Can I achieve the nose that I want? Told I can't because of my genetic structure (Photos)

Question

I've been doing some research and looking around for surgeons and one surgeon has told me that I cannot receive the outcome that I desire because of my genetic structure and bone results. This has made me devastated as I don't know what can actually be done with my nose. I don't like how over projected it is and how much it turns up as well. I have attached pictures of my nose and also the desired outcome I would like. Can someone tell me if the doctor was right in what he said?

Steven M. Denenberg, MD · Answer

The surgeon who made the statement was doing something that I hear about far too often: HE can't improve your nose, so he tells you that NOBODY can improve your nose.

You have a strongly-projecting tip. Expert rhinoplasty surgeons know how to operate on a nose like yours. The woman whose before and after photos I posted with this answer had her nose dramatically deprojected in her operation.

Finally, it's unlikely that you'd need the angle of your nose changed. When the tip of a nose is deprojected, it makes the nose *look* longer, as if the tip had lowered. So when your nose is deprojected, the tip will very likely achieve an attractive angle. If grafts or other techniques are used to specifically try to lower the tip, especially if they are tried without a large deprojection of the tip, they will make the nose look bigger, and I don't think you'd like that!

How *much* to de-project the tip, or work on the angle of the tip, 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. 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.

Bora Ok, MD · Answer

Hi from Istanbul, thank you for sharing your photos. Deprojection of the nasal tip cartilages and septum can help achieve the look you desire. This involves repositioning and reshaping the tip cartilage and septum for a more balanced and aesthetically pleasing profile. By trimming and reshaping the lower lateral cartilages, the forward projection of the nasal tip is reduced. Addressing both the cartilage and septum allows the tip to be rotated downward, making the nose appear less upturned. It's important to find a surgeon you trust and whose aesthetic aligns with yours. Best of luck!

Paul E. Chasan, MD, FACS · Answer

Thank you for your question. You are an excellent candidate for rhinoplasty, I think it is one of the most beautifying surgeries that we do as plastic surgeons. A large portion of my practice is dedicated to rhinoplasty surgery. It is important to only see plastic surgeons with extensive experience in rhinoplasty, ie perform at least 6 per month and have performed hundreds of cases. Also, critically evaluate on-line galleries to see if their art form resonates with yours. Rhinoplasty is definitely a grey haired plastic surgeon's sport. Best wishes to you.

Oakley Smith, MD, FRCSC · Answer

Hi 
It is better for you to consult with a facial plastic surgeon who can examine you and discuss the surgical procedure and the post op recovery 
process.

Ramin Behmand, MD, FACS · Answer

Thank you for providing excellent photos for evaluation.  Based on the provided images, you appear to be an ideal candidate for rhinoplasty.  Your goals are both realistic, and, achievable. Instead of relying solely on one individual's perspective regarding feasibility, I recommend researching experienced nose surgeons and scheduling multiple consultations. During these consultations, the surgeons can thoroughly discuss your options and potential solutions.

Specifically, your nose would benefit from proportionately lowering the mid-nasal bridge and the tip, bringing them into closer alignment with your facial features. To achieve the shape that you desire, the nasion, or the top of the nose between the brows, will also need to be adjusted lower.

Dr. B.

Gary M. Horndeski, MD · Answer

Yes, your nasal columella angle is more than 110 degrees and it needs to be lowered down to 110 degrees. This can be done by using a cartilage graft to extend the lengthen of the dorsum and change the angle. You would also benefit from a simultaneous chin implant.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Eric M. Joseph, MD · Answer

Based on your photos, you appear to have an over-projected nasal profile appearance, thin nasal skin, and a tension lip deformity. Sometimes, correcting the prominent anterior nasal spine may lead to a less obtuse nose lip appearance. Continue to search until you find someone that is able to meet your needs. Computer Imaging would be particularly helpful in your situation. I'm not convinced you need a longer nasal appearance, just a deep projected one. I hope this helps. Sincerely, Dr Joseph

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photographs, you may benefit from a 
 rhinoplasty with tip deprojection and tip derotation. Instead of celebrity photos, I would highly encourage you to look only at photos on your surgeon’s own before and after gallery on their website.  With good surgical technique, you could have an outstanding result. 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

Shabnam Ghazizadeh, MD · Answer

Hi! Excellent question. From these pictures I think you could reasonably get close to the result you are looking for. However it is important to have good expectations going into rhinoplasty surgery and know that it wont be exact and your skin envelope needs to cooperate with that much reduction. I recommend a consultation with a rhinoplasty specialist. Best of luck, Dr. Ghazizadeh

Kenneth R. Francis, MD, FACS · Answer

Dear genlauren,
I'm hoping that "devastated" is an exaggeration.  You are a beautiful young woman and though there are features of your nose that you don't care for, it fits your facial structure very nicely.  There are two pieces of good news here.  The first is, as we age, our noses droop.  So over time your slightly over rotated nose will eventually rotate downward.  The second is that your nose is not far from the model nose that you seek.  So, if you are determined to have a rhinoplasty, you can get there fairly easily.  Good luck!

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