Justin Buro, MD

Hello! Thank you for your question. It is not uncommon for patients to request cosmetic improvement while holding on to certain anatomic features that they would like to remain unchanged. It is absolutely possible to refine or reshape the nasal tip while maintaining some of the natural dorsal profile. Many patients want to preserve some of the bony or dorsal height they are used to, while addressing tip concerns such as drooping, overprojection, or asymmetry. Rhinoplasty allows these areas to be treated independently, so the tip can be sculpted without completely altering the bridge.

Techniques like tip suturing, cartilage reshaping, cephalic trim, columellar strut placement, and alar contour grafts can refine the tip, improve projection, correct droop, and reduce fullness in a controlled way. Meanwhile, the dorsal hump can be left partially intact or modestly reduced to balance the proportions of the nose with the rest of the face. This approach allows for a harmonious, natural result that preserves your desired facial character while addressing the features that bother you most - the tip and nostrils.

An experienced plastic surgeon can design a surgical plan that targets the tip for structural improvement and aesthetic refinement while leaving just enough of the nasal bridge intact to maintain its natural look. With the right approach, patients often achieve a significant improvement in tip shape and nostril appearance without compromising the overall personality or character of the nose.

I hope that answers your question. Best of luck!

Justin Buro M.D.

Hello! Thank you for your question. It must be frustrating to not see the results you were looking for, now a year after your original rhinoplasty. It’s not uncommon for patients to feel that certain aspects of their nose, particularly the frontal appearance, haven’t changed as much as expected after a primary septorhinoplasty. While side profiles often show more noticeable improvement, subtle changes to the nostrils, tip, or bridge can sometimes appear minimal, especially if the tissues are thick, healing patterns vary, or the original nasal structure is more resistant to change.

Based on what you’ve described and shown in your photos, a revision rhinoplasty could be a reasonable option to further refine the areas that remain concerning. Revision techniques allow an experienced plastic surgeon to address nostril shape, tip definition, bridge width, and overall symmetry more precisely, while maintaining or improving nasal function. These procedures are highly individualized, and a careful evaluation of your healing, cartilage, and tissue structure can help determine the best combination of adjustments to achieve the more refined, balanced frontal appearance you’re hoping for. Many patients find that a targeted revision, such as one focused on the tip itself, can significantly enhance both aesthetics and confidence while preserving or improving breathing.

I hope that answers your question. Best of luck!

Justin Buro, M.D.

Hello! Thank your for your question. What you’re describing is alar asymmetry, along with some tip asymmetry, which is fairly common and can make the nostrils appear uneven in length or shape. The shadows really accentuate these differences in this portion of the nose. This type of asymmetry is usually related to differences in the lower lateral cartilages, tip projection, and the soft tissue that surrounds the nostrils. Many patients notice this more in photos or from certain angles, and it’s a very typical concern that rhinoplasty can address.

Rhinoplasty techniques for correcting this include refining and reshaping the lower lateral cartilages, using tip suturing to improve tip symmetry, and sometimes adding small alar contour grafts to balance the nostrils. In more complex cases, additional maneuvers can further refine the tip and nasal base to create a harmonious appearance. With careful surgical planning, an experienced plastic surgeon can usually achieve excellent results, making the nostrils appear much more symmetrical and natural. While no procedure can guarantee perfect symmetry, most patients see a significant improvement that enhances overall nasal balance and facial harmony.

I hope this answers your question. Best of luck!

Justin Buro, M.D.

Hello! Thank you for your question. What you’re describing and what we see in the photos is whats known as alar retraction, which is when the nostrils appear more rounded or elevated, creating excess nostril show. Many patients describe this as the nose looking a bit too “upturned” or the nostrils being too visible from the front and side views.

This can often be improved with rhinoplasty techniques that focus on reshaping and supporting the lower nasal cartilages. Tip deprojection (bringing the tip slightly down and back), refinement of the lower lateral cartilages, and the use of alar contour grafts are common maneuvers to reduce nostril show and create a more balanced appearance. In some cases, additional grafting or support is added to stabilize the alar rims so they sit in a more natural, less retracted position.

The exact approach depends on your anatomy and the degree of nostril show, but with careful planning, these techniques can make the nose look softer, more proportional, and less “circular” from all angles. An experienced plastic surgeon can evaluate your nose in person and design a surgical plan that addresses your specific goals.

I hope this answers your question. Best of luck!

Justin Buro, M.D.

Hello! Thank you for your question. Yes, based on what you’re describing, you are certainly a good candidate for rhinoplasty to refine a bulbous tip and address a wider nasal appearance. A rhinoplasty can reshape the lower lateral cartilages, narrow the tip, and refine the overall width of the nose, helping create a more balanced and harmonious profile. Techniques such as tip suturing, cephalic trim, and columellar support can further improve definition and symmetry, producing a refined yet natural-looking result.

For your eyes, a lower blepharoplasty can reduce scleral show, smooth under-eye fullness, and improve the overall contour of the lower eyelids. Many patients choose to combine rhinoplasty and eyelid surgery in a staged or simultaneous approach.

An experienced plastic surgeon can evaluate your nasal and orbital anatomy, discuss realistic goals, and recommend the most appropriate combination of procedures to achieve your desired aesthetic outcome. With careful planning, rhinoplasty and blepharoplasty can significantly enhance both function and appearance while maintaining natural facial proportions.

I hope this answers your question. Best of luck!

Justin Buro, M.D.

Hello! Thank your for your question. Yes, it’s very possible to address both functional and cosmetic concerns in the same rhinoplasty procedure. Correcting a deviated septum (septoplasty) restores proper airflow, reduces nasal obstruction, and relieves the daily pressure and swelling you’ve been experiencing. At the same time, a cartilage-heavy nose can be refined with techniques designed to slim and reshape the tip and improve overall nasal balance.

For example, the lower lateral and upper lateral cartilages can be carefully sculpted or trimmed to reduce width and bulk, while tip suturing can refine the tip’s shape and definition. A columellar adjustment or strut can help reduce and support the columella, improving the projection and symmetry of the nose. Together, these maneuvers allow the surgeon to create a slimmer, more balanced appearance without compromising the structural support or function of your nose.

The extent of improvement depends on your specific anatomy and the overall framework of the nose. An experienced plastic surgeon can evaluate your nose and recommend a surgical plan that addresses both your breathing concerns and aesthetic goals in a single, comprehensive procedure.

I hope this answers your question. Best of luck!

Justin Buro, M.D.

Hello! Thank you for your question. Steroid injections can be a very useful tool for managing persistent soft tissue swelling after rhinoplasty, especially in areas like the supratip where a mild fullness (sometimes referred to as pollybeak appearance) can develop. When used carefully and precisely, they can soften scar tissue, reduce localized swelling, and improve contour without needing surgery. Many experienced surgeons use them selectively for patients who are past the initial healing phase but still have lingering fullness.

That said, there are some potential drawbacks if injections are done improperly. Overuse or placement too superficially can cause skin thinning, pigment changes, or even small depressions in the nasal tissue. For this reason, it’s important that steroid injections are performed by someone experienced in post-rhinoplasty care and nasal anatomy. If your own surgeon isn’t offering them, the safest approach is to seek an experienced plastic surgeon or facial plastic surgeon who is comfortable with these targeted injections. They can assess your nose in person and determine the optimal dosing and placement to reduce swelling while minimizing risk.

I hope this answers your question. Best of luck!

Justin Buro, M.D.

Hello! Thank you for your question. What you’re describing, asymmetrical nostril movement after a Le Fort I osteotomy, is actually a known but uncommon outcome. The transverse nasalis muscle helps compress the nostrils, and during maxillary advancement, it can be partially transected or displaced. If the muscle doesn’t reattach or heal symmetrically, one side may not move normally, leading to a subtle slant or asymmetry of the alar base when smiling or pursing the lips.

In many cases, this issue can be addressed during a rhinoplasty procedure, but it requires a surgeon experienced in both nasal anatomy and functional rhinoplasty techniques. The approach may involve repositioning or reconstructing the affected alar muscles, sometimes using small grafts or precise suturing to restore symmetry, along with standard tip refinement or alar base adjustments to optimize appearance. Because this is a delicate functional concern, outcomes depend on the severity of the muscle disruption and the individual anatomy, but careful correction can often improve both function and aesthetics.

A consultation with an experienced rhinoplasty surgeon would help confirm whether these techniques are right for your anatomy and goals, but what you’re describing is something that can often be improved with precise tip reshaping and cartilage adjustement.

I hope this answers your question. Best of luck!

Justin Buro, M.D.

Hello! Thank you for your question. Yes, it’s very common to combine rhinoplasty and upper blepharoplasty in the same procedure. The two surgeries address different areas of the face, and though they are very close in proximity, there’s no conflict in terms of anatomy or healing. In fact, combining them can be efficient since you only go through one anesthesia and one recovery period. An upper blepharoplasty is often very well tolerated in combination with a number of other procedures.

Based on what you described, a rhinoplasty can address all three concerns: smoothing the dorsal hump, straightening the deviation, and refining a broader, more square tip. Techniques such as reshaping the nasal bones and cartilages, narrowing and supporting the tip, and creating better definition can give you a smaller, more balanced, and feminine-looking nose. An upper blepharoplasty at the same time can remove excess skin and open up the eyes, reducing the appearance of heaviness or hooding.

The key is making sure you’re a good candidate for both procedures at once, which depends on your general health, anatomy, and goals. A consultation with an experienced plastic surgeon will allow for a detailed exam and surgical plan. But many patients do have these procedures combined safely and are very happy with the overall balance and rejuvenation it provides.

I hope this answers your question. Best of luck!

Justin Buro, M.D.

Hello! Thank you for your question. What you’re noticing in the supra-alar crease isn’t really “extra skin,” but rather the way the lower lateral cartilages, soft tissue, and skin interact in that area. When the lower lateral cartilages are wider, fuller, or project more, they can create extra roundness at the side of the tip. This makes the crease above the ala appear deeper and more prominent, especially from side angles. It’s a subtle but common feature patients point out when they feel the tip of their nose looks heavy or lacks definition.

Improving this usually involves refining the shape and support of the lower lateral cartilages. Techniques such as a conservative cephalic trim and precise tip suturing can narrow and define these cartilages, while a columellar strut provides stable support to hold the tip in a more refined position. Alar contour grafts can be used to smooth the transition along the crease, softening the shadowing and reducing the three-dimensional fullness that bothers you in profile. In addition, maneuvers such as tip deprojection (slightly setting the tip back) and lateral crural steal (pulling some of that skin and cartilage medially) can further improve the lateral definition and balance of the nose.

Altogether, these adjustments aim to reduce the prominence of the supra-alar crease and create a smoother, more balanced contour that looks natural in both frontal and profile views. The exact plan depends on your anatomy, but your concern is almost certainly one that can be improved with precise rhinoplasty techniques. A consultation with an experienced rhinoplasty surgeon would help confirm which refinements are best suited to your goals.

I hope this answers your question. Best of luck!

Justin Buro, M.D.