Big nose and very deep prominent nasolabial folds - What will improve my nose/mouth area? (Photos)

Question

I have a big nose and very deep prominent nasolabial folds due to the structure of my face that are getting worse with age. My mid face almost looks sunken to me compared to the projection of my nose. Not sure if a rhinoplasty would help this or worsen it, any idea what could improve this area to make it more harmonious if not a nose job?

Semih Yildiz, MD, FEBOPRAS · Answer

Rhinoplasty can change nasal projection and shape, but it will not directly correct nasolabial folds or rebuild midface support. In your photos, the nose does not appear dramatically disproportionate, while the folds look moderate and are most visible near the alar base; lighting, expression, and camera angle may exaggerate them, so an in-person examination may change this assessment. The key is to determine whether the imbalance comes from nasal projection, cheek or maxillary support, volume loss, skin laxity, or dental/occlusal anatomy. If you genuinely want a smaller or less projected nose for its own sake, conservative rhinoplasty may improve overall balance, but it should not be used as a treatment for the folds. For the midface, carefully placed hyaluronic acid filler or fat grafting may help selected patients. Often support is added to the cheek, deep medial cheek, or piriform area rather than simply filling the crease, which can look heavy. Filler around the nose and midface has vascular and rare vision risks and should be performed by an experienced medical injector. If there is significant skeletal retrusion or a bite problem, maxillofacial assessment may be more appropriate; if aging and tissue descent are the main causes, lifting procedures may eventually be more effective than repeated filler. A full-face consultation with standardized photos and profile analysis can separate these issues and prevent over-treating either the nose or the folds.

Edward J. Gross, MD · Answer

Unfortunately, it isn't possible to provide a definitive answer based on your photos. Rhinoplasty won't make your nasolabial folds appear deeper. If you're self-conscious about the appearance of your nose, schedule a consultation with a double board-certified facial plastic surgeon who is also an ear, nose, and throat specialist with extensive experience performing rhinoplasty surgery. They will conduct a thorough exam and recommend a treatment plan. You could also consider getting fillers to add subtle volume to the folds.

Guray Yesiladali, MD, FEBOPRAS · Answer

If you are unhappy with the shape or projection of your nose, rhinoplasty can be an effective solution.
Rhinoplasty does not worsen nasolabial folds, but it also does not correct them.
If your main concern is the prominence of the nasolabial folds, an endoscopic midface lift may provide a more appropriate improvement by elevating and supporting the cheek area.
I wish you clarity in identifying your main concern and a result that brings balance and harmony to your facial features.
&mdash; Güray Yeşiladalı, MD

Jeffrey Lisiecki, MD · Answer

I will very often combine a rhinoplasty with a facial fat transfer to restore volume in the deep pyriform and midface and shape the nose to put the nose and midface more in harmony with each other.  Just like a small chin can make a nose appear larger and more projecting than it actually is, deep nasolabial folds can do the same!

Jeffrey H. Spiegel, MD · Answer

I'm afraid that these photos are minimally helpful, but from what can be seen there is nothing obviously sunken or abnormal about your face at all. The NLF (nasolabial folds) can be filled in somewhat, and the nose can be changed - but all is fine if you leave it.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photographs, you are a great candidate for rhinoplasty. Maneuvers for your surgery would include dorsal hump reduction, tip refinement, nasal tip deprojection, tip elevation, among other maneuvers. Make sure you are going to a surgeon with hundreds of long-term before and after pictures on their website with standardized lighting and standardized backgrounds. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Zoran Potparic, MD · Answer

It would be very difficult to discuss rhinoplasty based on these photos. Mild augmentation of nasolabial folds and cheeks with filler or fat grafts should be considered. In person consultation with a board certified plastic surgeon with experience in rhinoplasty and facial rejuvenation is recommended. Good luck.

Milan Doshi, MS, MCh · Answer

Hi Gentle765186From your photos, the concern appears to be midface volume deficiency with relatively stronger nasal projection, which can make the nasolabial folds look deeper over time. This is often more about midface support and fat position than the nose itself.
A rhinoplasty can refine the nose, but reducing the nose alone may not fully correct the imbalance and in some cases can make the midface look even flatter. The more effective approach is often to restore midface volume and support, using options like:
Filler or fat transfer to the cheeks/midfaceIn selected cases, structural lifting techniques (thread lift or surgical lift) to reposition tissue
Improving the midface projection usually softens nasolabial folds and creates better overall harmony without over-reducing the nose.
This is a great question. I would recommend consulting with a board-certified plastic surgeon to further discuss your goals and evaluate you in person.

Big nose and very deep prominent nasolabial folds - What will improve my nose/mouth area? (Photos)

Answers (8)

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