Procedures to Make Nose Symmetrical and Proportionate to the Face?

As you can see my nostrils are very big, and my tip is very bulbous, and although you may not see it, my nose is a little crooked (pictures reverse). Also, you can see that my nose overprojects far from my face due to the bulbous tip.

What procedures would you suggest? I know alar base reduction would be one of them. My nose is already pointy though, so I don't know how one can make it less bulbous from the front view. Please help.

Doctor Answers 8

Different Noses for Different Faces

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The problems that you point out with your nose are all very valid concerns.

With regards to your face, it has a rounder shape, which balances well with a slightly wider and shorter nose. If you have a long and thin face, then more work would be required to narrow and lengthen the nose in order to acheive balance.

Specific surgical interventions are hard to recommend without an examination. However, from the photography, there are some suggestions I can make for you.

The nose is a little short and the tip is a little too high. There is volume excess in the lateral or side cartilages of the tip, which should be reduced and a tip-plasty would benefit the frontal view. The nostril position is a little wide, so an alar base reduction would add to your result. The bridge of the nose is not too high, so that can be left alone or even built up a bit to produce the illusion of narrowing from the front.

Most importantly, I think your tip needs to be de-rotated, which is a difficult maneuver. One intervention that would be of significant benefit to you would be a graft called an extended columellar-tip graft. This will help to narrow the tip and also lengthen the nose so that the columella (the skin between the nostrils) lies slightly below the nostrils. This creates a much more pleasing look on profile and also helps to narrow the overall nasal appearance by making it a little longer.

Best of luck.

Manhattan Facial Plastic Surgeon
4.9 out of 5 stars 55 reviews

Closed rhinoplasty to feminize and refine bulbous tip

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Symmetry is the most important part of a rhinoplasty procedure. A closed approach can be used with a dome suturing technique to feminize and refine the tip cartilages. A portion of the cartilage is also removed from the tip. Osteotomies are performed to narrow the nasal bones. Alar plasty is used to reduce the alar flare and width of the nostrils.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 reviews

Bulbous tip of nose

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I would agree that the tip of your nose is a bit full and that it could be reduced. This can be done by reducing the cartilage beneath the nose and defatting the tip if your skin is thick enough. Your projection does not seem too bad to me on the photos above, but the tip is rotated up a bit and this would look better if it were brought down. Reduction of the alar base can be done, but this would give a small change to the overall appearance of the nose. I would suggest that you see a plastic surgeon in your area who can show you pictures of the changes that he or she recommends in order to make this clear to you, as rhinoplasty jargon can be confusing. Good luck, /nsn.

Bulbous Tip

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As you say the most striking feature is the bulbous tip. With thick skin it is best to change cartilage contour rather than do cartilage reduction. Alar reduction would also be beneficial. I cannot be sure looking at these pictures, but slight  profile reduction with decreased projection should be considered.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

The tip needs reduction

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In looking at your photos, it is obvious that the bulbous tip is the main problem and needs to be addressed. Your skin looks thick and ,with thick skin, tip refining is a more difficult addition, the tip is slightly elongated ,so you would need sculpting of the cartilage, narrowing of the tip using sutures to reshape the cartilage, possibly removing some of the fat between the cartilage and the skin, and shortening the septal cartilage. I don't think that the nostrils are too large, but the base of your nose is wide ,and this could be narrowed by removing tissue between the nostrils at the base of the strut (collumela) which runs from the base of the nose to the tip of the nose

Joseph M. Perlman, MD
Houston Plastic Surgeon
4.3 out of 5 stars 27 reviews

Bulbous Overprojected Tip

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Your bulbous tip is primarily due to thick skin and large lower tip cartilages. To refine this, the tip skin must be defatted and the tip cartilage reconstructed. I don't think that a nostril narrowing procedure will give you what you want. I believe that if you have a good tip - plasty, your nostrils won't appear as wide.
Hope this helps,
Dr. S.

Oleh Slupchynskyj, MD, FACS
New York Facial Plastic Surgeon
4.8 out of 5 stars 285 reviews

Small incision on the narrow divider between the left and right side of the nose-known as “collumela”

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The nose - in the center of the face - is very much the focal point of facial symmetry. Because of this, any assymmetries or irregularities of the nose are often the most obvious in the face. Correcting a crooked nose or bulbous tip are very common reasons for rhinoplasty surgery. Most often, with complicated tip surgery, I will use a small incision on the narrow divider between the left and right side of the nose-known as “collumela”. This is known as an “open” rhinoplasty. Through this approach, the crooked or bulbous cartilage can be seen very clearly and adjusted precisely to address your concerns. The small scar in this location heals beautifully and is very difficult to even find, once it has healed.

Michael R. Macdonald, MD
Bay Area Facial Plastic Surgeon
4.6 out of 5 stars 18 reviews

Bulbous Nose

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Yes the tip of your nose is bulbous and there is a broad alar base. However, I would not get caught up in all the technical jargon of what needs to be done. This is the job of the plastic surgeon. Safe to say, that looking at your picture refinements could be done on your nose to put it into better proportion.

What can't be determined from the picture is how thick the skin of your nose is. Nasal skin thickness is the greatest limiting factor when performing a rhinoplasty. This would have to be determined at the time of a consult. Find a qualified plastic surgeon and chances are you will be very happy.

Mark A. Jabor, MD
El Paso Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.