Contemplating Rhinoplasty a Small Percentage of the Time... Worth it? Or Risky Business? (Photos)

Question

I actually love my nose (for the most part). I say that because 85% of the time and from most angles, I think my nose is cute. Where I contemplate rhinoplasty is the times when it looks more enlarged or when I think about aging and how your nose only gets bigger/wider in time. I'm uploading several pictures so it can be seen how different it looks at times (at least to me). I love my profile and in the photo where my nose looks more slender, is my favorite. I hesitate on going the surgery route, as I am mixed race, I tend to keloid, and hyperpigment (don't know if that's a factor). I've experienced some really ugly scars from other surgeries (hernia, c-section) that had to be treated separately later and I fear touching my face. Additionally, from my research a lot of surgeons that are not well versed in my skin type (or some that claim to be), their before and afters often showcase a very pinched tip or over slenderized nostrils and has become a homogenous look and I'm not looking for that (I recognize that may have been the goal of the individual). I just wonder if it's even worth it. A dermetologist/cosmetic physician did trial botox on my nose to see if that helped addess the slightly bulbous areas, if it relaxed my nose when I smiled to appear not as wide, but I saw no real benefit there and would not revisit. Open to thoughts? I wouldn't want major changes, because I do like my nose and feel it fits my face. Just slight adjustment.

Kadri Ila, MD · Answer

Your question reflects a very balanced perspective. You like your nose overall, and that is an important starting point. When a nose is already in harmony with the face, surgical decisions should be approached conservatively.
My recommendation would be a two step approach.
First, focus on skin quality. In thicker skin types, the tip and alar area can appear fuller than the underlying structure actually is. Medical skin care protocols, treatments aimed at improving dermal quality, and anti inflammatory nutritional support can sometimes refine how the nose presents without altering its structure. After a period of optimized skin care, reassessing how you feel about your nose is often very clarifying.
Second, if the main concern is width at the base rather than projection or profile, an alarplasty consultation may be appropriate. Alarplasty is a limited procedure that narrows the nostril base without altering the nasal tip framework. In selected patients, this targeted approach is sufficient and avoids unnecessary structural rhinoplasty.
It is important to understand that once a full rhinoplasty is performed, returning to your original nose is technically difficult, unpredictable and often costly. Revision surgery is always more complex than primary surgery. Given that your current nasal proportions are naturally balanced with your face, a major structural change should only be considered if there is a consistent and clearly defined concern.
A few additional considerations are relevant in your case. The variation you see in photographs is often influenced by lighting, facial expression, and lens distortion rather than true structural fluctuation. Regarding aging, nasal bones do not continue to grow; however, cartilage and soft tissue support can relax over time, leading to subtle changes in tip position or width. These changes are typically gradual rather than dramatic.
Your history of keloid tendency and hyperpigmentation is understandable to consider. In rhinoplasty, the external incision in open technique is placed on the columella, and true keloid formation in this area is uncommon. Facial skin generally heals more favorably than trunk skin. That said, individual healing patterns must always be respected.
The fact that botulinum toxin did not improve the appearance suggests that the concern is not primarily muscular widening during smiling, but rather structural or skin related characteristics.
Surgery should not be driven by the fear that the nose might enlarge with age. It should be undertaken when there is a clear, persistent dissatisfaction that outweighs the risks. In a nose you already appreciate most of the time, a cautious and staged approach is often the wiser path.
To give you a realistic sense of what small refinements versus larger structural changes can look like, I have included case examples in the video as well.
I hope this framework helps you reflect with clarity rather than urgency, and that any decision you make feels measured, informed, and fully aligned with your sense of self.

Eric M. Joseph, MD · Answer

Since you love your nose for the most part, rhinoplasty surgery may not be a great idea, since our happiest patients have been those people with severe dissatisfaction for a long, long time. Additionally, you appear to have a pleasing nasal appearance. I hope this helps. Sincerely, Dr Joseph

Stephen Prendiville, MD · Answer

Thank you for the question.  I agree that minor refinements would best suit the aesthetics of your nose and your face.  A surgical approach would be more of a finesse rhinoplasty than a major change.  The critical thing is choosing the right Surgeon. Modern rhinoplasty is more about improving your facial aesthetics as opposed to the stereotypical Instagram nose for everyone.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photographs, you may benefit from a rhinoplasty. A surgeon can accomplish this by trimming, suturing, and reshaping the cartilage in your lower nose. Fascial grafts may also be used to help improve tip refinement. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Ayhan Isik Erdal, MD, FACS, FEBOPRAS · Answer

Yes, your nose is already quite beautiful. We can say there's no hump. The main changes that can be achieved with rhinoplasty are increasing the definition of the tip, thinning the dorsum, and slightly lifting the nasal tip (increasing rotation). Scar tissue in the nose is usually minimal and without problems. However, if you don't want that, you can opt for closed rhinoplasty. Best wishes.

Darryl J. Blinski, MD · Answer

That is the question! Based on great posted photos and your detailed text I would error on side of just a tip rhinoplasty - ONLY! Fee $8,000. Best yo virtual consult

Contemplating Rhinoplasty a Small Percentage of the Time... Worth it? Or Risky Business? (Photos)

Answers (6)

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