Why Rhinoplasty Fails: The Most Common Causes of Collapse and Deformity

Rhinoplasty is one of the most intricate and technically demanding procedures in all of plastic surgery. When certain structures are weakened, removed, or not adequately supported, the nose can change shape over time in ways patients never expected. As a surgeon who performs hundreds of revision rhinoplasty procedures each year, I see the patterns of failed or problematic rhinoplasty every single week.

My goal with this article is to explain why rhinoplasty sometimes fails, what actually causes and what is collapse or deformity, and how modern structural rhinoplasty avoids these issues.

1. Loss of Tip Support

This is a common reason why patients seek revisions.

The nasal tip relies on a delicate support system made up of cartilage, ligaments, and connections between the septum and lower lateral cartilages.

Many rhinoplasty techniques remove or weakened these structures. They must be reconstructed in almost every rhinoplasty or loss of support can occur.

When tip support is lost, patients can develop.

• Tip drooping

• “Polly-beak” deformity

• Shortened or overly rotated nose

• Breathing issues

• Loss of definition

• Progressive sagging with time

Why it happens.

• Weak or damaged septum

• No structural grafts for support

• Reliance on outdated techniques like cephalic trim or columellar struts alone

How I prevent it:

I use septal extension grafts in nearly all cases because they provide reliable, long-term tip support and prevent droop or collapse as the nose heals.

2. Over-Resection of Cartilage

This is one of the classic problems in rhinoplasty — and a major cause of revision surgery. If too much cartilage is removed from the tip or sidewalls, the nose loses strength.

Over-resection can cause:

• Pinching

• Narrowed nasal tip

• Collapse of internal or external valves

• Inverter V deformity

• Loss of nostril rim support and alar notching or retraction

• Sharp shadows on the nose

• Irregularities or asymmetry

Many patients are shocked to learn that their breathing problems — or their “pinched” look — are due to aggressive cartilage removal years prior.

How I avoid this:

I perform minimal to no cephalic trim and instead use:

• reshaping sutures

• structural grafts

• cartilage preservation

This maintains strength while still achieving refinement.

3. Dorsal Collapse or Midvault Collapse

This often happens when the dorsum (the bridge) is reduced without maintaining proper support.

Causes include:

• Over-aggressive hump removal

• failure to recognize the need for spreader grafts at the time of hump reomoval

• Weak upper lateral cartilages

• Destabilization of the “keystone” area

What patients see

• Inverted-V deformity

• Collapse on inspiration

• A scooped or irregular bridge

• Shadowing or asymmetry

• Breathing obstruction

My approach:

Unless I’m doing a specific dorsal modification technique, I routinely use spreader grafts to support the midvault and prevent collapse.

4. Bone Irregularities or Asymmetry

Traditional rhinoplasty tools (osteotomes, rasps) can create small irregularities, uneven fracture lines, or asymmetric bone contours.

Problems this can lead to:

• Rough or “bumpy” dorsum

• Crooked appearance

• Persistent or new asymmetry

• Visible edges or shadow lines

Why it happens:

• Unpredictable fracture patterns

• Micro-fractures

• Trauma to soft tissue

• Limited ability to fine-tune the bone

My solution:

I use ultrasonic (piezo) and power tools to sculpt bone with millimeter-level precision and reduce trauma.

5. Scar Tissue & Poor Healing

Even perfect surgery can be affected by the body’s healing response.

Issues scar tissue can cause:

• Thickening of the skin

• Tip distortion

• Poor definition

• Asymmetry

• Dorsal irregularity

• Stiffness or pulling

Some patients — especially revision patients — naturally form more fibrosis.

What I do:

• Handle tissues gently

• Reinforce structure to resist scar tension

• Use meticulous suturing

• Provide postoperative protocols to limit fibrosis

6. Weakening of Internal Nasal Structures

If key support mechanisms like the L-strut or internal valve are weakened, the nose simply doesn’t have the architecture to hold its shape long-term.

This leads to:

• Collapse of the bridge or sidewalls

• Breathing obstruction

• Internal valve collapse

• Functional issues even if the nose “looks fine”

Prevention:

Structural rhinoplasty reinforces these areas instead of removing them.

How Structural Rhinoplasty Prevents These Problems

My approach focuses on preserving structure, reinforcing support, and controlling long-term stability.

This includes:

• septal extension grafts

• minimal cartilage removal

• spreader grafts

• dorsal component reduction

• ultrasonic bone refinement

• side-to-side SEG fixation

• controlled tip reshaping with sutures

• preserving natural anatomy whenever possible

The goal is always the same:

A strong, natural-looking nose that maintains its shape over time and breathes well.

Who is at highest risk for failed rhinoplasty?

Patients with:

• thin cartilage

• weak septum

• past trauma

• deviated nose

• prior rhinoplasty

• aggressive prior reduction

• poor nasal support

• significant asymmetry

These cases benefit most from a strongly structural approach with an expert rhinoplasty surgeon like Ari Hyman.

If your rhinoplasty has changed over time

You are not alone — and there are excellent solutions.

Revision rhinoplasty can:

• restore strength

• improve breathing

• correct asymmetry

• fix collapse

• smooth the dorsum

• restore definition

• create natural balance

These cases are more complex, but with proper planning, results can be life-changing.