Richmond Doctors

Can I Elevate my Tip to Disguise my Hump Without Dorsal Rasping? (photo)

I am ok with my small hump, width of nose bridge from frontal view, nostirls & alar base.I want to change my droopy tip. It points downwards, nearly touching my upper lip when I smile.I will stay with my hump cause a rasping plus an osteotomy will cause me too much down time, cost is fine.Will a tip rotation disguise a dorsal hump to be lower? Can suture technique alone elevate my tip without cutting of cartilage and implant? What do you suggest for me? My surgeon will rasp hump & suture my tip.

In my opinion, you do need something to stabilize the tip.  This usually is done with a columellar strut, but can be accomplished with other techniques as well (ie the septal tongue-in-groove maneuver).  You are right that by first projecting your tip, the amount of reduction of your bridge will be less.  You have basically a "pseudohump" caused by a low radix (the starting point of the nose) and an underprojected tip.  The key to having a long-lasting and pleasing result for your nose is stable tip projection.

Matthew Bridges, MD

Richmond Facial Plastic Surgeon

What is Wrong with my Neck? I Dislike My Profile. (photo)

I am not really what sure is wrong with my neck. I am 29 and fairly in shape I have come to really dislike my profile. Is there anything that can be done?

I agree with the others.  A chin implant would be the main thing I would recommend.  I agree also that just liposuction or at the most a platysmaplasty (tightening the fan-like neck muscle) would help.  At your age, it's quite unlikely, in my opinion, that you would need any skin removed.  In fact, with a chin implant in, the skin will be a bit tighter anyway. 

Matthew Bridges, MD

Richmond Facial Plastic Surgeon

Is My Deviated Septum Serious Enough to Fix During Rhinoplasty?

I had 3 consults for a primary rhinoplasty. The last surgeon found i have a deviated septum. I really dont have breathing issues. Should i get this fixed? Also should i only go with the surgeon who found this deviation? I like the last 2 i saw. I was leaning towards the second surgeon but he asked me if i had breathing issues at my consult and i said no. By the way, i am just going to have tip work done. No bridge work is nessacary. Both surgeons agreed with that. Help please. Thank You!

That's a bit tough without examining your nose.  However, I would have a hard time leaving a significantly deviated septum alone during rhinoplasty, but I'm biased as an ENT/Facial Plastic Surgeon.  In my hands, I almost always harvest cartilage from the septum for grafting and in doing so would correct any septal deviation.  One thing to consider is that just because you don't have breathing problems now doesn't mean you won't after surgery.  I see this all the time in revision cases where no septoplasty or other maneuvers were done to prevent new onset breathing issues.  The reason is that some cosmetic maneuvers done to shape the tip or take down bumps on the bridge can cause slight narrowing of the airway that might make an underlying septal deviation symptomatic, even if it want not prior to surgery.  Good luck.

Matthew Bridges, MD

Richmond Facial Plastic Surgeon