Is the results I'm looking for realistic? (Photo)

I'm going for surgery in 18 days and when I went for a 'mini' consultation, I basically told them what my expectations was and they said I was being unrealistic because they can't change the thickness of my nose and the tip. I'm basically wanting to change the thickness of both my bridge and the tip, wanting to make the tip thinner and the bridge slopes down as does the tip so I want the tip lifting and the slope taking out of the bridge? Is any of this at all possible? .

Doctor Answers 11

Based on the information you posted, you should cancel your surgery. Right now.

You said that you scheduled surgery after a "mini" consultation. A rhinoplasty consultation takes a long time. After a "mini," how can you possibly know whether the surgeon doing your surgery knows what you want, and can accomplish what you want.

Actually, you *do* know: you were told that the surgeon *cannot* make the changes that you want. So why would you let him do the surgery, then? If I or another doctor here says that the changes that you want *are* possible, that doesn't mean that your doctor will do them.

You also said "I told THEM," and "THEY said." Who is "they"? Did you talk to the surgeon himself? If you didn't talk to the surgeon, then you didn't even have a "mini" consultation; you had no consultation at all. Get out of there fast.

Read the "Web reference" link, just below my post, for excellent advice on how to find a good surgeon for a rhinoplasty."

Omaha Facial Plastic Surgeon
4.8 out of 5 stars 41 reviews

A complete consultation would better inform you.

You should see a board certified plastic surgeon for a detailed consultation and explanation about what can realistically be achieved with your specific tissues and bone/cartilage structure.  Patients with thinner tissues can achieve more refinement in the shape of their nose because the modified shape of the bone and cartilage will show through the skin.  Achieving this refinement in patients with thicker tissues is more difficult.  A frank discussion between you and your plastic surgeon should help you reach an agreement about the result you could expect.

Jeffrey M. Darrow, MD
Boston Plastic Surgeon
5.0 out of 5 stars 98 reviews

Mini consultation for rhinoplasty?

  It is very important that back to your  proposed surgeon and sit down spend extra time with him/her discussing your needs to understand what can and cannot be accomplished with your skin, bone, and cartilage on your nose.  A mini consultation is not sufficient.  You will most likely be very unsatisfied after the procedure.  Communication is of the utmost importance in the process of rhinoplasty.  Digital computer imaging will be also helpful to understand what can be accomplished with your nose on your facial features.  A consultation for a rhinoplasty in our office lasts approximately one hour to  Make sure the patient's get all their questions answered.  In addition, rhinoplasty is one of the most difficult procedures to perform correctly in the entire field of cosmetic surgery, so it is critically important to choose  a surgeon with extensive experience with the procedure.  In addition it is important to have close follow-up with your surgeon to monitor the healing process  with cortisone shots and taping for the first year after the procedure.   For more information about rhinoplasty and many examples of before and after results for dorsal hump removal, please see the link and the video below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 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 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.   It is extremely important that you and your surgeon are on the same page in regards to plans and expectations prior to surgery.  I highly recommend that you go back to see your surgeon again prior to surgery.

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 125 reviews


the modifications you desire sound reasonable. You have to remember that you will likely have a lot of swelling for up to a year especially in the tip.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Realistic Goals

A cosmetic rhinoplasty can remove and reposition tissue in the nose for better aesthetics. Based on your photos I feel you would benefit from lowering the dorsum and refinement of the tip to narrow the tip defining points and produce a slight supratip break.

These are big movements that are often intended to create subtle, millimeter changes to the shape of the nose once it heals. You are correct in that the thickness of the nose skin can affect the overall result. An improvement can, however, be obtained for most patients. 

See the link below for more info.

A detailed examination will help delineate the best treatment. Consultation with a plastic surgeon certified by the American Board of Plastic Surgery would be the next best step.

David Tauber, MD
Albany Plastic Surgeon
4.8 out of 5 stars 29 reviews

Rhinoplasty goals

Thank you for your question.

It is important to know you can only refine the thickness of the bridge and tip so much with one surgery. I often tell my patients to consider Michael Jackson's nose for example. It took multiple rhinoplasty procedures to go from where he first began to his last outcome. So, please don't expect to have a nose like Morgan Fairchild on your first rhinoplasty. You should have a noticeable improvement on the first try, but if that is not enough expect to go under a second or third time. You should also know that recovery from a rhinoplasty procedure is lengthy and can take almost a year before you see final results. I frequently employ Crisalix imaging to give you a better idea of what can be expected. I hope this helps.

Best wishes and kind regards,

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 223 reviews

Are the results I'm looking for realistic? (Photo)

If you are not clear as to what is realistic or achievable, it would be in your best interest to seek out a full rhinoplasty consultation with simulation with a board-certified facial plastic surgeon or plastic surgeon that specializes in rhinoplasty. That way you can get all your questions answered and have a realistic understanding of the goals and limitations of rhinoplasty surgery.  Best wishes.

A. Joshua Zimm, MD
New York Facial Plastic Surgeon
5.0 out of 5 stars 32 reviews

Realistic expectations

You need a real consult with a board certified plastic surgeon, not a mini one.  It looks like your skin is quite thick so this will limit how much refinement and reduction can be done.  Based on your photos,  I believe you may benefit from a rhinoplasty and tip refinement. 

Robert E. Zaworski, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 60 reviews


Thank you for your question and photographs.

I would recommend that you schedule a consultation with a board certified plastic surgeon who specializes in rhinoplasty so they can perform a nasal examination and give adequate time to discuss your cosmetic goals and recommend to you the best options to achieve this. From the photographs you have posted, I believe you may benefit from a rhinoplasty and tip refinement. The bridge of your nose can be flattened/curved by cutting out the extra cartilage along with filing of the bone to smooth it out to create the shape you desire. A tip rhinoplasty includes trimming the lower lateral cartilages and placing precision sutures to refine the tip and make it look more pleasing. 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 75 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.