Revision Rhinoplasty

Q: Dr. Eppley, I recently had a rhinoplasty and lip lift procedure that I am unhappy with. I wanted my nose to be narrowed and instead the surgeon rotated it up and shortened it. It now looks wider at the tip. I want it to be much more narrow. I think a slight alar base reduction would look nice in conjunction with narrowing the tip and de-rotating the tip. Also, the lip lift did not lift my upper lip enough. I am hesitant to pursue another lip lift procedure as it may complicate the revision rhinoplasty and make the tip appear more upturned by pulling the columella and nostrils down. I’ve consulted with several surgeons who have advised me that this will be a very complicated procedure. I would love to know your thoughts on what, if anything, should be done. Do you think you could narrow my nose (possibly alar base) and bring the tip down to look this way? This was the “projected outcome” photo. Thank you very much for your time!

A: I think the first concept you have to grasp in that after a primary rhinoplasty the obtaining of a dream or ideal nasal outcome is probably not realistic. Whether it was ever a realistic goal initially I can not say as I wasn’t involved in that process. Now you are looking to recover from an over correction in a nose that is now scarred and is short of cartilage structure. Getting the tip of the nose back down is a lofty goal in itself and will require significant cartilage grafts to do so. That will be an accomplishment by itself. Making the more narrow is probably not going to happen as much as you would like. For a revision rhinoplasty, now a reconstruction project, one’s goals should be more modest.

I would certainly agree that any further lip lift efforts should be delayed until well after the revision rhinoplasty.

Dr. Barry Eppley
Indianapolis, Indiana