Do I Need Nose Surgery/Rhinoplasty?

I feel like my nose shouldn't point up so much. I can see up my nose from looking in the mirror. Also that the gap between my nose and top lip is too big; perhaps my nose is too small in length? Can you help me in suggestions for possible rhinoplasty?

Doctor Answers (12)

Elongatiing the short nose.

+3

I would agree with your assessment that your nose is too short and that the tip is up-rotated too much.  Rhinoplasty can indeed achieve a more balanced appearance. 

The length of the nose is defined by most plastic surgeons as the distance from the Nasion (the break point where the forehead turns into the nose) to the Nasal Tip.  Modifying either of these points will change the nasal length.  The nasal region just above and below the nasion is known as the radix or nasal root.  The nasion should ideally be located as Dr. Bridges has pointed out, somewhere between the upper eyelid crease and lashes.  In your case the nasion is situated at the level of your pupils imparting a low take-off to the bridge of your nose and contributing to a shortened appearance.  Unlike Dr. Bridges, however, I would not recommend removal of bone in this area.  The only way that bone removal from the radix can move the nasion point superiorly (upwards) on your face is to make sure all of the bone is removed at a location above the nasion point, ie. along the lower forehead region.  This is quite challenging and will further deepen the root of your which in your case already seems to be somewhat under-projected.  Instead, I would propose a radix graft to increase the projection of the upper nasal bridge regions and move the nasion (take-off point) upwards on your face.  The overall result will be a longer nasal length.  Radix grafts are typically comprised of fascia +/- cartilage preshaped into the proper configuration then inserted into the root of your nose and secured with sutures. 

The nasal tip can be down-rotated at the same time that the nasal root is moved upwards to give a more pleasing angle between the base of your nose and your upper lip.  While lengthening the lower third of the nose is quite challenging, it is certainly much easier during primary rhinoplasty than during revision rhinoplasty when one is fighting the effects of a shrunken and scarred soft tissue envelope.  In primary rhinoplasty, the mucosal lining and skin cover are supple and elastic enough that they will stretch without significant recoil following surgery.  The mucosa and skin therefore, do not need to be addressed during tip elongation in primary rhinoplasty as they often require during revision rhinoplasty.  Elongation and down-rotation of the nasal tip can be achieved with the following cartilage graft techniques;

  1. septal extension grafts
  2. lateral cural release and spacer grafts
  3. nasal tip onlay grafts

 


Denver Facial Plastic Surgeon
5.0 out of 5 stars 46 reviews

Short Nose

+3

There are numerous "studies" that have described "normal" angles and lengths/ratios concerning the nose.  However, beauty is in the eye of the beholder.  You have pointed out a few things that we look at with patients who are considering rhinoplasty.  Your nose is probably a bit "over-rotated" meaning the angle between the lip and nose is somewhat obtuse.  Also, again technically speaking, your nose starts somewhat low.  We typically want the nose to start about the level of the upper eyelashes or the upper eyelid crease.   Your nose starts well below that level.  I think a bit of angle reduction as well as some augmentation to the starting point of the nose would help give the illusion of more length. Bringing the angle down can be somewhat challenging, depending on how much you need to reduce it.  Overall, a rhinoplasty could certainly address the issues you pointed out.  Good luck!

Matthew Bridges, MD
Richmond Facial Plastic Surgeon
5.0 out of 5 stars 5 reviews

Surgery to bring down nose

+1

Surgery to bring the nose down is a very difficult procedure and should only be performed by experienced rhinoplasty surgeons.  To bring the tip down often requires dorsal augmentation, resection of the nasal spine, and bilateral extended spreader grafts. 

William Portuese, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 55 reviews

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Improving upturned nose

+1

As the others have mentioned, you nose is somewhat more upturned than ideal. There are rhinoplasty techniques that can be used to improve this along with raising the starting point of your bridge (the area between your eyes) which would also effectively lengthen your nose.

You would need a rhinoplasty surgeon well-versed in such techniques. This is much more complicated than a reductive rhinoplasty.

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 13 reviews

Correcting a short nose

+1

From the photos you have provided, it appears that your nose is foreshortened and upturned. This can be corrected by performing a rhinoplasty to lengthen the nose and drop the tip so that it is closer toward your face correcting the upturned or "piggy" appearance. This also gives you the appearance of a short upper lip. By retrodisplacing your nose or letting it sit closer to your face would give both the nose and upper lip a more natural appearance. I hope this information helps.

Scott Trimas, MD
Jacksonville Facial Plastic Surgeon
5.0 out of 5 stars 8 reviews

You Probably Do Want A Rhinoplasty

+1

Your nose is short and upturned.  There is no way to change this but with a rhinoplasty.  To change your nose in the fashion that I think you desire is very possible, but it will require a skilled rhinoplasty surgeon.  These changes are considerably more challenging than the more common reduction rhinoplasty. 

I suggest you visit with a couple of surgeons and discuss the surgery.  There are a number of things you need to consider.  No surgeon can predict exactly what the result will be but instead should explain to you the goal and the likelihood of it being a little this way or a little that way.  Make sure you are OK with that.  You also need to consider the cost, healing course, and risks of surgery.  If all of these things are acceptable to you then moving forward is likely to help you feel good about your appearance.

Louis W. Apostolakis, MD
Austin Facial Plastic Surgeon
4.5 out of 5 stars 15 reviews

Lenghthening your nose would make it look more natural

+1

I agree with your assessment that your nose is somewhat short with the tip upturned.  Structural rhinoplasty could help.  Repositioning your tip cartilages downward with structural cartilage grafting would be the technique I think would help the most.  There is a limit in the extent of lenghthening because the skin envelope can only stretch so far.  But I think evern 2-3 millimeters would be a very nice improvement.

David W. Kim, MD
Bay Area Facial Plastic Surgeon
5.0 out of 5 stars 20 reviews

Rhinoplasty for the short nose.

+1

No one "needs" a rhinoplasty. Your nose is short and upturned. It can be derotated and lengthened. This is an advanced rhinoplasty technique and you should select an experienced rhinoplasty surgeon to do this!

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 14 reviews

Do you need a rhinoplasty

+1

Many individuals can find faults and characteristics in their nose that they don't like. Your nose is shorter than many and your comments are true. Do you need rhinoplasty? One of the best way to work out what a change will look like is with computer imaging and simulation of changes to try things out beforehand. During a consultation look for a surgeon who can work with rhinoplasty simulation, and bring with photos of what you would like to see.

Best of luck,

peterejohnsonmd

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 26 reviews

Rhinoplasty for Under Projected Nose

+1

Based on your picture, your comments about your nose is correct. You have an exaggerated nasolabial angle which makes your upper lip look longer than it otherwise might. This is known as an under rotated or under projected nose where the tip of the nose (lower third) is tilted back too far. This is often associated with a low nasal bridge area as well. Rhinoplasty can de-rotate the nose and give it more projection and a decreased nasolabial angle. This requires an open approach with cartilage grafts  to push the nasal tip downward and hold it in place. It is also likely that you will require dorsal augmentation as well to increase the prominence of the dorsal line as the tip comes down. They key to this type of rhinoplasty is the use of cartilage grafts and it may require a rib graft to provide the proper amount of graft material.

Barry L. Eppley, MD, DMD
Indianapolis Plastic Surgeon
5.0 out of 5 stars 26 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.