Fast facts

Rhinoplasty


What it is: A plastic surgery procedure to improve the appearance, proportions and structural functionality of the nose.  Rhinoplasty, commonly called a nose job, can enhance facial symmetry and harmony to improve the patient's self-confidence.  Breathing can also be improved as a result.


What it addresses: Specific aspects of the nose, such as:

- Nose size
- Nose width
- Asymmetry
- Nostrils


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Question

Rhinoplasty - I want a smaller nose. Why do rhinoplasty surgeons suggest only minor changes?

I have been told by one surgeon that if I had nose surgery that he could only make a small change to it. Should I get a second opinion? I have already seen a surgeon elsewhere and liked what he suggested could be done but, I would like it also to be a little smaller. He says that this isn't possible. He says my nose really does not have very much that would be considered abnormal but, I think it is too big.

Look forward to your reply.


Asked by: dottie
Surrey

Answers (7)

Sort by: Most recent | Most helpful
1
September 24, 2008

Commissioning a piece of sculpture

David C. Pearson, MD
David C. Pearson, MD
Board Certified
Facial Plastic Surgeon

As my colleagues have mentioned, there are many reasons why someone's nose cannot or should not be made as small as they'd want. Skin thickness and cartilage strength are two of the primary structural reasons that may limit the amount of change possible. Aesthetic considerations--how the nose would look in proportion of the rest of the face--are other considerations.

Here's a helpful tip, I think: consider a rhinoplasty consultation as if you're commissioning a piece of sculpture. By that I mean take a critical look at the surgeon's before and after photos and ask yourself these questions:

  • Do the surgeon's results all have the same "look?" Rhinoplasty should be customized to the individual. If they all have the same cookie-cutter look, stay away.
  • Does the surgeon's aesthetic sense agree with yours? Each surgeon has his or her own style, to some degree.
  • Does the surgeon tend to make consistently major changes to patients' noses? Consistently minor changes? Or does that surgeon's results span the gamut. Ideally, the surgeon should be able to make both major and minor changes depending on what's required or possible. (If they're all too conservative a change, maybe the limitation is the surgeon, not the patient).
  • And remember, much like a piece of sculpture, once carved you can't get the original piece of marble back. So consider your choices carefully and listen to the surgeon.

 

2
September 8, 2008

Smaller doesn't always mean Better

Sam Naficy, MD
Sam Naficy, MD
Board Certified
Facial Plastic Surgeon
Answer by Sam Naficy, MD

In rhinoplasty shape matters more than size.

Experienced rhinoplasty surgeons may promise you a more subtle change in size for a number of reasons:

  • You may have thick skin which will limit the degree of size reduction as it will not conform to a smaller size framework
  • You may have weak cartilages that cannot be further reduced in size without causing collapse of the nose
  • You may have internal nasal problems such as septal deviation and nasal valve collapse which would put you at more risk for nasal obstruction if the nose is significantly reduced in size

 

3
August 19, 2008
Shahram Salemy, MD
Shahram Salemy, MD
Board Certified
Plastic Surgeon

First of all, there's certainly nothing wrong with a second opinion, as it's always important to find a surgeon that you are comfortable with.

When it comes to rhinoplasty, smaller does not necessarily equal better. The key is to balance not only the aesthetic units of the nose with each other but also the nose to the face as a whole. With this in mind, just making the nose smaller or shorter may take away from the overall shape of the nose and its relationship to the face.

The bottom line is to relay your thoughts to your surgeon, listen to his or her recommendations, and then consider proceeding with the procedure only when you're comfortable with the plan.

Best of Luck!

Dr. S

4
August 9, 2008
Richard P. Rand, MD
Richard P. Rand, MD
Board Certified
Plastic Surgeon

It is very often the case that patients dislike their noses more than they should and percieve problems with them that are really very minimal.  They will frequently say "I've always hated my nose!"  In these cases, the surgeon should be very honest and try to redirect the expectations of these patients to accept a conservative and natural change in their nose.  

Certainly, you should seek multiple opinions but if other well-qualified doctors are telling you the same thing, please listen.  If you see enough doctors you will eventually meet one who will tell you that you can have whatever you want...you will likely be unhappy with the results this surgeon gives you. 

5
July 16, 2008

Do what is necessary and nothing more

Plastic surgeons often discuss with their patients maintaining their “facial harmony” when exploring various rhinoplasty options. By this, it’s important to consider maintaining the overall symmetry and proportion of your nose with the rest of your facial characteristics. It is my opinion that putting a nose back into such a harmonious relationship with the rest of the face is often more attractive than creating a “new” nose.

There are anatomic restrictions that should be respected when your surgeon performs your reductive rhinoplasty. Our experience in rhinoplasty has taught us that preserving those structures which are important toward maintaining long-term fundamental support shouldn’t be taken for granted – “do what is necessary, and nothing more.”

In summary – sometimes a little change lends a better result than a drastic change.

6
July 15, 2008

Perception of your nose

A thorough evaluation of your nose will place the size and shape of the nose in the context of the other features of your face. It may be that your nose does 'fit' your face, but that your attention is directed only to your nose.

I would suggest asking your plastic surgeon to comment on the size and shape of your nose as it relates to your face as a whole. Your hair style, makeup application and seasonal skin coloration may also affect your perception of the size of your nose. These issues are important to sort out before consenting a rhinoplasty.

Yours,
Scott Sattler MD FACS

7
July 15, 2008

Getting what you want vs. what is possible...

Michael A. Bogdan, MD
Michael A. Bogdan, MD
Board Certified
Plastic Surgeon

Without actually examining you, it is difficult to completely answer your questions. To change the shape of your nose, the supporting framework of bone and cartilage is modified, and the overlying skin re-draped. The skin plays a vital role in the final result – if it is very thick, even the most refined sculpting of the supporting framework may be hidden, and the results disappointing. In cases of reduction rhinoplasty, you have to be careful of how much the framework is reduced, as skin has limitations on how much it will shrink to fit. Simply stated: You can make a size 3 nose into a size 2, but not into a size 1.

It is always reasonable to seek additional opinions – if everyone is saying the same thing, you will feel more comfortable when you make your final decision.

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