Is It Possible to Contour One Side of Nose Cartilage While Maintaining a 'Blended Look'? (photo)

    The closed obviously avoids the scar.  Removal of tip cartilage has less variability than the placement of a graft.  Sanding makes sense as does the cartilage graft.  If the scoop does not bother you, then no cartilage graft necessary.  The female nose tends to look more scooped out than a male nose, but that is, of course, your decision.

First, thank you for the photos. You mentioned several treatment options recommended by different surgeons but you didn't mention your specific concerns about your nose. It's more important to hear what you like and dislike about your nose. Do you have a clear idea of what you want your nose to look like? Make a wish list and then go to the surgeons and ask each one how they would address your surgical goals. The surgical plan should match what you are trying to accomplish. There may be more than one treatment plan that can help you achieve your goals and it's critical that you feel comfortable with both the surgeon and the plan.

Best Wishes

Spreader grafts are placed on the concaved side of the midthird of the nose when there is a differential in the profile.  If there is a severe convexity to one side, then shaving the high side down to match the concaved side will also be performed in addition to the spreader graft.  Spreader grafts are a patients own cartilage, harvested from the internal portion of the nose and placed along the bridge line to improve the profile and symmetry.  Repair of a deviated septum itself will not effect the outside portion of the nose and is simply performed only for improvement of airflow dynamics through the nose.  Both of these procedures can be performed through closed rhinoplasty techniques.

The most important issue is understanding what you don't like, and having a clear understanding of the 'goal'. Each surgeon will have their bias, though we sometimes find adding a cartilage graft to the side of the nasal bone very hard to blend. The skin is thin and with touch and glasses the laid on or added graft just might be a bother. We like the idea of the graft over the dip in the bridge (if that is the look you are drawn to) and fracture (with septum straightening) to reduce the deviation in the nose. Closed or open can both work.

Hi.

Just going by your pictures, I would vote with surgeon #1.  But, believe me, this is not the right way to decide what to do.

 Sadly, you will get different opinions that can vary widely as you seek advice during a Rhinplasty consultation.  The aesthetic judgement varies among Rhinoplasty Surgeons as does their level of training, experience and ways of doing the same thing.  You, as the consumer, are left to sort all of this out and make a decision which I understand is difficult at best.

 Aesthetically speaking, from the photos provided, the nose is a bit wide across the bridge with a slightly lowered "scooped" nasal dorsum.  The nasal tip is asymmetric with a fullness on the right that extends into the supra-tip region.  This may be excess cartilage and or subcutaneous tissue.  The tip is close to the maximum rotation at 110 degrees and IMHO, would be over-rotated using an Open Rhinoplasty technique.

 A Closed Rhinoplasty could thin and refine the nasal tip without filling in the left side (remember onlay grafts add volume so in this scenario, your tip would be wider, not smaller which does not seem aesthetically correct IMHO).  The bridge can be raised if you like and the sides, of the nasal bones rasped making them more narrow.  Hope this helps.

 

 

With all of the different suggestions for surgical approaches, I understand your frustration in deciding what to do and who to choose to perform your surgery. I am not going to give my opinion about how to make your nose look different, because I don't know what it is that you dislike about your nose. Make sure the surgeon you choose completely understands what it is about your nose that bothers you. Based on your concerns, you and that surgeon should be able to come up with a game plan to meet your expectations. Hope this helps! :)

Thanks for your question and photos. Best of Luck!