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Steven M. Denenberg, M.D.
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Making a long nose shorter involves what I consider advanced work on the cartilages of the nasal tip.  Many of the noses I see for revision surgery after an unsatisfactory rhinoplasty elsewhere were left too long because the previous surgeon didn't know how to decrease the nose's length.

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Questioner: Could these results be achieved and how do I deal with depression from a bad rhinoplasty until I can get a revision?
I'm over 7 months post op, I'm aware that I have to wait a year before a revision so don't tell me "swelling" will go down. I looked so much prettier before the surgery, I absolutely hate my surgeon for ruining my life, I've pumbled into a deep depression over this. I can't pursue relationships, I can't love myself, etc. I want to know if there's any way I can deal with this and if the imaging I did looks possible and if I could go back to how I looked from the front before surgery. Thank you.
(Questioner submitted photos)

Dr. Denenberg's answer: Yes, there is a problem, but there are ways to improve it, too.
Hi, sjd,

I'm sorry you find yourself in this position. I'll tell you everything I can, based on your story and these photos.
It's true that the tip of your nose looks substantially bigger than before surgery. Your nose is also long, with the tip hanging down more than it needs to.

Of course, I haven't had the chance to evaluate your in person, but most likely, you're intuition is correct that the issue isn't swelling, for the most part. Although we say that swelling lasts about a year or so, at seven months after surgery, most of the excess size you see is probably scar tissue from the first operation, and it's not likely to change dramatically. I think you indeed are looking at a revision.

When it comes to the plan for a revision, I would encourage you to set a goal of not only carving the scar tissue out of the tip area, to reduce its size and the fullness above the tip, but also to elevate the tip, so the entire nose is shorter, along the lines of the modification I made in the video link of this post. There are a couple reasons for this. First, a revision is so difficult, that you're not looking to restore what you wanted in the first place, but rather to start from where you are now, and try to get the nose as good as possible. Secondly, in truly expert hands, elevating the tip of the nose is one of the more predictable changes to make, even in a revision, and since your nose looks big now, it's good to have many different ways of making the nose look smaller, such as elevating the tip at the same time as trying to narrow it. I would be optimistic about the outcome of a revision.

When it comes to *who* should do the revision, here's what I tell people who ask me. Do you *know* that your surgeon is truly expert in rhinoplasty? Most plastic surgeons are not. If you saw lots of good before and after photos, showing results that you would want for yourself, and not just profile views where a hump was taken down, then that's a good sign. Certificates and board certifications, however, mean nothing. If your doctor is expert, and he discusses your situation with you openly and honestly, then yours is probably one of those cases where the operation might have been done quite well, but something unexpected happened during the healing.
If you did not see before and after photos before selecting your doctor, or if he is evasive or dishonest about handling your problem, then he is not expert, and you must not let him perform your revision: your nose will just get much worse.

Concerning your depression, it is normal to have a reaction to the huge stress of looking worse after an operation like this. Many people describe what you are feeling. I'd encourage you to do two things: one, see if you can get a referral to an excellent counselor or a psychologist. Perhaps you have a friend who sees one, who likes the therapist a lot. It doesn't mean you're crazy; it means you've had a big stress, and therapist can help you cubby-hole the stress so it doesn't affect everything you do, so you can ignore it most of the time. Two, remember that you are still the same person. Almost all of the changes you don't like are right at the tip of your nose, and most people don't even look there when they're interacting with you. You must try to get your life back together, with help if you need it. It's too important, and you should try hard not to let the tip of your nose get the better of you.

Link to this question on RealSelf.com