Hate my side profile! What can be done to my nose? I heard before that I have too much skin to get good results? (Photo)

Question

I hate my side perfil - I don’t mind the front at much as I do the side- however I have i bulbous cartilage popping on the front side . I went to a local plastic surgeon and was told I had too much skin as changes will not be noticeable. What are your opinion ?

Steven M. Denenberg, MD · Answer

Click on the "Learn more" link, just below my response, or go here:
FacialSurgery.com/RealSelf/RealSelf_ir69558.html
I made a computer morph of your nose, and an animation of the morph, to show the changes that could be possible for your nose in truly expert hands.You didn't say *exactly* what it is about your profile that you hate, so I took some educated guesses. I lowered the bump on the bridge, and I elevated the tip, and I brought the entire nose back closer to your face.At the same time, the tip could be narrowed. The woman in the short video that I posted with this answer had the tip of her nose narrowed in a rhinoplasty.It's true that thick skin can put a limit on how much change is possible, but with strong cartilages, a meaningful amount of change can often be accomplished. It's really necessary to see the nose in person, though, in order to get a "feel" for the skin's thickness and how it might affect surgery's outcome.
See if you think the morph captured what you're looking for.
You should understand that the changes I demonstrated in the morph require advanced techniques, techniques that most plastic surgeons cannot handle.  Be sure to read the section in the "Learn more" link on how to stay out of trouble while searching for a rhinoplasty surgeon. 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. Read that page very carefully. Most plastic surgeons are quite poor at this operation, and I believe my advice will go a long way toward keeping you safe. For most noses, it's better to not have surgery than to have inexpertly-performed surgery.
I'd love to hear what you think of the morph. Did it seem to address your main concerns? I could modify the morph to your taste if you wish.
Your nose is also a good example of why computer imaging is mandatory in rhinoplasty. You need to know exactly what the surgeon is planning to accomplish -- what features he thinks he can change, and by how much he thinks he can change them. When you see his goals, you'll know whether he has an eye for an attractive nose, and whether he shares your opinion of what constitutes an attractive nose. You'll also know whether the changes he proposes are enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. How would you ever get that figured out without the morphs?! But remember, you're not hiring him for his skills with the computer. The doctor must then show you his before and after photos to prove that he can actually accomplish what he draws on the computer.
In your case in particular, you need to find a surgeon who understands all of the issues I mentioned, and how they fit together, and who can actually accomplish them in surgery.

Richard G. Reish, MD, FACS · Answer

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. You may also benefit from a 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. FACS
Harvard-trained plastic surgeon

Umang Mehta, MD · Answer

Thanks for the question and photos. You do seem to have thicker skin on your nose, which is an important feature to consider. The skin thickness can limit the degree of refinement of the tip of the nose. In other words, thinner skinned patients generally end up with a more refined and narrow tip than thick skinned patients. That said, there are still several improvements which could be made. Your bridge could be lowered, making the nose appear more feminine and soft. The tip cartilages (lower lateral cartilages) could be made thinner and sharper as well. This is done by shaving the cartilage conservatively and using sutures to change their shape. The skin and soft tissue of the nose can also be conservatively thinned, while the nostril flaring could also be reduced. After surgery, taping the nose at night and performing steroid injections can help the final result as well.  A common problem I see when performing revision rhinoplasty in thicker skinned patients is that the first surgeon removed too much cartilage from the tip, making the tip lose shape and look like a blob. I'd suggest consultations with two or three rhinoplasty specialists, and ask to see noses similar to yours. Computer morphing of your nose during the consultation can help you and your surgeon communicate the aesthetic goals.  Best regards,Dr. Mehta

Jonathan Kulbersh, MD · Answer

Your nose could be improved with rhinoplasty, which would give permanent improvements in symmetry, shape and tip. You can bring the pictures that you think would be flattering to your face and these can be discussed. When you meet with a facial plastic surgeon, he or she will consider your nose in balance with your other features and can over the cost of the procedure. I hope this helps.

Edward Buckingham, MD · Answer

I would schedule a consultation with a facial plastic surgeon to address your specific concerns.  While it appears you do have thicker nasal skin which can make it difficult for subtle refinements, there are plenty of changes you could make to your nose which I think you would be happy with.  Making sure you and your plastic surgeon are on the same page with desired goals and expectations is critical.  With regards to your side profile, lowering your dorsum and removing your nasal hump is certainly achievable and you would see a dramatic difference.  You could also refine your tip.  Good luck.

Philip J. Miller, MD, FACS · Answer

I would recommend starting with a consultation with a board certified facial plastic surgeon that specializes in rhinoplasty surgery to discuss if rhinoplasty can address your concerns. 
I would recommend writing down the following questions before scheduling your consultation:
1. Are you unhappy with the tip of your nose? 
2. Do you feel that your nose is too wide? 
3. Do you want to make your nostrils smaller in appearance? 
4. Are you looking to decrease the general size of your nose?
I hope some of these questions will help you pinpoint what it is that you don't like about your nose.  Cost will vary due to various factors like anesthesia fees, facilities fees, etc. I wish you the best as you research your options when scheduling a rhinoplasty consultation.
Sincerely,
Philip J. Miller, MD, FACS Double Board Certified Facial Plastic Surgeon

John Michael Thomassen, MD · Answer

A rhinoplasty to reduce your dorsal hump, refine your tip and possibly add a radix graft would be a nice change for your profile.

William H. Sabbagh, MD · Answer

Hi, After looking at your pictures I think you would get a noticeable improvement from a rhinoplasty.  The bridge of your nose can be made straight and your nose can be made thinner from the front view.  You don't have too much skin but you do have thick skin.  This may limit how defined the tip of your nose can be but you would see nice improvement from a rhinoplasty.  See a surgeon who performs many rhinoplasties and can show before and after pictures of patients with similar shaped nose and skin thickness so you can have realistic expectations.

William Portuese, MD · Answer

There are some improvements that can be accomplished with the rhinoplasty procedure, but thick-skinned local event refinement and tip area. It's very important to have realistic expectations about what can and cannot be accomplished With the rhinoplasty procedure. The boldest nasal tip can be reduced and refined, and the dorsal hump shakedown of the bridge line narrowed.

Robert Singer, MD · Answer

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

Hate my side profile! What can be done to my nose? I heard before that I have too much skin to get good results? (Photo)

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