Your question: I'm due on my revision rhinoplasty next month. Photo
These are 19 months after my 1st rhinoplasty,my tip have dropped remained very swollen although it was extremely thin when cast was removed last 2 pic I wanted short nose but now they said they will straighten the bump further resize nostrils thin the tip but have to make a cut at side of my nostrils for better profile said length is difficult to shorten otherwise if they did, chances are my nose will spread flat on face. Is it true? What's best for me? Kindly tell
Dr. Denenberg's answer: Some of what you posted, if absolutely accurate, is concerning.
Of course, I haven't had the opportunity to examine your nose in person, and my comments are based only on these photos that you submitted. But ...
One of the main features of your nose is that it is very long -- with the tip drooping down. In my opinion, shortening your nose should be one of the primary goals of a rhinoplasty. I made a computer morph of one of your photos to show that kind of a change. See the Web reference link, below, to see the morph.
If the plan is specifically to not shorten your nose, I think that's a mistake, and that you might be very disappointed with the result, even if everything else goes fine. In my experience, shortening a nose doesn't cause a nose to get wider. Rather, deprojecting a nose, bringing it back closer to the face, is the movement that has the possibility of making a nose look wider. And with your thick skin, your nose probably can't and shouldn't be deprojected very much at all.
There are other problems with your comments you don't have much of a bump, in my eyes. I don't know of any way to re-size your nostrils. Making a cut at the side of the nostrils won't change the profile view. In fact, I don't see any reason at all for making a cut on the side of your nostrils.
It just seems as though not much makes sense. I'd recommend having another deep conversation with your surgeon about what he's planning to do, and see if it makes sense to you then. Have him make computer modifications to show what the goal will be. Maybe there will be some good clarification.
Have him show you before and after photos of his other revision patients. That's very very important. If he doesn't have any photos to show you, you should cancel the operation and take your time and re-consider what to do.
Proposed before and after:
Here's an animation of those changes. Give it a couple seconds to load:
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Plain talk about picking a plastic surgeon for your first-time or revision rhinoplasty.
I do lots and lots of revision rhinoplasties; I'll try to give you some advice here, to maximize the chances that you'll be happy after surgery, and to minimize the chances you'll need a revision.
Important!! How to tell whether your consultation was acceptable:
Photos. If a surgeon doesn't show you before and after photographs, scratch him off of your list. Period. No exceptions. Deal-breaker.
You pick a surgeon primarily from his before and after photos. Diplomas, board certifications, hospital affiliations, academic appointment, and even reputation tell you nothing: a surgeon is never tested for his skill, his artistic eye, the quality of his outcomes, or even whether he cares that his patients are happy.
You must see photos of other patients who had some features similar to your nose. For example, if your nose has a wide and drooping tip, don't accept profile-only photos of patients who had a hump carved down. You can't see the width of the tip on a profile photo.
Revision nose operations are much more difficult than first-time operations, so if you are consulting a surgeon about a revision operation, you must see photos of his revision patients.
If you do see the surgeon's photos, but you don't love them, scratch him off your list. You want to use a surgeon whose work you like. Don't assume that he'll do great on you when he didn't do great on the other people.
Thought experiment: you are going to hire a portrait painter to paint your portrait. Would you really hire the painter if he wouldn't show you any of his other portraits?! No, it would never occur to you to hire him. Well, now you're going to hire a surgeon to change your nose, in the middle of your face, and you aren't going to insist on seeing examples of his work, proof that he knows what he's doing? Think about it. Teach your friends.
Communication. If the doctor treats you disrespectfully, scratch him off your list. If he won't patiently listen to what you want for your nose, same thing. How will he know how to make you happy if he won't hear what you want for your nose?
If he conducts the consultation from behind his desk and doesn't examine your nose, deal-breaker. If it's the nurse and not the surgeon who conducts the consultation, run away fastest. All due respect to the nurse, she doesn't know what's possible and what isn't. If the plan is to see the surgeon for the first time on the morning of surgery, deal-breaker. For sure.
Computer morphing. If the surgeon doesn't do computer morphing of your nose, scratch him off your list. The morphing is crucial, so the surgeon can prove to you that he understands exactly what your goals are. Also, if the surgeon recommends some changes that you hadn't thought of, you need to see the morphs, so you can see whether you like those changes.
Your intuition. If your gut tells you "no," don't use the surgeon. Don't ever use a surgeon only because you know him, or your kids know him, or he lives on your street, or your primary care doctor referred you to him, or he did your breasts, or your tonsils, or your wisdom teeth, or you saw his advertisement, or his awards.
I hear these stories all the time from my revision rhinoplasty patients. You must do your own evaluation of any surgeon you visit. And by "evaluation," again, we're talking mostly about seeing his photos and seeing how well he communicates with you. Don't bother checking the surgeon's licensure and board certification and hospital affiliations and all that; it'll just distract you from what's important.
Conclusion. The fact is, the great majority of plastic surgeons who perform rhinoplasty shouldn't be doing the operation. It's an incredibly difficult procedure, technically demanding, requiring experience, skill, judgment, an artistic eye, an exceptional level of communication and thoughtfulness, and a rare level of empathy and caring for the patient. No hospital board protects you by judging the quality of a surgeon's rhinoplasties and prohibiting him from operating if he's terrible. It's the wild, wild west out there, folks.
More plain talk: should you let your primary surgeon perform your revision?
First, you need to consider whether things didn't turn out great on your first operation because of some unusual circumstance with the surgery or the healing, or whether things went wrong because your doctor was not expert in rhinoplasty in the first place.
Evaluate your surgeon again. Read the section above, on how to evaluate a surgeon for a rhinoplasty. If you saw lots of before and after photos of your surgeon's other patients who got excellent results, in noses at least somewhat similar to yours, then your surgeon probably knows what he is doing, and you can consider letting him perform your revision. Even the very best surgeon has the occasional disappointing result.
However, if, on looking back, you decide that you did not do excellent research on your original surgeon -- perhaps you relied on a referral, or on his board certification, without being able to see his photos -- then you probably should not have him perform the revision. If he couldn't get you close to your goal the first time because of a lack of skill, he will have no chance at all on the second try, and then you'll be in the tough position of looking for a third operation.
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