Which nose procedure is recommended? (photos)

I have wanting a nose job and my down turned mouth fixed since my teen years. I have a deviated septum on the right side, which I believe is what is making my nose look crooked. My main concern is the tip of the nose looking too fat and my mouth looking like I'm mad. i used to call them The Golden Arches (McDonald's). What would be the recommended procedure for these 2?

Doctor Answers 12


Even though a patient will often have only one main issue of concern regarding his/her nose, there are commonly a number of other issues that can be addressed at the time of surgery, such as septal repair, reducing a large bridge, etc. After a good consultation with an experienced nasal surgeon most patients will have a good idea of what is possible. As for the lips, there are a number of possible treatments that may help to some degree. Neuro modulators, such as Botox can weaken the muscles that can pull the corner of the mouth down, fillers can support the lips and de-emphasize the down turned lips and even procedures that directly excise skin can be utilized in select cases.  Best of luck   Dr Harrell

Miami Plastic Surgeon
4.9 out of 5 stars 49 reviews


Thank you for your pictures! Great question, and very common at that.  It is best if I tackle this answer in two parts.  In regards to your nose, a septorhinoplasty would help fix the deviated septum, improve your breathing, all while helping define your tip and give you a more elegant nose that fits your face.  Remember, the most important part of a rhinoplasty is ensuring that your nose fits who you are - the last thing you want is to go through surgery, look in the mirror and not recognize the person you see reflected as things were "overdone".  Your PS can go over this in more detail during your consultation - as examination will give a better idea of your tissue, the cartilage structure, etc.  In regards to the down turns of the mouth, you have a couple of different options.  I always suggest starting with something simple - things like either a filler or botox/dysport.  Depending on the thickness of the tissue, amount of deficiency, how your mouth moves, where the light points are, etc you could benefit from different types of fillers. Again, this is best gone over during a consultation.  In regards to the botox/dysport, it relaxes the corners of the mouth such that there isn't that down pull (or macdonalds M's as you called it).  Best of luck! I hope this helps. 

Miguel Mascaro, MD
Delray Beach Facial Plastic Surgeon
5.0 out of 5 stars 8 reviews

Rhinoplasty and septoplasty procedures

A septoplasty is performed in the back of the nose to improve airflow dynamics when there's blockage present. Medical necessity must be documented at the time of the examination and consultation in order to bill medical insurance for that component. A septoplasty will not change the shape of the nose. The rhinoplasty is performed to shave down the dorsal hump, decrease the projection of the nose, and reduce the hanging columella. Both procedures can be performed simultaneously, however expect to pay for the cosmetic component yourself. For more information and diagrams explaining the differences between the two procedures and many before-and-after rhinoplasty results, please see the link and the video below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

Rhinoplasty, advices:

Thank you very much for sharing your concerns with us.

The harmony between facial parts makes us instinctively recognize the beauty... without knowing it, without defining it, just a perception that surprises and captivates us. In this regard, I suggest perform a Closed Rhinoplasty (without visible scars) to treat the tip, base and nasal bridge.
With this procedure you get a delicate nose, better harmonize with your other facial features. Respectfully,
Dr. Emmanuel Mallol Cotes.-

Emmanuel Mallol Cotes, MD
Dominican Republic Plastic Surgeon
4.7 out of 5 stars 255 reviews

2 distinct issues

Hello. These are two separate issues. A tip plasty will certainly improve the appearance of your nasal tip, giving you more symmetry. In order to lift the corners of the mouth, you could look into neuromodulators, fillers, or even a face lift. 

Marcelo Ghersi, MD
Miami Plastic Surgeon
5.0 out of 5 stars 149 reviews

Nose and face

You would have to be evaluated in person for both. The nose obviously could benefit from rhinoplasty.  AS for the mouth, sometimes fillers help, or a lift.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 reviews


Hello and thank you for your question. Based on your photograph, you may benefit from a tip refining rhinoplasty. Your surgeon can accomplish this by trimming, suturing, and reshaping the cartilage in your lower nose. Cartilage grafts may also be used to help improve tip refinement. You may also benefit from a septoplasty and spreader grafts to straighten your nasal tip.  I recommend fillers to help with the corners of your lips and mouth.  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. The most important aspect is to find a surgeon you are comfortable with. 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

Richard G. Reish, MD
New York Plastic Surgeon
5.0 out of 5 stars 124 reviews


thank you for your question. As an artist I like using the reshaping technique when performing Rhinoplasties. Using advanced suturing techniques I can change the nasal cartilages giving you a thinner, more refined natural looking nose. I like to find out from the patient what they don't like about their nose and what their goals are. I then examine the nose and write up a detailed operative plan. I incorporate the FINNESSE technique which I invented. Bleeding, bruising and post operative pain is minimal when compared to traditional techniques and recovery is quicker. I don't routinely pack the nose. It's not uncommon that some patients have no bruising after surgery. I hope you find this information useful.

Joshua Halpern, MD, PA
Tampa Plastic Surgeon
4.8 out of 5 stars 61 reviews

Which nose procedure is recommended?

The best procedure for your nose is a Rhinoplasty and a Septal straightening that creates for you your most elegant looking nose. These details are best discussed in person with your highly experienced and qualified Board Certified PS. It can be done from the inside of the nose utilizing the closed technique. In the right hands - this will give you the best looking nose. As far as your mouth goes- a full facelift/neck lift can address these issues- but physical exam is essential

Thomas Trevisani, Sr., MD
Orlando Plastic Surgeon
4.9 out of 5 stars 63 reviews


You do have slight asymmetry of the nasal tip as well as bulbosity of the tip.  A procedure to modestly reduce your dorsal hump, reduce the size of your domal cartilages for a finer tip, straighten your septal cartilage, and correct slight alar retraction would be indicated.  For your lips, the use of fillers in the oral commissure will help reduce the lines.  Fat grafting to this area is another option.  Best wishes, Dr. T. 

John Michael Thomassen, MD
Fort Lauderdale Plastic Surgeon
4.9 out of 5 stars 49 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.