Your pictures demonstrate a left caudal septal deviation, this is causing a significant obstruction to the left side. Whether or not there is another issue as described by your family doctor, that would require an examination in the office. Keep in mind that there may be some internal structures hat may be factors in your nasal breathing.
For your appearance, we recommend a discussion complemented by computer imaging so that surgeon and patient can agree on a shared surgical goal. We require this of all cosmetic rhinoplasty patients. On that basis we can discuss the nature of any planned surgery in detail.
For your breathing issues we recommend evaluation by a specialist in functional issues. In some cases the rhinoplasty specialist will seek the help of an ENT colleague who specializes in "inside the nose" issues. In other cases, a cosmetic rhinoplasty surgeon will be "double board certified" in Facial Plastic Surgery and also ENT and will be able to evaluate and treat the inside and outside of your nose. I am one such surgeon, and of course there are a substantial number of surgeons like me.
In any case, I hope that answers your questions. Good luck!
Your Nose Is Not Collapsed Inside
Your family doctor is mistaken. In your photo, you
clearly have a deviation of your septum at the anterior extent, which is why
your nostril looks so different on the left side. It also explains why the
airway collapses when you breath in strongly: The opening is so narrowed by the
deviated septum. A septoplasty should help you a great deal, but it is also
important to evaluate you for other causes of nasal obstruction, such as
enlarged turbinates or internal valve collapse.
You have, aesthetically speaking, an easy nose to
improve. The overall shape is nice. You
would benefit from removal of the dorsal hump, some subtle refinement of the
tip cartilages (which look a little boxy) and an elevated nasal tip. I would
suggest that you ask to see before-and-after pictures when you are consulting
with your surgeon, to help you get an idea of what you can achieve. Imaging can be useful, but be careful. Just
because the surgeon can show you a nice image does not mean they can reliably
achieve that result, which is why before-and-after pictures are very helpful
for demonstrating a surgeon's actual skills.
Fix the inside and outside together...
You appear to be a great candidate to have the nose refined at the same time as having your septum corrected. Your nose would look nice with the bump removed and the tip refined. Be sure to see a rhinoplasty specialist for consultation and you could have computer imaging at the same time to determine what shape you would like best. After the surgery, you should both breathe and look better.
What type of Rhinoplasty ?
Hi and thanks for your question and photos. I completely disagree with your family doctor. Clearly, you have a deviation of your septum to the left inferiorly as can be seen in the base view of your nose. You would benefit from an open septorhinoplasty to take care of the bump and the depressed right upper lateral cartilage and bulbous tip and the obvious deviated septum. I would be happy to show you with computer imaging what I would do. Whoever you go to for this, you should make sure that they are experienced with this type of surgery as deviated noses are on the difficult side. Good luck.
To make the nose more feminine, lower the bump and raise the tip.
See the "Web reference" link, just below my response. I made a computer morph of your nose, and an animation of the morph, to show the changes that are possible for your nose in truly expert hands.
I elevated the tip, and lowered the bump, and then brought the entire nose back a little closer to your face, so overall it's less prominent. Breathing issues, on the inside, can be addressed at the same time as working on the appearance of the nose. Often, too, elevating the tip of the nose helps with the breathing all by itself.
You should understand that the changes I demonstrated in the morph require advanced techniques, techniques that most plastic surgeons cannot handle. Be sure to read the section in the "Web reference" link on how to stay out of trouble while searching for a rhinoplasty surgeon.
Your nose is also a good example of why computer imaging is mandatory in rhinoplasty. You need to know exactly what the surgeon is planning to accomplish -- what features he'll change, and by how much he'll change them -- so you know whether it's enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. Then, he must show you before and after photos to prove that he can actually accomplish what he draws on the computer.
Cosmetic rhinoplasty and functional nasal surgery for breathing
There are many issues on the inside of the nose that can cause blockage of airflow which include a deviated nasal septum, turbinate hypertrophy, valve collapse, vestibular stenosis, allergies, and chronic sinusitis. Each one of these issues are treated differently with medications or surgery. It's also important to try and fail medical management first ,before undergoing surgical improvement of airflow. Functional surgery is billed to the patient's medical insurance and is completely separate than cosmetic nasal surgery. A rhinoplasty procedure is performed for cosmetic purposes to change the shape of the nose, and has nothing to do with breathing. Both a rhinoplasty and functional nasal surgery can be performed at same time under the same anesthetic with the same recovery period. Patients must pay for the cosmetic component themselves, although functional component can be billed to the patient's medical insurance, once medical necessity has been documented. For more information and many examples of rhinoplasty, please see the video and the link below
Rhinoplasty to Correct Breathing Problems and Improve Appearance
Your base picture does show that you have septal deviation. The frontal view with a slight hour glass shape suggests that you have internal valve collapse. Both of these problems, which can be corrected with a septorhinoplasty, will obstruct nasal breathing. I suggest you consider removal of a small hump, correct the asymmetry of your nasal bones, and narrow and refine your asymmetrical tip. It may be the position of your head in the profile view but it appears that you have a weak chin which can be improved with an implant. ou can achieve a natural result and feminize your nose which will be proportional to our surrounding facial features.
A conservative rhinoplasty can help improve you concerns. Your septum also looks deviated as well. Best to be seen in person.
Hello and thank you for your question. Based on your
photograph, you may benefit from a conservative dorsal hump reduction. Spreader grafts can be performed to help your breathing. The most important aspect is
to find a surgeon you are comfortable with. With good surgical technique, you
could have an outstanding result. I recommend that you seek consultation with a
qualified board-certified plastic surgeon who can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon