August 07, 2026 | Plastic Surgery News, Rhinoplasty
The bump on the bridge of the nose is the thing patients notice in the mirror, and it is the thing that brings people back to me after a rhinoplasty that was otherwise fine.
Sometimes it is bone. Sometimes it is cartilage. And sometimes, in a nose that has already been operated on, it is scar tissue that built up under thick skin and refused to lie flat. That last one is a different problem, and it needs a different answer than the one the internet gives you. The internet says filler. I say no.
These are my answers from the exam room, anonymized.
“Why Is the Bump Still There After My Rhinoplasty?”
In a revision, the bump is often not the original bump. It is scar tissue that formed over the area we worked on, and thick skin is the reason it stays. Thick skin has memory. It wants to drape back over the old contour, and if it has anything to hold on to, it will re-create the shape you were trying to get rid of.
That is why I look at your skin before I look at anything else. Healthy skin is what lets me go back in safely.
“Can’t We Just Fill Around It Instead of Operating?”
No, and this is the strongest opinion I have on the subject. Filler is going to make your nose bigger. All we do with filler is cheat by adding to other places, so instead of lowering the bump, we build up everything around it.
Then there is the part nobody warns you about. What we see now is that filler in the nose does not really go away. It spreads. It ends up on the sides, and in the end it makes you look wide. That is the opposite of what almost everybody who walks into my office is asking for.
“What About Kenalog? Is There Something Stronger?”
Kenalog injections can soften scar tissue on the dorsum, and I will use them. They often give partial improvement, and they are a reasonable way to see how much a bump will respond before you commit to surgery.
But no, there is nothing stronger. Kenalog is the strongest thing we have for this. And I would not inject something like Kybella into the nose, because it can eat up things other than fat. You could end up with chronic pain, or it could discolor the skin. That is not a trade I am willing to make on somebody’s face.
“Do You Have to Open the Nose Again?”
Yes. I have to go through there to look at it. Otherwise it is blind surgery, and blind surgery is how you end up with an irregularity you cannot explain.
A revision on the dorsum means carving out scar tissue and shaving it down under direct vision. I want to see the surface I am working on, feel it, and know exactly what I left behind.
“What Are You Actually Doing In There?”
I shave the area down more than a first-time nose. Because thick skin has memory and wants to re-drape over the old shape, I am not aiming for a perfectly flat line. I am aiming for a slight depression, so that once the skin settles back down, it reads as narrow instead of wide.
I may also place internal sutures to tuck the skin envelope down so the bump does not pop back. And I change the dressing approach from whatever was used the first time, because if something did not heal the way I wanted, I am not repeating the same conditions.
“Is There a Risk to the Skin on a Revision?”
There is. Operating through scarred tissue always carries some risk to the blood supply. But blood flow in most noses is very good, and a single area of scar is usually not cutting off the whole supply. If your tip healed well the first time, that tells me a lot.
I will tell you honestly whether I think you are safe to operate on. If I am not comfortable, I will say so. And timing matters: the nose needs time to settle and for the swelling and scar to mature before anybody goes back in. I would rather wait and do it once than rush and do it twice.
“My Nose Is Broken and Deviated. Is That the Same Operation?”
Different problem, and often a bigger one. If you have fractured your nose and the septum is deviated, sometimes to the point where one side barely moves any air, the surgery is a septorhinoplasty. I have to fracture everything again, put it back in its place, and straighten the septum.
The first goal there is breathing. Straightening the outside is the second goal, and yes, we can usually do both in the same operation. I will use 3D imaging so you can see the profile change before you commit to it.
“What Are the Real Risks of a Septorhinoplasty?”
When the septum is broken in both cartilage and bone, I have to separate the mucosa from the cartilage and bone, straighten everything, and put the mucosa back. Where it is bent, the mucosa can perforate. A septal perforation can leave you with a whistle when you breathe, or with nosebleeds. The chance is less than one percent, but it is real and you should hear it from me before surgery, not after.
The other honest one is memory. The nose keeps growing your whole life, so even when I set it perfectly straight, it can shift back a little over time. You will breathe better. That part I am confident about.
“How Bad Is the Recovery?”
Surgery runs about two to two and a half hours under general anesthesia, and you go home the same day. The good thing about the nose is that it usually does not hurt. I always give you medication for pain, and most people never take it.
The nuisance is the splints. If we place one outside and one inside, breathing is restricted for about a week. We remove everything at a week and you should breathe much better right away. You will see the change immediately, but you will be swollen. Most of the final result shows at about six weeks, and the nose keeps improving throughout the year.
“Why Are You Talking About My Chin?”
Because I look at the whole profile, not just the nose. If the chin sits back, the nose looks bigger than it is. Bringing the chin forward creates a curve, makes the neck look tighter, and makes the nose look smaller without touching the nose.
It is a solid silicone implant, and it does not need to be changed. It is entirely up to you. But if we are already fixing the septum, it is very easy to do both at once, and the analysis of the whole face is what you are paying me for.
Why I Take Revisions Seriously
I am a double board-certified plastic surgeon with a Mayo Clinic fellowship, and revision noses are some of the most demanding work in this field. The tissue is scarred, the anatomy is not where the textbook says it should be, and the skin remembers what it used to look like.
That is exactly why I will not paper over the problem with filler. Filler is a tax that keeps coming due, and in the nose it eventually widens the very thing you wanted narrowed. If the shape is wrong, fix the shape.
For my editorial take, see the companion piece on drworldwide.com. The Southwest Plastic Surgery team covers the practice side at swplasticsurgery.com.
Ready to Talk?
If you have a bump that came back, a nose that will not breathe, or a result you are not happy with, come in and let me look at it honestly. Some of these are worth revising, some are worth waiting on, and some just need a plan. Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com. #StayBeautiful
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