Your question: Lumpy bridge and bigger nose 6 months post op, is this normal?
I got my rhinoplasty and septoplasty 6 months ago and it was supposed to narrow my bridge, get rid of a bump, narrow the tip, and fix my deviated septum. My nose is NOW twice as wide, appears larger, and looks deformed because it is both lumpy and uneven. My tip is also droopy and way lower than before. Is this surgery botched? Can I expect any major changes? I have also gotten steroid shots for swelling about 6 weeks ago.

Dr. Denenberg's answer: Yeah, your complaints seem justified by the photos you posted.

See the Web reference link, just below my response. I made a computer morph of your nose, and an animation of the morph, to show the changes that likely are possible for your nose in truly expert hands.

Mostly, I elevated and narrowed the tip of your nose, as I did in the short video just above. Depending on your preferences, the tip could be elevated even more. The bad news is that the tip of your nose probably won't elevate on its own any more with continued healing from your previous surgery. The good news is that elevating a tip is one of the most predictably changes to make, even in a revision, with an expert's skill. If your nose was not expertly handled, then narrowing the tip should be fairly predictable as well.
You should understand that the changes I demonstrated in the morph require advanced techniques, techniques that most plastic surgeons cannot handle. Be sure to read the section in the Web reference link on how to stay out of trouble while searching for a rhinoplasty surgeon, specifically, whether you should let your primary surgeon perform your revision.
Your nose is also a good example of why computer imaging is mandatory in rhinoplasty. You need to know exactly what the surgeon is planning to accomplish -- what features he thinks he can change, and by how much he thinks he can change them. When you see his goals, you'll know whether he has an eye for a beautiful nose, and whether he shares your opinion of what constitutes a beautiful nose. You'll also know whether the changes he proposes are enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. But remember, you're not hiring him for his skills with the computer. The doctor must then show you his before and after photos to prove that he can actually accomplish what he draws on the computer.< p>

 

1) Proposed before and after:

Here's an animation of those changes. Give it a couple seconds to load:

 

Does this fit with what you have in mind for yourself?

 

2) Click here to ask Dr. Denenberg a follow-up question, or to comment on his changes,
or to thank him for the morphs.

 

3) Click here to see more rhinoplasty before and afters of patients who had revision rhinoplasty.

 

 

Click here to see most of the morphs that Dr. Denenberg prepared for other RealSelf participants!

 

More info on Dr. Denenberg:

Click here for Dr. Denenberg's profile, and more before and after photos, on RealSelf.com

"I went to many different surgeons but I liked him the most. "
Click here for reviews of Dr. Denenberg on RealSelf.com

Patients from over 55 countries, ...

... and almost every U.S. state, have come to Omaha to see Dr. Denenberg. We put a red or white flag on each location: (click the map to see a huge blowup)

 

Plain talk about picking a plastic surgeon for your first-time or revision rhinoplasty.

I do lots and lots of revision rhinoplasties, and 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 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.

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?

Rhinoplasty is by far the most difficult of the facial plastic surgery operations. And revision rhinoplasty is ten times more difficult than a first-time operation.

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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Dr. Denenberg has been selected as one of America's Top Doctors by Castle Connolly Medical Ltd.

The America's Top Doctor award is not a popularity contest. Unlike all the local copycats and spin-offs, Castle Connolly allows only physicians to nominate, and vote for, Top Doctors. The "America's Top Doctor" is a doctor who is voted into that position by a national review of recognized experts in the doctor's field. Dr. Denenberg is one of the rare doctors to receive that award every year since the program began in 2001.

Here's a link to Dr. Denenberg's recognition page at Castle Connolly.

 

If Dr. Denenberg asked you to post or send better photos ...

Go here, to see how to position and take photos that are best for a plastic surgeon's evaluation.