Am I a good rhinoplasty candidate? I'm 19 years old. (Photos)

Question

Wanted a nose job for years and am finally looking to get one done next year. I would want my bulbous tip reduced, dorsal hump flattened, nostrils reduced and for its crooked lean to the right to be corrected. Is this all possible/realistic? I also have acne prone skin and have heard this affects healing. Please give advice on what changes you would recommend and what can actually be achieved, thank you! (Sorry for the awkward photos just wanted to show it at all angles)

Steven M. Denenberg, MD · Answer

You do have that bulbous tip. As is typical, the tip width is best seen in a three-quarters view, your number 5 of 6, where the wide tip looks like a second bump below the bridge bump.The woman in the short video that I posted with this answer had the tip of her narrowed in her rhinoplasty.And yes, the bump on the bridge can be lowered. But as I said, there are other features to your nose as well, and you must be certain that the surgeon recognizes them and has a way to correct them, because if they persist after surgery, you might like your nose less rather than more.Your nose is very strong in its forward projection from your face. The tip can be brought back closer to your face. We call that "de-projecting" the tip. 
Then, when a nose is de-projected, it tends to *look* longer, as if the tip had drooped. So it's crucial to elevate the tip. Your tip is a bit droopy anyway, so the tip elevation is doubly important. I'm not talking about making a Miss Piggy nose here, just keeping the proportions good.
Then, here's another important issue. Your bridge is strong up at the top of the nose -- in front of your eyes, or just below your eyebrows. When the nose is strong there, if the tip and bridge are de-projected (brought closer to the face), it's important to reduce the strength of the bridge up there at the top, or your profile would resemble the profile of a Roman statue, where the profile of the forehead slides right down onto the nose, without that little dip we like to see in front of the eyes. Search for Roman statue profile to see what I mean. Your surgeon must pay attention to that, too.Frontal asymmetries can be improved, though not completely corrected.
How *much* to elevate the tip, or deproject the nose, or lower the bridge, or narrow the tip, or make other changes? We figure that out with morphs, well before surgery. I'd love for you to see some excellent professionally-designed morphs of what could possibly be done with your nose. Morphs could also help you identify what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. Profile and three-quarter views would be particularly important in morphing your nose. (Side note: in my opinion, morphs should always be done by the surgeon, or he should direct an assistant as she makes the morphs. Morphs should be made with a constant eye to what actually *can* be done in surgery, for that particular nose, and only the surgeon has that information and judgment. Another aside: I also recommend that you not show morphs made by one surgeon to a different surgeon. If a surgeon makes his *own* morphs, you get to see whether he understands the important issues of your nose, and how your nose should be changed. But if you show the surgeon someone else's morphs, and he says "Of course I can make your nose look like that," then you don't really know if he fully understands, or even recognizes, the important changes shown in those morphs. And you don't know if he can make those changes during surgery.)
Remember that rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The changes that your nose needs require advanced techniques, and skill that most plastic surgeons don't possess with expertise. For most noses, it's much better to not have surgery than to have inexpertly-performed surgery. Read my essay on how to stay out of trouble while selecting a rhinoplasty surgeon. And it also discusses how to take photos that are best for online evaluations.
Your nose is also a perfect example of why computer imaging by the operating surgeon is mandatory in rhinoplasty. You need to know exactly what the surgeon is planning to accomplish -- what features he thinks he can change, and by how much he thinks he can change them. I always email morphs to my online rhinoplasty consultations. When you see the surgeon's goals in the morphs, you'll know whether he has an eye for an attractive nose, and whether he shares your opinion of what constitutes an attractive nose. You'll also know whether the changes he proposes are large enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. How would you ever get that figured out without the morphs?

Lucian Ion, FRCS · Answer

Thank you for your question and sharing your photographs.

The description of your goals seems sensible and realistic and it is mostly a matter of how much change you wish to achieve along these lines that would retain the realistic element. This can be evaluated in a computer simulation.

When the nasal skin is oily and prone to acne, there are some topical treatments that can be used before and after the surgery to reduce the oiliness.

Behrad Elmiyeh, MBBS, MRCS, FRCS (ORL HNS) · Answer

You are a good candidate for rhinoplasty to reduce your nasal dorsal hump, refinement of your bulbous nasal tip. Nasal septum is an important midline structure of a nose and is most likely deviated this needs to be addressed by a septoplasty to correct the deviation of your septum and nose (see link for further information). Make sure to seek out the care of a surgeon with extensive experience in rhinoplasty. The use of manipulated (morphed) digital clinical photography provides a platform for discussion as to your desires and expectations. Such images are not a guarantee of exact results, but a great tool to ensure that you and your surgeon are on the same wavelength.It is paramount that you have a realistic expectation before proceeding with this surgery. Best wishes,

Ali Mosharrafa, MD · Answer

I do believe your goals are realistic regarding rhinoplasty surgery.  It is important that you choose a qualified surgeon and have clear communication with that individual to give you the best chance for success.
Hope this helps.
Dr. Ali Mosharrafa

Sang Hoon Park, PhD, MD · Answer

Yes, those are all possible. For the deviation, it looks like an osteotomy would be needed based on the photos. An osteotomy is a procedure to break the bridge bone to correct the crookedness of the bone. The hump can be shaved down for a straighter nose line, but you should understand that it is hard to make the bone completely smooth. The bulbous tip can be enhanced by tying the cartilages together, which will make your nose tip taller and slimmer. This would also make your nostrils seem smaller. I would not recommend alar base reduction if that is what you meant by smaller nostrils because your nose is not a candidate for it. 
Overall, I think that you would benefit a lot from a rhinoplasty.

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