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Steven M. Denenberg, M.D.
Steven M. Denenberg, M.D.
rhinoplasty
 
Views of this rhinoplasty patient:

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Let's try to evaluate the surgical changes from this frontal view.  You can see some of the changes from removing the hump: the before picture has two parallel vertical white stripes along the dorsum of his nose.  Those stripes are the return from the flashes in my photo room.  The stripes give you a feel for the position of the dorsum and the presence of the hump, and they are missing in the after picture.

Nasal length: in the after picture, we can see just a glimpse of his nostrils.  That glimpse is our indication that his nose was shortened, because in the before picture, his somewhat droopy tip hung over and obscured our view of the nostrils.

Actually, he has his head tilted down slightly in the before picture, but the analysis is still valid. (You can tell that his head is tilted down a bit by looking at his right eye and his right ear.  In the after picture, his right eye is at the level of the top of his ear.  In the before picture, his right eye sits below the level of the top of the ear.)


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Next: an example of the solid advice Dr. Denenberg gives patients on RealSelf.com.
Get that advice for your own situation by emailing your photos to Dr. Denenberg.

Questioner: Shall I consider a revision? Wide & asymmetrical nose by the front and tip is sticking out. 6 months Rhinoplasty post-op.
I got Closed Rhinoplasty 6 months ago because my nose was huge, with a big dorsal hump and a deviated septum. When the cast was removed, I liked my nose very much by the side because it looked straight and small. However as the swelling was going down, the bone became smaller and my tip started to stick out so much. I think my tip now looks much bigger than right after removing the cast. Is that swelling? Do you think that my nose can improve with time or shall I consider a revision?
(Questioner submitted photos)

Dr. Denenberg's answer: I don't think the tip problem is swelling
I think the problem is that the tip was too projecting, given the position of the bridge, and when the cast came off, there was so much swelling on the bridge that we couldn't see the problem. Now that the bridge swelling has gone down, we see how prominent the tip is.

I don't consider this a polly beak. A polly beak is where the there is unwanted fullness above the tip, and if that fullness weren't present, the tip would look about right. in your case, if that fullness about the tip goes down, your nose would look even longer, which would pose a new problem. Also, a polly beak is usually scar or cartilage *above* the tip cartilages, but the fullness we see there could very well be the tip cartilages themselves.

Seems to me, you need a revision, where advanced work would be done on the tip, to deproject it, and especially to elevate it upwards. In expert hands, these can be fairly predictable changes to make, even in a revision, but all plastic surgeons would not possess the skill to accomplish the changes. So you need to be sure to see before and after photos before you launch into an operation like that.

Link to this question on RealSelf.com



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