Got 2 consult: md 1 said to use cartilage and SHAVE the bone from sides (?), md 2 said to use soft tissue from scalp since the skin is so thin (true) and cartilage will be visible and break bone since the bone will fall in if shaved. please advise, i almost scheduled op-n with MD1 but now so confused.
I want to reduce bone, remove slight crookedness, make 100% straight profile, reduce droopiness, reduce nostrils? (photo)
Doctor Answers (4)
How to Achievwe Nasal Refinement
My comments are based solely on the pictures you submitted. Your skin does appear thin but I think that is an advantage because it gives an experienced surgeon the opportunity to give you a refined surgical result, avoiding the full appearance in a patient with thick skin. I don't agree that you need soft tissue from your scalp. A rhinoplasty specialist can give you a natural result.
Straightening a crooked nose
With rhinoplasty in particular, often surgeons have different approaches and different ideas of what looks beautiful. It's good you are clear on what you want to accomplish with your rhinoplasty. A truly crooked nose usually requires more than just shaving down the sides of your nasal bones. In a case like yours where you are fixing a crooked nose, taking down a hump, and doing tip work, I agree that an open approach is best. I also think a fascia graft is helpful in the setting of thin skin, making it less likely you have any visible deformities later on. It may not be required, but giving the surgeon the permission to do so at his/her discretion is helpful. Also, breaking the bone may be required in order to achieve your goals. It is hard to give real recommendations based on the limited views in the 2 photographs. I recommend seeking out a board certified plastic surgeon or facial plastic surgeon that has experience doing rhinoplasty, and who also understands your goals. You want to make sure you are on the same page before surgery, and that the surgeon feels he/she can deliver what you are expecting. When I see patients for revisions that had rhinoplasty elsewhere, a lot of times they got a good operation, but it wasn't quite what they wanted or expected. The best way to achieve the vision in your head is to describe it clearly to your surgeon, and ask if it is achievable. If you are at all unsure about whether or not your surgeon gets what you mean, or has the ability to deliver those results, then have another consultation to clarify, or look elsewhere.
Rhinoplasty to staighten nose and fix bridge.
Thin noses need some soft tissue so irregularities do not show. If the bones are crooked they need to be reset. How high the bridge is depends on what you like--not the surgeon!
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Rhinoplasty for straight profile
To straighten the nasal profile during the rhinoplasty procedure, osteotomies of the nasal bones will be required to narrow and straighten them. Cartilaginous spreader grafts are placed underneath the concave upper lateral cartilage. A bony hump located across the bridge can be filed or shaved down, while in alar-plasty is performed to reduce the width of the nostrils. For many examples, please see the link below
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