Looking for details on what is possible with a rhinoplasty (Photo)

Question

Hello, I have consulted a few doctors regarding what is possible for me in a rhinoplasty. All have indicated they can remove the dorsal hump, but I am wondering what is possible regarding the width and tip. Is there any questions I should be asking regarding how they would approach reducing or refining the tip? Any concerns I should have? Thank you! Also, just acknowledging this is totally personal preference -- I know there is nothing hugely "wrong" with my nose right now.

Steven M. Denenberg, MD · Answer

Actually, the "bump" is more related to your nose's asymmetry. If you compare the two 3/4 views that you posted, the view that shows most of the left side of your face reveals a much larger bump than the view that shows most of the right side of your face, and the profile view hardly shows a bump at all. All that indicates probably some excess width to the upper, boney part of your bridge on your right side.
On the profile view, your nose could be made less prominent by bringing the tip closer to the face. Then, when that's done, it has the tendency of making a nose *look* longer, as if the tip drooped, so it's often important to elevate the tip as well. All of these changes together might make you happier with your nose.
How *much* to elevate the tip, or deproject the nose, or make 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.)

Finally, remember 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 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. And it also discusses how to take photos that are best for online evaluations.

And for those who have had previous surgery, it also discusses how to tell whether your first surgeon should be performing your revision.

Selcuk Inanli, MD · Answer

Hello! Thank you for your question. As far as I can understand your question, maybe you can ask your surgeon to design a simulation according to your wishes. This way you would have an idea of what is going to be your nose after the surgery. Best Regards!

Jonathan Kulbersh, MD · Answer

Thank you for your question and for the photos you provided. Rhinoplasty can reduce the appearance of the dorsal hump, as well as redefine the tip and create a more narrow nasal shape. Narrowing the nose often requires an alar base reduction, which entails osteotomies or tissue reduction to create the desired result. 
Please 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 discuss your aesthetic goals with you and help you decide on the best approach.

Gianfranco Frojo, MD · Answer

I would highly recommend seeing a board-eligible of board-certified plastic surgeon with rhinoplasty experience, particularly one with 3D imaging that is capable of simulating your surgery so you can be on the same page regarding the outcome. Best of luck.

Lucian Ion, FRCS · Answer

Thank you for your question and sharing your photographs.

You are absolutely right in saying that there's nothing dramatically wrong with the appearance of your nose as it is and this means you need to careful when deciding whether rhinoplasty is a meaningful procedure for you.

The characteristics of the nasal skin influence how much refinement you can achieve for the nasal tip in combination with a reduction in projection. There seems to be moderate flexibility for this in your situation but a consultation in person would provide more clarity.

One way to produce the impression of a smaller nose is to combine the tip de-projection with slight rotation which creates an overall smaller size for the nose. Your right tip defining point is slightly higher and gives the impression that the nose is relatively upturned on the oblique view from your left side but I suspect that it is not the case in photographs that are not selfies.

To produce a reduction in the bridge projection combined with narrower appearance of the bridge I have found the ultrasonic rhinoplasty to be the most reliable approach.

I suggest that you have a consultation with a surgeon that uses computer imaging and simulation to try and get more clarity regarding the impact of the changes you describe and whether you would like the effect, and get some clarity from the surgeon whether they feel that's such changes are achievable.

Nima Shemirani, MD · Answer

Hi @Persistent565274. I recommend seeing an expert rhinoplasty specialist for an in person examination. There are several options for you that can be determined after examination. 
A rhinoplasty in my opinion is one of the most difficult procedures to perform. I utilize piezo surgery in my practice. Piezo surgery is a more gentle technique that allows for greater precision. Less bruising and swelling is common with Piezo surgery. In a typical rhinoplasty, a hammer and chisel technique is performed leading to more inadvertent fractures. Best of luck, Dr. Nima.

Man Koon Suh, MD · Answer

Basically the surgery you need for your nose is hump reduction and osteotomy. What you want about the nasal tip is a bit subjective when it comes to your nose, but some volume reduction surgery seems to help. Since the height of the tip of your nose does not look low after hump reduction, tip projection seems unnecessary, and shaping and realignment of lower lateral cartilages is required for volume reduction.

Andrew Miller, MD · Answer

It's ok if your nose isn't terrible. A well performed rhinoplasty can still make a nice improvement while keeping it looking natural. The bump can be taken down and your tip refined. You want to go to a specialist that has a lot of photos of patients he or she has done. You should also be able to have computer imaging done to give you an idea of what can be achieved. Be sure to see a rhinoplasty specialist for consultation.

Oakley Smith, MD, FRCSC · Answer

Hello,
In addition to removing the dorsal hump, the tip of your nose can be refined to give it better definition, de-projected and slightly rotated. The base of your nose can also be made narrower. These changes can be made with surgical rhinoplasty procedure either open or closed approach, and various techniques can be employed to achieve such results.

Zoran Potparic, MD · Answer

It is very difficult to give you good advise without in person evaluation. You should consider consultation with a board certified plastic surgeon, expert in rhinoplasty, who has 3D simulation system in the office. In that cace, subtle changes of the dorsum, tip, nose width, can be discussed and partially visualized. Good luck.

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