Reversing some maneuvers? Is it possible to make my nose less projected? (Photo)

Question

Hi, I really wanted to bring back my profile look. My doctor was from Brazil and said he used Dr. Davis techniques. He used my septum cartilage to project the nose (strut). He also added some diced cartilage to build up the bridge. I would love to have a less projected, a little thicker and rounded nose. Is that possible?

Steven M. Denenberg, MD · Answer

I agree with you: I don't like how the surgeon increased the projection of your nose. It's too prominent.Also, though, the tip is hanging low, and could be elevated. The woman in the short video that I posted with this answer had the tip of her nose elevated in her revision operation.The good news is that usually, de-projecting and elevating a tip are two of the more predictable changes to make in a rhinoplasty, even a revision.How much to de-project and elevate the tip? 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. 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.)
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, requiring 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 for those who have had previous surgery, it also discusses how to tell whether your first surgeon should be performing your revision.
Your nose is also a perfect example of why computer imaging 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?

Michael Elam, MD (retired) · Answer

Dear Viviooo, Your tip is over projected and slightly rotated and can be corrected with revision rhinoplasty surgery. Seek some consultations with experts in the field and discuss your concerns with your current result and have imaging performed to show you the changes that would be proposed to ensure you and your surgeon are on the same page. If you can request a copy of your operative report from your surgeon in Brazil then this would be advantageous to have on hand while seeking secondary opinions. Best regards, Michael V. Elam, M.D.

Reversing some maneuvers? Is it possible to make my nose less projected? (Photo)

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