling to fully subside.  Your plastic surgeon would most likely charge a fee for a Rhinoplasty Revision surgery.  I hope this was helpful to you.  

Best Wishes, Dr. B.

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