Primary rhinoplasty - can I accomplish everything and do I need grafting? (Photo)

Based on your photos, you are a great candidate for rhinoplasty. All of the things you mentioned can be done to create a smaller, better defined nose. Usually some cartilage grafting from your septum is done to support the nose, better define it, and keep from pinching. Be sure to see a rhinoplasty expert for consultation.

Thank you for your question and photos. The changes you mentioned can be successfully achieved during rhinoplasty. Your nose can be straightened, the tip redefined and deprojected, and the dorsal hump reduced. Grafts may be necessary to provide adequate structural support if you have thin nasal skin, to straighten the nose, or to lift the nasal tip.

Keep in mind that rhinoplasty is one of the most complex of all plastic surgery procedures, requiring experience, skill, and even artistry to achieve an optimal outcome. I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon, with expertise in rhinoplasty techniques. They will be able to conduct a thorough exam to determine what steps are necessary to help you achieve your aesthetic goals.

Based on your photos, you appear to have somewhat of a crooked nasal appearance with a bulbous droopy tip a dorsal hump and nostril asymmetry. Since you have thin nasal skin, the expertise of your surgeon is very important. Insofar as grafting goes, we place a columella strut graft in nearly everybody to add additional tip support. Other reason for cartilage grafting may be to improve your nasal Airway. Many times, when we're downsizing someone's nose, very few cartilage grafts are required

Once you find a specialist that produces results that you like, consider scheduling several consultations, with computer Imaging, so you could see what might be best for you moving forward. Hope this helps! Dr Joseph

Thank you for your question and sharing your photographs.

Your nasal tip skin appears to be intermediate thickness or thin which is favourable to the combination of reducing the size of the nose and achieving definition.

The main typical conflict is between the degree of de-projection for the nasal tip and the ability to create a defined and chiselled appearance of the nasal tip on the front view. This is due to the relative skin excess generated by the reduction in the support framework compared to the original and the fact that the skin is not trimmed down for a tight fit.

A computer simulation can help to determine what you would like to achieve and how feasible it is.

Grafting for support to the nasal tip is common but this most of the time sourced from the nasal septum and in your case it seems very likely that this would be achievable.

Hello! Thank you for your question.I have evaluated your case regarding the information you provided and your photos.From the photos it looks like your nose is a bit deviated to the left, you have a bulbous droopy nose and the tip is long. From the photos it doesn't look like you need cartilage reconstruction. But of course this can be decided only during face to face consultation.By the way I also recommend you a lip lifting on the same time with rhinoplasty. Lip lifting is a surgical procedure, which aims to reduce the distance between the columella (base of the nose) and the vermilion border (red upper lip line). This distance tends to elongate with age, although it can be congenitally long even in young people. Lip lifting + Rhinoplasty would be a very good combination in your case. But of course if you want to proceed only for rhinoplasty surgery, the result would be good in both cases :)

Rhinoplasty surgery will help achieve the goals you are looking for. It is unlikely that you will need a rib graft. Cartilage graft can be taken from your nasal septum if needed. It is better to consult with a facial plastic surgeon who can examine your and discuss your goals from surgery

In my assessment, your nose would benefit from the changes you describe: lowering the bump on the bridge, bringing the tip and bridge back closer to your face, narrowing the tip and gaining more symmetry there, and a significant elevation of the tip. How *much* to elevate the tip, or deproject the nose, or make the other changes? 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 better just what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. Profile and three-quarter views would be particularly important in morphing your nose. (Side note: in my opinion, morphs should really 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 the surgeon has that information and judgment best.)
The main issue for your nose is 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 in particular 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. It also discusses how to take photos that are best for online evaluations.

Whether you are recommended cartilage grafting depends on who you go to. Some surgeons seem to always use cartilage grafts whereas some, like myself, rarely if ever use them. I would do a closed rhinoplasty in your case with no graft. Grafts are overused in my opinion and often serve no purpose

Thank you for your questions and for sharing your photographs.
You would require having a Septorhinoplasty (Septoplasty + Rhinoplasty). Septoplasty to correct your associated deviated nasal septum (the cartilage and bone in the nose that separates the nasal passages) and to harvest septal cartilage and use it as a graft to improve nasal support and aesthetic appearance of your nose.
I would suggest that you consult with a nasal surgeon (Rhinologist) with expertise in performing complex rhinoplasty and to discuss what you like or dislike about your nose.
Best wishes

You may accomplish what you described in one session and without cartilage grafts from other sources/places, as this will be your first rhinoplasty and you have a nose that needs reduction, not elongation or augmentation. The only reservation I have about your results is the deviation problem. If you have your deviation since your childhood it may have a risk of recurrence.