Matthew Wolpoe, MD

You are right rhinoplasties are a difficult operation and even in the best hands will still have about a 10% revision rate. So all aspects of the surgery need to be based on a thorough understanding of the aesthetics of nose, its anatomy and rhinoplasty techniques. That being said taking down a small bump is usually an easier endeavor in that there is 1-2 mm of leeway in how much can be removed. However, even this can be over or underdone and can leave an open bony roof or breathing problems if not done properly. Fixing a crooked nose can be a challenge especially if there is cartilaginous involvement as the cartilage has memory and this can rebend with time. Tip changes when they are small can be straightforward but again can cause major issues if overdone. Changing rotation, projection and length of the nose are all very technically demanding and are difficult to execute well. Best bet is to not ever assume a rhinoplasty will be easy and only go to a board certified facial plastic surgeon or plastic and reconstructive surgeon who does a lot of these operations. 

Without examining you and from a single picture I can only give you a relative assessment of your issues. Big also means different things to different people. Sometimes when patients come into my office and feel that their noses are too big, it is actually that their profile is out of balance. When we look at the size of the nose there are several factors, but a big one for patients is their projection or how far their nose extends away from their face. This can be determined by specific measurements but can be estimated by looking at the length of the lip with the length of the tip of the nose. Your measurements looks relatively the same, or perhaps the nose is slightly overprojected. Your profile also shows that your dorsum could be taken down a little bit as well to give your nose a more refined appearance. Your projection can be reduced while rotating up your nose a slight bit by some minor refinements in the tip during an open rhinoplasty. This would produce a subtle deprojection of the nose (or move the tip in a bit), a slight decrease in rotation (upturn it a bit) and some reduction the the dorsum (remove a tiny bump) giving it a more refined appearance. That being said, the thing that is most apparent is that you have a relatively small chin. When one looks at a woman's chin from her profile it should be just shy of the lower lip. Yours is a bit back from that point. There are a few reasons why this could be: you could have an overbite, you could have a normal bite with a small chin or a combination of both. Overbites usually are best fixed by an oral maxillofacial surgeon to advance the jaw. If you have a normal bite or are unwilling to have the advancement a small chin is helped dramatically by a chin implant. This strengthens your profile and helps your neckline as well. This procedure is very simple and can be done in the office in about an hour. If you did this you may find you don't want to do anything to your nose. I would recommend obviously seeing a local board certified facial plastic surgeon or plastic and reconstructive surgeon that do a large volume of these cases. Good luck!

The most common fillers for this purpose now are HA's such as Restylane or Juvederm. These products have slightly different properties but both work for this purpose. It is more important to choose a qualified injector than the particular HA in my opinion.    The advantages of these fillers for liquid rhinoplasty are that they are relatively smooth, moldable, produce less inflammation than thicker products, and if necessary they are reversible. Because there is not much motion in the nose the product can last a year or in some circumstances longer. The most common indications would be to smooth out a bump, change the rotation or projection of the nose. Fillers can work as sort of a rent with an option to buy meaning if you like the way the nose looks you could consider a rhinoplasty for a more permanent correction.    However, these must be used with caution. There is a potential to create inflammation and contour irregularities if not injected properly. Further there are reported cases of skin necrosis when using fillers in the nose. These complications would make corrective surgery more difficult. If you absolutely do not want surgery fillers can be done safely but make sure you go to an experienced injector with knowledge of the products and the anatomy of the nose to limit the chance of these potential pitfalls.