How can I improve my nose and sunken cheeks? (Photos)

Question

I'm a 26 year old woman and my two biggest insecurities are my nose and my cheeks, which have become more sunken with weight loss. I've photoshopped several photos to give a general idea of what I would like to improve, but am unsure how realistic they are or what exactly could help me get there. Expert opinions would be very much appreciated, thank you!

Ronald J. Edelson, MD · Answer

I agree that the rhinoplasty would be a tremendous improvement.  I would concentrate on that part first. Treatment for sunken cheeks is not always very successful.  You’re either talking about fat injections, other injectables or cheek implants.  I’m really not crazy about any of those options so just get the nose done first.  After that you may not even want anything further done.

Steven M. Denenberg, MD · Answer

Click on the "Learn more" link, just below my response, or go here:
FacialSurgery.com/RealSelf/RealSelf_vanytree.html
I made a computer morph of your nose, and an animation of the morph, to show the changes that are possible for your nose in truly expert hands.Besides lowering the bump, it would be nice to elevate the tip a little, and to make the tip a little bit less pointy. Perhaps you can see that best in the animation.
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. 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.
I'd love to hear what you think of the morph. Did it seem to address your main concerns?
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. 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.

Eric M. Joseph, MD · Answer

You appear to have a long nasal appearance with a dorsal hump and a droopy nasal tip. Consider consulting with several rhinoplasty specialists so you could see what might be best for you. Adding volume to your cheeks may be considered in the form of injectable fillers, or fat grafting, depending on your examination. Thank you. Dr Joseph

Aaron Stone, MD · Answer

Assuming the photoshopped photos are on the right it looks like you want the hump on the bridge taken down and the nasal features softened. Those are reasonable and achievable goals though the photos are not optimal for surgical planning.I don't know how much weight you lost but large weight loss can contribute to what you see in the photos. The deeper cheek fat has descended down to the plane of the corners of the mouth and lower skeletonizing the cheek bones/zygomas that also appear to be pushed back from the frontal plane. Just injecting fat or fillers is not going to move the deeper fat back into a higher plane. If the cornea cheek bone vector slopes downward and backward (you can't tell this from only a photo) the likely best option for the cheeks is cheek implants with resuspension of the cheek fat as in a subperiosteal facelift without the outer facelift incisions. I just added photos of such a facelift to my realself gallery. They should be visible in 1 to 2 days.I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.
My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship in order to know if this assessment is valid.

Jason Litner, MD · Answer

Hi vanytree,The goals you set out in your imaged views can absolutely be accomplished by an experienced rhinoplasty surgeon. You should attend an in-person consultation so you can have a more detailed conversation about your goals and how to best achieve them. For your cheeks, if you are at a stable and healthy weight, you can consider some form of cheek augmentation. We find that fillers or facial fat transfer are more useful at providing an individualized natural contour as compared to cheek implants. Of the two, we prefer fat transfer for its ability to provide long-term enhancement. Let us know how else we can help.

William Portuese, MD · Answer

A closed rhinoplasty procedure can accomplish  shaving down the dorsal hump, refining the nasal tip and narrowing the bridge line with all of the incisions placed on the inside of the nose. Fillers placed in the office setting can temporarily augment the cheeks which are flat. For a permanent augmentation, consider placement of cheek implants. Cheek implants are manufactured in the larger array of sizes, thickness and shapes, and are usually placed under general anesthesia as an outpatient surgical procedure. For many  before and after examples both procedures, please see the link and the video below

How can I improve my nose and sunken cheeks? (Photos)

Answers (6)

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