• Rhinoplasty
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rhinoplasty FacialSurgery.com
Steven M. Denenberg, M.D.
Dr. Denenberg's articles on Medium.com.
Views of this rhinoplasty patient:

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The oblique views that are more darkly lit are the best views in which to see the strength of the cartilages that form the tip of her nose.  The more rounded those cartilages are, and the thinner the skin that covers the tip, the more we are able to see the outline and the curves of the strong cartilages.

The surgery on those tip cartilages is also what allows the tip of the nose to elevate, shortening the nose, and to move back toward the face.

next view of this patient

"I am so happy that I cannot even put it in words ... "
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All views of this rhinoplasty patient:
current: Right oblique

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Next: an example of the solid advice Dr. Denenberg gives patients on RealSelf.com.
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Questioner: Does my New Nose Fit my Face?
I had rhinoplasty 4 years ago, but I've never been completely thrilled with my results. I told my surgeon at my 1 year that I was concerned too much was taken off the bridge, and the tip looked a little bulbous. He said I was over analyzing it and kind of got frustrated with me when i was upset my nose was dipped when we discussed keeping it straight. Here are my questions: is my tip bolbous, or does it fit my face? Is my nose still long? Does the profile view fit my face and look good dipped?
(Questioner submitted photos)

Dr. Denenberg's answer: You are correct about your nose, but the issue is the tip, not the bridge!

You absolutely are not over analyzing your nose; there are some real issues, and your doctor should be able to recognize them. Click on the "Web reference" link in my answer for a morph showing a correction of the main part of your issues.

The problem is not that your bridge was over-resected; I don't think it was. The problem is that the tip of your nose is still over-projecting. That is, it projects too far forward, away from your face. Also, when a bridge is carved, and then when the tip's projection is lessened by bringing it closer to the face, the tip should be elevated. That is, raised, to make the nose look shorter.  "Shorter" means that the distance from where the nose begins between the eyes, down the length of the bridge to the tip, is less. As you'll see in the morph, when the tip is brought back closer to the face, the bridge no longer looks over-resected!

The problems that you have are not unusual, because deprojecting and raising a tip involve complicated work on the tip cartilages. An over-projecting and drooping tip are two of the most common issues I see in patients who are considering revision surgery.

The good news for you is that, in competent hands, bringing the tip of the nose back toward the face, and elevating the tip, are two of the most predictable changes that are made in rhinoplasty, even in the much-more-difficult revision rhinoplasty. Also, the techniques that elevate and deproject the tip often also work to narrow the tip.

As revisions go, I would be optimistic for a good result for you.

Link to this question on RealSelf.com