Rhinoplasty Side Views
This patient had a previous rhinoplasty.  Notice that after the first rhinoplasty his nose has the following characteristics.  First, the tip is rotated up and we are looking into his nostrils.  The angle between his nose and lip is approaching 120-degrees, which is a side effect of many moves used in rhinoplasty designed to make the tip smaller.  Next, notice that the tip of his nose is blunted and smaller, which was probably the goal of the first surgery.  Still, nothing has been done with the rest of the nose to make it balance the tip.  After cosmetic rhinoplasty we have placed more cartilage into the tip rather than less cartilage.  We have replaced the cartilage with grafts that actually make the nose taller like placing a tent pole under a wet blanket.  This is a concept that is difficult for patients to understand how a big amorphous tip can be made to look smaller by placement of cartilage grafts that make the nose bigger; however as you can clearly see, his nose looks significantly better as we made it bigger rather than smaller in order to make the entire nose look smaller.

Rhinoplasty Oblique View
Notice from the oblique views that by building up the tip where it had been resected in the past, the nose actually looks smaller and balances his face better.  This is a concept that is difficult to understand but in this case we used cosmetic revision rhinoplasty to replace the cartilage that had been removed in his first surgery and thus better defined the tip.

Rhinoplasty Frontal View
The frontal view in this cosmetic revision rhinoplasty is not significantly changed other than the tip is more defined than it was before and we are no longer looking into his nostrils as much.  Once again, we have done this by actually making his tip larger by replacing the cartilage that was once removed in a previous surgery.  Revision rhinoplasty is extremely difficult but can be very rewarding as long as our expectations are reasonable.

Patients who have had previous surgery and/or trauma often have severe deformities of the nasal tip with twisting as well as nasal obstruction even if their goal may be just to improve their breathing often improving the shape is necessary.