Are my goals to fix my radix, nostrils, nose tip and philtrum achievable?

Question

The first pic is unedited and the second is how I would like to look. I have a high radix and I don’t have that little dip where my nose meets my forehead like most girls do, I would like that fixed. My nose sticks out too far from the side, from the front it’s very thin and my tip is pinched looking, and my nostrils are too high. I also want the area under my nose (philtrum?) to stick out more. I also made my eyes less surprised looking and jaw a bit shorter. Are these changes attainable?

Steven M. Denenberg, MD · Answer

Actually, the images that you posted on Aug 22, 2019 show your nose even much better. They show a nose that is strong in its forward projection away from your face, and bringing the tip back closer to the face would be important as part of a rhinoplasty.Then, when a tip comes closer to the face, it usually makes the nose *look* as though the tip drooped, so it's often important to elevate the tip a bit as well.And then, as you mention, attention to the radix, which is important whenever the projection is being lessened.
How *much* to deproject or elevate the tip, or lower a bump on the bridge of the nose? 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. Well-posed 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 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?And by the way, you do *not* have a microcephalic-type appearance to your forehead! You have absolutely gorgeous features. Forehead strength, jawline, chin, lips, cheekbones, eyebrow position, eyelids. My two cents.

Andrew Miller, MD · Answer

From the photos, you certainly don't have a bad nose to begin with. However, many patients undergo rhinoplasty to simply make small changes. The changes you request seem reasonable and should be attainable. Be sure to see a rhinoplasty surgeon with a lot of experience that can do computer imaging for you at the same time.

Thomas Romo, III, MD · Answer

You use a lot of specific terminology used by rhinoplasty surgeons. Hopefully that was obtained from several great rhinoplasty consults and not from looking it up on Google. Goals to accomplish during a  rhinoplasty are established during the consultation with your rhinoplasty surgeon. The actual physical exam of your nose is key in developing these goals that why ultimately you need a physical versus virtual rhinoplasty consult.

Thomas Trevisani, MD · Answer

In order to evaluate accurately especially when it comes to Revision Rhinoplasty - in person exam is essential, as well as review of pre-op+post-op photos - all views , and reading the op-report. The photos you posted are not adequate to render evaluation . I suggest that you seek an experienced Board Certified PS for in person exam

Zoran Potparic, MD · Answer

Unfortunately, it is not possible to give you a meaningful answer based on these photos. There are no details that you are addressing visible in these photos? Considering that you may need multiple aspects of nose addressed, it would be in your best interest to seek in person consultation with an reputable board certified plastic surgeon, expert in rhinoplasty. That will give you opportunity to discuss all the issues and, if available in surgeon's office, have a 3D simulation of projected result. Good luck.

Ronald J. Edelson, MD · Answer

Your nose could benefit from lowering the bridge and raising the tip. Deepening the radix is also possible but only to a slight degree. There are no other issues I see that need to be addressed on your face. It’s beautiful, no need to mess with it.

Daniel Barrett, MD · Answer

Dear Dani966,
based on your photos, it looks like you would benefit from a rhinoplasty and your desired results look realistic. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photograph, you may benefit from a tip refining rhinoplasty, a cephalic rotation of your tip to turn up your tip slightly and a conservative radix reduction. Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and not just a computer animation system. You should be able to view numerous pictures of actual patients with noses similar to yours performed by your surgeon. If you cannot find enough real before and after pictures, then consider continuing your search for a surgeon. Best wishes and good luck.

Richard G. Reish, M.D. FACS

Harvard-trained plastic surgeon

Richard G. Reish, M.D. FACS

Harvard-trained plastic surgeon

Burak Alhan, MD · Answer

Hello, 
First of all a full set of the pictures of your face is required for a better evaluation,as all the comments here would be really limited to your one picture from only one angle. However, I can see that your complains are mostly about the projection of the tip and high radix. I totally disagree with the idea of cartilage removal from your lower lateral cartilages which will end up as  nazal valve collapse in the end. The better option would be redefining the tip according to the what we call the tip polygon system,so the pinched tip would be corrected,just by  repositioning the cephalic malpositioned lower lateral cartilages. A very controlled uprotation may be applied depending on the way the tip looks after deprojecting the tip to a very limited degree.You should keep in mind that you don't have an ugly nose,and the better preserved nose of yours with slight changes will prevent unwanted results.Deprojection to a certain degree is possible without the tip hanging more if you know how to deproject it with additional certain maneuvers. A detailed examination with a surgeon specialised on nose and the lastest tecniques would give you the answers of ''what is possible without comprising the breathing and natural look?''. Because you are a patient who can lose a lot in wrong hands since you already have a beautiful nose.

William Portuese, MD · Answer

Much more information is required such as a full set of facial photographs from all angles to make a determination about how best to proceed. The nose is a three-dimensional structure, and rhinoplasty is performed in all three dimensions. A closed rhinoplasty approach can accomplish shaving down the dorsal hump into the radix, decreasing the overall projection of the nose and placement of spreader grafts to widen the frontal appearance of the midportion of the nose. All of the incisions are placed on the inside of the nose. No external incisions are required. Digital computer imaging of your entire nose from different angles would be helpful in the communication process to understand what can and cannot be accomplished with the procedure.

Are my goals to fix my radix, nostrils, nose tip and philtrum achievable?

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