Hi, I'm a female, mid 20's, & have wanted a rhinoplasty for awhile! My main issue is that it's just too big for my face! Specifically, I'd like the profile brought down to reduce projection. I'd also like to reduce the bulbous tip. Lastly, I'd like to reduce the nostrils (they are huge!). I used photoshop to show changes I'd like to see but are these realistic & can I bring these to a doctor to show him what I desire? Are the nostril reduction expectations realistic? (thinned/narrowed) Thanks!
Is It Possible to Reduce the Nostrils on a Big Bulbous Nose??
Doctor Answers 19
Reducing nostril width on a bulbous nose
Through alarplasty incisions at the base of the ala the overall size of the nostrils are reduced. The bulbousness of the nasal tip is best treated with a combination of both cartilage removal and suturing of the tip cartilages to narrow, refine, and feminize the nasal tip. In addition, thick skin will have to be trimmed a little bit so as to give more definition to the tip and super tip area. Close follow up with cortisone injections will also be needed as part of the postoperative regimen to prevent a pollybeak or fluid retention buildup in the super tip area of the nose.
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Yes. It is called alar base reduction. This can be performed within the nostrils and the incisions hidden or in the crease between the nose and the cheek.
Nostril length is proportional to tip size
Everything in rhinoplasty is proportion. Your tip is bulky and can be reduced and reshaped with grafts to give you the kind of angularity that you have Photo-shopped. Be careful about nostril reduction, however. The smaller your nostrils are, the fatter your tip will look--just because of proportion.
You need some reduction and also some augmentation--to create shape where more is needed. A pure reduction strategy will disappoint you. Please select a surgeon whose results you like in patients with noses similar to yours.
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Rhinoplasty Preoperative Decisions
Yes, you describe problems that we deal with everyday. I tend to not like photoshop programs as much as some other doctors and even patients. I think it is more valuable to see before and after pictures of patients with similar features to you to try to get a feel for how the surgeon deals with these problems. The after pictures are actually results that your surgeon has attained.
Vargas Face and Skin Center
Thanks for posting your pictures in more than one view. I agree that you may come quite close to your desired endpoint, partly because YOU ARE DOING A GOOD JOB IN DESCRIBING WHAT YOUR CONCERNS ARE!
Many patients can not articulate what is bothering them about their noses, and that makes our job as plastic surgeons more challenging.
With regard to your particular issues, assuming your examination in my office confirms the photographic impression, I would recommend an "open tip" rhinoplasty to sculpt the bulbous nasal tip cartilages, reduction of the upper ("cephalic") portion of the lower cartilages, and possibly a reduction of some of the excess tissue of the nostrils, which can be done by removing some skin and tissue along the outer crease of the nostril, or even from the floor of the nose, or both.
A comprehensive, in-person consultation is required in order to offer you surgery, of course.
Realistic rhinoplasty results
From your photos you do seem to show reasonable goals. Tip skin thickness is the main limiting factor when reducing the size of the nose. An exam would help verify your goals, but certainly refining your bridge and narrowing your nostrils is possible. With refining the tip one must be careful not to overdo it at the expense of hindering your nasal breathing.
You should certainly bring your morphed photos to your consultation as they would be very helpful during the discussion with the surgeon.
Reducing Bulbous Tip and Narrowing Nostrils
Reducing bulbous tips requires a 2 surgical interventions: adding cartilage grafts to the tip for more structure and defatting the tip skin. The extent of bulbous tip reduction depends on the degree of bulbosity. Narrowing the nostrils also comes in 2 varieties: Horizontal and vertical reduction. Horizontal refers to bringing the nostrils closer together and vertical pertains to reducing the bulk of the nostril itself.
To get a better idea of what your nose would like, consider a computer imaging consultation. You can do this by either making an appointment or emailing a frontal and profile shot of your nose.
Nostril adjustment in large nose
From your photos, I think you can come close to what you may be looking for. Narrowing the nose and refining the tip can certainly help, but remember that living tissue does not act the same as our manipulations with computer imaging. If your skin is a little thicker and more oily" it will take longer to reslove the swelling and may not reflect the changes done to the nose quite as well as thinner skin. I certainly would take your photos with you as they form the basis of excellent communication with your surgeon. Get several opinions from board-certified plastic surgeons experienced with rhinoplasty. The nostrils can also be narrowed by an alar wedge technique, although this may prolong resolution of the swelling. Good luck
Rhinoplasty reducing size and narrowing nostrils
I think your goals are very realistic and the changes that you demonstrated on the imaging are fairly attainable. Reducing the projection and narrowing the nostril base (alar base reduction) would certainly help to give you a nose which is more balanced with the rest of your face. Reducing the bulbous nature of the tip is achievable, however, with thicker skin, you will have to be reasonable with the amount of definition that will be produced and will also have to wait at least 8 to 12 months to see the final results as this subtle healing take quite a long time.
Make sure to find someone experienced in your area, and good luck!
-Dr. Jamil Asaria
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.