Thomas Funcik, MD

Let's approach your question several ways. First off. A short upper lip is a sign of youth. The recent surge in the popularity of the sub nasal lip lift is a testament to that fact. So having a short upper lip is not all bad!

Next. You are really cute, as is. Pretty smile, aesthetic proportions.

Third. You have a strong nose. Google the "anterior nasal spine." It is a tiny bony projection at the origin of your columella. It is a feature often overlooked in rhinoplasty. Usually it can be left alone. But sometimes it needs to be reduced to balance an overall reduction rhinoplasty. Also, google nasolabial angle. If I were analyzing your nose, I would reduce the small hump, and elevate the tip just a bit, including the area of the anterior nasal spine.

Hi. Your RealSelf name is "fantastic", and you look fantastic! Noses do not rally "grow" appreciably once we reach puberty. But they do change a bit over time. You have beautiful facial proportions. But your nose is on the large size and your chin is diminutive. And the skin on your nose is also rather thin. Nasal skin tends to thicken with age. I will venture a guess. My hunch is that as you have aged, the nasal tip (like everything due to gravity) has fallen ever so slightly. If your tip is already a little low, and you have a tiny hump, those changes can compound and make the overall nose less attractive. On top of that, it appears as though your tip has drifted ever so slightly to your left side. So when you were younger, your tip was more symmetrical and elevated. And since the rest of your face is so pretty, as your nose has drifted and drooped ever so slightly, the TINY imperfections in your nose are more bothersome. Don't worry, the nose ages slowly and there is no 911 situation here. I would recommend you go take your sweet time and go to a handful of rhinoplasty consultations with experienced surgeons who perform digital imaging of your nose slightly smaller and more straight. You can decide for yourself how much reduction and elevation you desire. And then make your decision. Choose carefully. Thin skinned, slightly deviated noses are challenging.

I have used Sculptra and all of the hyaluronics quite literally from their inception. I also do a great deal of fat grafting. The temples generally need a lot of volume. I very rarely treat temples HA's and almost always use either Sculptra or fat. I Other HA fillers cost a lot of money for a syringe that contains only 1cc. That is one fifth of a teaspoon. Temples almost always require more than 1cc for significant correction. There is no published study that can support my observation. However, I started and have continued using Sculptra since it was first approved in 2009. And I honestly believe and have told patients for decades that in MOST patients, a vial of Sculptra creates approximately 4-5 cc of volume. Plus, the collagen it produces lasts far longer than the two year FDA quote. And I have not had a patient challenge me on this expectation. It DOES take about nine months to fully proliferate, and response varies a little from patient to patient. Make SURE your injector is very experienced and is very well versed in terms of rare possible visual complications from intravascular injection.

It would really help to see a photo. 90cc is quite a large volume for one session of fat grafting. I have been doing fat grafting for about twenty years, full face, and never injected that much in one session. At three months you may still lose some of the fat, and you probably still have a little bit of swelling. Unfortunately fat grafting is very hard to reduce.

Maintaining a healthy body fat percentage is more important for your general health. The fat still "thinks" it is where it was harvested from. So if you are above your ideal body weight, some weight loss would help. If you are already thin, unfortunately gaining weight later in life could make it worse.

I would wait an entire year. Then, I would be extremely careful "caveat emptor" and only let an extremely experienced and ethical doc address your concerns. I know of no "magic bullet" such as Kybella or other fat reducing device that I would trust under these circumstances.

IF you posted pics you might get more expert input on RealSelf.

Sorry for your troubles.

Sorry you are having this problem. It is unfortunately not an uncommon problem. First a little background. Our bones are designed to heal after fracture. If you look at an X-ray of ANY bone on the body after a fracture is healed (whether it was left to heal on it's own, whether it was casted, or whether the fracture was plated and screwed), some "callus" forms. Think of it like this. Skin heals ONLY by forming a scar; bone is the same. The bone does not "understand" your Doc casted it. Over many years, we have developed a protocol to minimize such issues. It still does not prevent 100% of these from occurring. First off, I do most rhinos open. This provides better exposure to the bony dorsum as well as the area just below it where the skeleton transitions to cartilage, some of which is partly calcified in the transition zone. Then, after rasping, we let the bone recover from the force of rasping for a few minutes and go work on something else. Sometimes a small projection will hide itself for a few minutes and then re-appear. Before closing, we thoroughly irrigate the area to wash out ALL bone fragments. Then, my RN I each carefully palpate the nose skin with wet gloves to detect the slightest projection. Then I do a final inside inspection. Postoperatively, we wait about six weeks for the bone to partly heal. Then we do a careful exam for the slightest bump. If we find one, we have YOU do twice daily compression of the area. Kind of like wearing a retainer after braces. The bump is more pliable and compliant to massage early on before it is fully calcified. We do occasionally do steroid injections for soft tissue bumps, but it would be ineffective for bony bumps. And yes. One time I had a recurrence of a bump after rasping! My hope for you is the bump is much more palpable than visible. You profile is pretty. If you were to carefully palpate the bony dorsum of some friends and family you will probably realize they have a few bumps too, rhinoplasty or not.