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 trimming the caudal septum slightly and the caudal portion of the medial crural footplates the help address your columellar show. 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
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon
Hello simply_g - Thanks for your question. All of the maneuvers your surgeon is suggesting make sense accept for the alar width reduction. Alar width reduction has the tendency to cause the tip to swing up a bit. It can still be performed, but it must be done very conservatively or you will look pinched. On profile view, you already have an increased columellar-labial angle which means you are already starting to tip up. Bringing the columella up further will increase the chance of a piggy nose. Your main problem is that you have malposition of your lower lateral cartilages, which make up the bulbous tip. These cartilages can be repositioned to lower the height of your nostrils while harmonizing your tip to the rest of the nose. Make sure that your surgeon is a rhinoplasty specialist.Good luck,Dr. Shah
Your ala are not wide so I would not recommend an alar base reduction. Your tip is a bit wide so suturing the domal cartilages together would be good. From the side your nostril shape is nice without excessive alar retraction or columellar hang so I would not reduce your columellar show. A slight dorsal reduction would femenize the nose nicely. Best wishes, Dr. T.
Outcomes are surgeon dependent
Plan of operation for your rhinoplasty makes sense. Outcome depends on skill of the surgeon. With an operation that is done well you will not have piggy nose.
Rhinoplasty for angled tip
Your nasal tip shape does pose a bit if a challenge for a rhinoplasty in that caution needs to be exercised in making sure that the tip is not turned further upward. I would suggest a slight relaxing of the columella so that it doesn't appear to 'hang.' A technique whereby the columella can be set back would allow for the relaxing of the upper lip as well so that it is less obtusely angled and more relaxed (ie the upper lip can be made to appear less "pulled" upward). Additionally, internally placed incisions with in the nostrils can make them less apparent on the frontal view.
A closed rhinoplasty approach can accomplish straightening the nose, shaving down the dorsal hump, reducing the projection of the nose, rotating the tip downwards, reducing the bulbous tip, and reducing the hanging columella with all of the incisions placed on the inside of the nose. It is very important to not turn the tip up. For many examples, please see the link and the video below to our closed rhinoplasty photo gallery