Can My Bifid Tip That Has Appeared After A First Closed Rhinoplasty Be Successfully Treated By A Second Closed Rhinoplasty?

Dr. Eppley, Hello, I am 8 months postop now with really thin skin after a closed rhinoplasty and my tip skin was pretty much gone I thought for a while. Now my tip is shrink wrapping even more all of the sudden and causing a bifid tip? The right half of my tip cartilage has been longer than the left all thus time and it’s also really obvious from the front. Can this still be uneven swelling? What can be done to fix it? 

A:At 8 months after a rhinoplasty this is not swelling this is the reveal of the shape of the nose that eventually occurs. While there is a lot of appeal to a closed rhinoplasty it does not offer complete exposure of the cartilage structures of the tip so some asymmetries/irregularities would not be uncommon. The key question is where these residual tip cartilage anomalies could be adequately addressed by a secondary closed rhinoplasty. I would think the bifid tip could be treated by a cartilage graft placed between the domes. The differences in the lengths of the lower alar cartilages are more challenging in that regard but could also be done so. Obviously opening the tip is the more visualized and assured method of revision but you have gotten this far into your nasal surgery without doing so so another closed effort at it seems worthwhile.

Dr. Barry Eppley

World-Renowned Plastic Surgeon