Thomas J. Walker, MD, FACS

Turbinate reduction has no impact on nasal appearance and is not necessary as part of a rhinoplasty. The two procedures are completely independent of each other. It solely has functional implications and improves nasal breathing. Although empty nose syndrome is a possible but very rare complication, a conservative and properly done submucous reduction of the inferior turbinates excludes this complication. Good luck with your rhinoplasty and best wishes, Thomas Walker, MD, FACS

It seems that a rhinoplasty might be a great option to help refine your nose. I generally do not recommend an isolated tip procedure as the proportions and balance within the nose and face matter. Altering one aspect affects others, i.e. if nasal tip work is done, the bridge typically needs to be adjusted as well. Please see a rhinoplasty expert for a consultation. Best, Thomas Walker, MD, FACS

Given your retracted columella (portion between your nostrils) requiring quite some nasal tip work, I believe you would benefit most from an external/open approach with a caudal septal extension graft to establish a more favorable alar-columella relationship. Best, Thomas Walker, MD, FACS

Not sure what the hesitation and concern is about cartilage grafting but I essentially never recommend a rhinoplasty without cartilage grafting, both from an aesthetic and functional perspective. You may be breathing well through your nose now but rhinoplasty without grafting possibly or likely will make your nasal breathing worse. The focus should be on your aesthetic goals, not the technique. Best wishes, Thomas Walker, MD, FACS

A structural rhinoplasty with grafting by an experienced rhinoplasty expert should be able to accomplish your goals. Select your surgeon based on their work and judge them by their previous results more than what they tell you during your consultation or what they show you on computer imaging. Although computer imaging is a helpful communication tool, it’s not reflective of surgeon skill. What you ask for should be relatively standard for a surgeon who performs structural rhinoplasty with cartilage grafting. Best wishes, Thomas Walker, MD, FACS

No. That can’t happen. You should see your dentist or orthodontist for an evaluation. Best wishes, Thomas Walker, MD, FACS

You already analyzed things correctly meaning your middle and upper section of the mode are quite narrow exacerbating the wide and bulbous appearance of your tip. Therefore, a tip-plasty without addressing the upper portions would be an incomplete surgery and not recommended. An external rhinoplasty with cartilage grafting would be the surgery to address these things assuming you are otherwise healthy and a hire candidate. You seem to have quite thick nasal skin and need to be patient for final results to show (1-3 years) and realize it had some limitations although more refinement can definitely be achieved by an experienced rhinoplasty surgeon. Best, Thomas Walker, MD, FACS

Thanks for your questions. There is no treatment to get completely rid off those lines but you can improve them through the injections of hyperdilute Radiesse or Renuva for instance. Typically requires up to 3 treatments but leads to a nice improvement. Remember that looking down at the phone as we all do in the 21st century doesn’t help the cause. Best, Thomas Walker, MD, FACS

Thanks for your question. Having some tooth show at rest is actually completely normal and attractive. In fact, as we age, the upper lip elongates and the teeth no longer show, which we perform a surgery called an “upper lip lift” to create what you naturally already have. Therefore, I recommend against a surgery in your case as it’s normal and desirable for your lips not to touch at rest. Best, Thomas Walker, MD, FACS

The question is why do you want a closed/endonasal rhinoplasty? The only advantage of a closed approach is the avoidance of a tiny incision between the nostrils that heals so well that it essentially becomes invisible once healed (plus nobody looks at the bottom of the nose). The tradeoff is that closed rhinoplasties are very limited when it comes to the nasal tip due to limited exposure and the inability to make certain changes. Most endonasal rhinoplasties leave patients with a “pollybeak deformity”, which is a lot more noticeable than a tiny invisible scar in an invisible location. Although external rhinoplasties may take an extra 1-2 hours in surgery and may have an extra 2 weeks of nasal swelling, those factors should not matter when looking at the benefits with not having a lifelong suboptimal nasal tip or pollybeak. For your nose as it requires nasal tip work, I would recommend an external approach. Endonasal rhinoplasties are best for patients who only need nasal bridge work and nothing at their tip, which is not the case in your scenario. Hope that helps. Best, Thomas Walker, MD, FACS