Stephen P. Smith, Jr., MD

Hello Enthusiastic306 and thank you for your question. Thick skin does not make septorhinoplasty risky – it only covers the underlying changes made to the bony and cartilaginous structure of the nose during rhinoplasty more than thin skin. Therefore small changes such as tip refinement may be less noticeable than with thin skin, which is sometimes a good thing! Also thick skin does not always “shrink” down after reduction rhinoplasty as quickly as thin skin, and postoperative swelling may last longer. In your case based on your photos, if your dorsal hump is reduced this will still be apparent after surgery despite your skin envelope thickness. The fact that your tip falls when you smile is more of a function of your depressor septi muscle, rather than your skin envelope as well, which can be addressed during surgery. Postoperative strategies to address a thick soft tissue envelope can be utilized to optimize your results. Undergoing septorhinoplasty to change the appearance and function of your nose can be a life-changing surgery however, so if you feel uncomfortable at all about your surgery or do not feel like you saw enough sample photos of your surgeon’s work, I think it is reasonable to schedule another preoperative visit with your surgeon to discuss all your concerns. 

Hi Nathanboek and thank you for your question. Chin aesthetics are best assessed by looking at height, width, and projection compared to the rest of the face, including the nose. Sometimes underlying orthognathic issues can contribute to chin appearance, so it is important to have your bite and mandible position evaluated by a facial plastic surgeon or dental colleague. If your bite is normal, there are several options for improving the way your chin looks. You could consider botox for an overactive mentalis muscle (the chin muscle that gives the chin a walnut appearance if overactive), or filler in the area to improve projection/height. Both of these options are temporary, lasting months. A more permanent option that can improve projection or height of the chin would be a chin implant, which may help you achieve the profile you desire.

Hello Amanibarrie and thank you for your question. Excessive scleral show, when the whites of your eyes show too much, can happen for a number of reasons. In older people we see this due to laxity of the tissues with age. In someone young like you, this is less likely. It may be due to genetics or the anatomy of your eye, periorbital tissues, and facial skeleton. If you have always had this look to your eyes, or if your parents or siblings have a similar look to their eyes and eyelids, this would support an anatomical reason. Another important consideration is hyperthyroidism or Graves disease, which can cause the eyes to become more prominent with excessive scleral show. I would recommend you first get your thyroid labs checked (simple blood test) to make sure this is not a contributing factor. If normal, you could consider having filler placed in the cheek (malar) and under eye (infraorbital) area to help lift and support the lower lid tissues. Filler would be a temporary option (tends to last 6 to 18 months in this area or potentially longer), and if you were pleased with it you could consider fat grafting, which is more permanent. Canthopexy or lid tightening surgery would only be reserved if you had any laxity of your lid, which again would be rare for your age, and is best assessed in person by an experienced facial plastic surgeon. 

Hello Celiacelia and thanks for your question. I often have patients with deviated septums or evidence of nasal trauma who have no recollection of any past major facial trauma. I also see many patients with facial trauma and evidence of fractures who don’t have any trouble breathing or notice any deformity. There have been some reports of nasal deformity in newborns that are thought to be due to pressure on the face while the fetus is intrauterine, or from pressures exerted on the face during delivery – so it is possible to have a “traumatic” nose an not even know it. A dorsal hump can be caused by genetics or by trauma. If you have a hump that looks similar to others in your family this suggests a more genetic cause. Deviated or shifted nasal bones with stepoffs along with a fractured or deviated septum suggest a more traumatic cause. Again you may have a combination of both factors as well. If you are interested in changing the appearance and function of your nose I would suggest seeing a facial plastic surgeon who is experienced in rhinoplasty and can go over reasonable changes you can expect from surgery.

Hello Jamilaqeera and thank you for your question. Ethnic rhinoplasty, or rhinoplasty procedures performed on non-Caucasians, can be tricky because idealized nasal aesthetics have classically been based on the Caucasian nose. However, having a pinched or overdone look is definitely NOT inevitable with ethnic rhinoplasty! Standards of beauty are changing and it is important to pick a facial plastic surgeon who understands the anatomy of your nose and can assess whether the changes you want will realistically look balanced with the rest of your face. In our practice we utilize three-dimensional imaging to make sure we are aligned with our patient’s aesthetic goals during preoperative planning. I suggest you see an experienced facial plastic surgeon.