Steven J. Pearlman, MD, FACS

A low dorsum can be augmented using finely diced cartilage. After the cartilage is reconstituted with tissue glue, called Tisseal, we then cover it with perichodrium from the rib where we got the cartilage graft from. This will yield a higher bridge but still have a smooth dorsum even in patients with thin skin.

Ever since I stopped using nasal packing after rhinoplasty the level of post op discomfort (don't like to use the word "pain") has gone down significantly. Other medications we prescribe are antibiotics for 24 hours, which is the latest evidence based recommendation, and Arnica Montana, a homeopathic medication to reduce bruising. If you still have pain the day after surgery, studies have also shown that most patients get equal pain relief from a combination of Acetaminophen (Tylenol) and Advil.

When I look at your photos, your entire mouth is tilted. This is present in a majority of the population. It is from an underlying skeletal (bone) asymmetry. Lip lift will enhance the upper lip and can make up for minor asymmetry but not when the corner of the mouth is lower on one side than the other.

I always start a consultation asking the patient what they don't like about their nose and what their goals are. It is not about asking them to design their surgery but more to see why they came in. I then examine the patient and use computer imaging to show what I see and what changes I suggest. Most patients are realistic about their goals. Computer imaging is a great way to have a dialogue about realistic changes and what looks best on the patient. If the surgeon is honest and doesn't overdo the imaging it is very good for both coming to a mutual goal and also to weed out unrealistic expectations.

African American Rhinoplasty is about refining your nose but still maintaining a natural ethnic look. Rhinioplasty can do all of the things your desire: narrow and raise your tip, create a more defined bridge and also gently narrow your nostrils. You should see an expert in ethnic rhinoplasty who has good before and afters for a consultation.

It is difficult to make specific recommendations for revision rhinoplasty based on the photos. Revision rhinoplasty often requires further cartilage grafting. The source could be your own septum, ear cartilage or rib. A personal exam so your surgeon can view your nose from multiple angles as well as feel the structures for strength is necessary to make a specific plan. You should see an expert in revision rhinoplasty for a consultation since this is a more challenging procedure than primary surgery

You did not show your face without smiling. For most patients, to show more teeth with smiling and help evert (roll out) your upper lip, as you do with your finger in the second photo, a lip lift will achieve just that. You should see someone with a lot of experience with lip lifts. It is not just about removing a set amount of the lip skin under the nose. There are calculations we can do to control how much more teeth you can see.

I find that computer imaging is a great way to see of a tip plasty would be sufficient to improve the appearance of your nose. Many patients who are only bothered by the size of their tip might also have a small hump or excess width of their bridge that is overwhelmed by the tip. We can simulate reduction of your tip with imaging and see if your nose is still in balance.

Yours is a common concern for patients from the Middle East. You seek changes in your nose but still look natural in a family environment. Ethnic rhinoplasty is about making such changes and still respect the general appearance of your middle eastern nose. I find computer imaging very helpful in projecting potential changes.It is a good time to discuss with patients who want more and others who want less changed. See an expert in rhinoplasty. Look at their before and after for similar noses and see if their surgical results match your aesthetic goals.

It appears that you have what we call and over projected tip. Yes, it can be brought closer to your face. You have other issues that are caused by the skin shrink wrapping around your nasal cartilage. You should see an expert in rhinoplasty for a full examination where they can feel your nose, the structures under the skin and determine the best treatment. But, yes, your nose can be made to better fit your face.