Am I Being Realistic with Rhinoplasty Expectations, Can This Be Done

Without additional photos, it is hard to say whether or not you are being realistic with your rhinoplasty expectations. For instance, candidacy for alar base reduction is best made on the front and base view of the nose. Your lateral view here does not provide me with sufficient information to render an opinion on this particular maneuver. With regard to your tip region, it appears to droop down slightly, which may be giving you the impression that it is pointing downward. This is typically corrected by rotating the nasal tip up slightly. Without seeing the rest of your face, it is also somewhat difficult to say whether or not the nose should be deprojected, or brought closer to your face, at the same time. If you happen to have real thick nasal skin, you cannot have your tip deprojected to any significant degree. The risk in doing so with patients who have thicker than average skin is that the skin will not ultimately shrink wrap down enough to provide the desired definition. In some cases, the tip will become less defined and simply look amorphous. With thicker than average skin, your rhinoplasty surgeon may indeed need to graft the tip cartilage (build it up as you say) so that it looks more defined. If this is necessary, you will likely not be able to deproject the tip at the same time. This is why consideration of your nasal skin is so important when it comes to rhinoplasty planning. Good luck with your decision. Dr. Hilinski. 

As every reviewing plastic surgeon has already noted, it is impossible to really give you any meaningful information on the basis of one photo alone.  I really do not think that this is the right forum for you to determine what should be done with your nose. The nose has to be evaluated in context with the entire face.  Furthermore, the interior of the  nose has to be evaluated, the skin has to be evaluated, the nasal tip etc........I think you are getting the picture.  I would strongly suggest that you see another board certified plastic surgeon or facial plastic surgeon to evaluate your nose.  It is very important that the two of you are on the same page BEFORE surgery.  Good luck.  Dr. D Brown.

I see you nose as under rotated not overprojected. As far as the alar base reduction, you need to supply a/p photos to evaluate

Clinical Examination is crucial to your expectations. The overlying skin, particularly at the tip and alar bases will have a significant impact on your results, and therefore your expectations. I would suggest that you be evaluated by more than one surgeon, and establish a comfort level with your surgeon, and also confirm what may or not be a realistic outcome.

Without a full set of pictures, it is impossible to determine whether or not your expectations realistic. Your tip can be rotated and projection decreased while lowering the dorsal profile. I cannot comment on the feasibility of alar base narrowing without a frontal and base view. Having said that, it is impossible to know if your expectations are realistic without meeting you and examining your nose.