What surgery details may possibly be done to even and smooth my nose out? (Photos)

My nose is crooked, pointy, bumpy and I can't breathe out of the right side nostril. When I smile it points even further downward similar to the wicked witch of the west on the wizard of oz.

Doctor Answers 10

Rhinoplasty considerations

An in-person exam is critical to discuss these issues - but in general terms, an open rhinoplasty approach with septoplasty and turbinate modification is how many nasal breathing issues can be addressed. Other cosmetic changes to the nose can be made at that time.


Thank you for your question and photographs.

From what you have described and the photographs you have posted, it seems as though you would be a good candidate for a septorhinoplasty. The septoplasty could correct your breathing issues and the rhinoplasty will correct the appearance of your nose. I think you could benefit from a hump reduction and tip rhinoplasty to remove your hump and reduce the tip of your nose to make it look more pleasing and proportional to the rest of your face. I would definitely recommend scheduling a consultation with a board certified plastic surgeon to have a physical nasal examination performed to see exactly what is causing you breathing issues and If you do indeed have a deviated septum. 
Best of luck in your endeavors!

James Fernau, MD, FACS
Board Certified ENT
Board Certified Plastic Surgery
Member of ASPS, ASAPS, ISAPS, The Rhinoplasty Society, AAFPRS, OTO/HNS, ASLMS, International Federation for Adipose Therapeutics & Science

James Fernau, MD, FACS
Pittsburgh Plastic Surgeon
4.9 out of 5 stars 64 reviews

Improving nasal appearance

Hello lidtothemayo and thank you for your question. When looking at your pictures, you do appear to have collapse of the middle portion of your nose on the right side, which may be contributing to your nasal obstruction on that side. The complaints that you are referring to may likely be corrected with a rhinoplasty and, specifically, grafting to help straighten and support your nose. I recommend a consultation to discuss the procedure more and to discuss details of the procedure. 

Rhinoplasty to Improve Crooked Nose

A septorhinoplasty can be done to improve form and function.With these pictures I'm not sure if you have a crooked nose or just asymmetry. This can be clarified with an examination. You do have narrowing of the mid portion of your nose which can cause restriction of air flow through the internal valve corrected with spreader grafts. Surgery can also narrow and refine your tip and shorten a long nose. A full set of pictures for nasal evaluation as described on my website would be helpful.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 37 reviews


Hello and thank you for your question. Based on your photograph, you may benefit from a cephalic rotation of your tip to turn up your tip slightly and a conservative dorsal hump 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. 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 67 reviews

What surgery details may possibly be done to even and smooth my nose out?

Every nose is different and unique to that individual. If the appearance of your nose concerns you enough to do something about it, it can be improved with a natural artistically performed rhinoplasty. What would be the best option and exact procedure would depend on an in person examination (not just an online consultation) and discussion about desired outcome. Excellent results can be achieved with either a closed or open technique.

Keep in mind that following advice from a surgeon on this or any other website who proposes to tell you exactly what to do and how technically to do it based on two dimensional photos without examining you, physically feeling your tissue, assessing your desired outcome, taking a full medical history and discussing the pros and cons of the operative procedure would not be in your best interest. Natural appearing results need to be individualized and what is appropriate for one patient is not necessarily the best for someone else. I would suggest that you find a surgeon with extensive rhinoplasty experience certified by the American Board of Plastic Surgery and one who is ideally a member of The American Society for Aesthetic Plastic Surgery (ASAPS) that you trust and are comfortable with. You should discuss your concerns with that surgeon in person.

Robert Singer, M.D., FACS

La Jolla, California

Robert Singer, MD
La Jolla Plastic Surgeon
4.6 out of 5 stars 19 reviews


A rhinoplasty can help soften some of the features that your are concerned about. Best to seek consultation with a plastic surgeon.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Rhinoplasty candidate

Based on your photos you would likely be a fairly typical candidate for a rhinoplasty. This procedure can improve both the function and appearance of your nose. The specifics of the procedure however are best laid out in person with a thorough consultation with a plastic surgeon in your area with a large experience in nasal surgery. 

Rhinoplasty and Facial Harmony

Thanks for your post and photos. Don't think you bear any resemblance to the wicked witch of the west, but your nose does seem too long, pointy and crooked for you. Many patients experience tip ptosis with smiling.  Fortunately a well designed and performed rhinoplasty through an open approach can restore balance, facial harmony and tip support. Specifically, your overall nose could benefit from slightly less length, the bridge could be refined for straightness with dorsal reduction, spreader grafts and osteotomies to improve aesthetic lines and softness. Tip modifications may include suture modification, strut graft for support and conservative changes to the cartilages to soften the pointy shape. I recommend you consult with an experienced Facial Plastic Surgeon who specializes in rhinoplasty and performs nose surgery on a regular basis. Discuss your goals and focus on natural, not overdone results and all should be fine. Best wishes. 

Fred J. Bressler, MD, FACS
Houston Facial Plastic Surgeon
5.0 out of 5 stars 7 reviews

Rhinoplasty procedure

A closed rhinoplasty approach can accomplish making the required changes to the nose with all of the incisions placed on the inside of the nose. The dorsal hump can be shaved down which is composed of both bone and cartilage. A spreader graft will need to be placed underneath the concave upper- lateral Cartlidge on the patient's right side. The tip may need to be adjusted as well minimally. Osteotomies can accomplish narrowing the bridge line and straightening it. Rhinoplasty is a very difficult endeavor, so choose your surgeon very wisely based on extensive experience . For many Rhinoplasty before and after examples and more information, please see the link and the video below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 126 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.