Will Further Revision Rhinoplasty Be Of Benefit?
Q: Dr. Eppley, I have a primary rhinoplasty in eight years ago in the Middle East. The surgeon straightened out my bridge and tucked in the nostrils a bit. Over time, the tip drooped more than the original nose. The nostrils were still quite wide.
I then had a revision rhinoplasty there years later by another surgeon. The surgeon lifted the tip and reduced the nostrils. It looked quite ok and I felt quite attractive but the nose was still quite long and the nostrils still a bit big. He wanted to shorten the tip and further tuck in the nostrils after 1 year, because he first wanted to check how my nose healed in that year.
I then had a third rhinoplasty with the same surgeon. He shortened the length and further tucked in nostrils. As this has healed, the tip is still overprojecting and now looks bulby. It is also drooping a bit with a fullness (slight hump) which I’m guessing is scar tissue? This time around, there seems to be an unevenness in my nostrils as well.
Attached are my current pictures. I’d really appreciate a realistic view of what is possible for an improvement.
A: Thank you for sending your pictures and detailing your rhinoplasty history and current concerns. What is most revealing about your 3 rhinoplasty surgeries is what happened from the second to the third one…and this is very common in thick skinned noses where further tip shortening is desired after multiple procedures. Unlike the first two procedures where sequential improvements were obtained, after the third surgery new problems developed that were not present (or recurred) after the first two procedures. What this speaks to is that at some point in any revisional procedure the balance between improvements vs tradeoffs becomes less favorable. In an effort to take the procedure to an even better level (and you can not be faulted for asking to do so) the benefits are just not realized or some form of negative shape changes occur. In the spirit of the old saying..’past history predicts future behavior’…this provides a note of caution about a 4th rhinoplasty endeavor.
Does this mean no improvements in the shape of your nose is not possible? I can not yet say whether I can provide such improvements as I need to know what was done in rhinoplasty 2 and 3. You should be able to get those operative notes from your surgeon for my review.
Dr. Barry Eppley