Swelling after a nose job (rhinoplasty) can initially make the nose appear larger. For the first two weeks, the swelling will be noticeable. After the second week swelling usually subsides such that it’s not obvious, however, the nose can still look “puffy” to the patient for several months. By 4 months the majority of the swelling should dissipate, but it may take a full year for all of the swelling to subside.

Fullness or bulbousness, specifically, of the nasal tip following surgery is a complication that can be very disappointing and ruin a near perfect result. Fullness over the tip is termed supratip fullness and can cause the tip to look like it is drooping, much like a parrots beak. The first thing to consider is that your surgeon, in fact, did place your tip in the proper position. An aesthetic tip should be positioned to lead the dorsum (external ridge of the nose) by about 1 to 2 mm. Tip support must be appropriately provided so that it maintains its position.

Proper Positioning of the Nasal Tip

What I would like to discuss is a tip that has been positioned appropriately during rhinoplasty, but which continues to appear droopy, well after surgery, due to fullness above the tip. Several factors can lead to this supratip fullness complication, thereby compromising your nasal tip aesthetics:

Pictured above: side profile of a normal vs. drooping nasal tip.

Pictured above: The nose anatomy.

  1. Under resection of the septum just behind the tip  The septum is the wall between your nostrils and acts as the main central pillar support to the nose. Often, areas in the septum are removed to eliminate any deviation that can be affecting your breathing. Despite the removal of septal cartilage, a
    good amount of septum needs to be preserved to maintain the infrastructure support of the nose. This is especially important in the front of the nose where the nasal tip is often supported on the most projected portion, called the anterior septum. Yet, there is an area just behind this region that needs to be lowered or it will remain prominent and lead to the supra tip deformity.
  2. Soft tissue fat of the nasal skin – Often nasal skin is fatty and if not addressed, this fat can actually blunt the shape of the nasal tip despite surgical maneuvers to refine it. In addition, this fat can fill the area behind the tip resulting in supratip fullness. Proper defatting of the supratip region is required to ensure a well defined nasal tip.
  3. Memory of the skin shell – The skin of the supratip region often stiffens to a fuller convex-shaped shell over decades of life. Despite removing the underlying structures that have created a fuller supratip region, sometimes the skin does not accommodate to the newly created shape. In such cases, light scoring of the under-surface of the skin may be required. Additionally, a small internal stitch may assist in pulling the supratip skin down to its newly designed contour. And finally, aggressive taping and use of an external splint can further assist in reforming the shape of the supratip skin shell.

Dr. Arian Mowlavi is an expert rhinoplasty surgeon at the Cosmetic Plastic Surgery Institute in Laguna Beach, CA. Click on the button below to view amazing before and after photos. If you have concerns about the appearance of your nose, please come in for a free consultation to determine whether you could benefit from a Revision Rhinoplasty.

SEE ALSO: The non-surgical Rhinoplasty

View Rhinoplasty Patient Before & After Photos