What could be done to reduce my nose size? (photos)

I have a petite Face and wanting a Rhyinoplasty that will give me a small nose

Doctor Answers 8

My comments

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Your frontal view is within the stardards in high-end nose jobs, however the profile is one of the most difficult scenarios when patients strive to find what they are looking for and how might this wish be made technically safe and real. I fully agree you want a "small nose" and "reduce your nose"... you don't say "I want my bump gone" or "wish to shave my bridge"... that is the cornerstone of your case, your nose is oversized, but... you do not have any profile / dorsum bump or bony prominence... it is neat! straight, but still it is a large nose, why so? because you have a high dorsum without a bump. This means the distance between your dorsum and the so called Joseph's angle (angle between nose and face) is large, but not all the same in all areas; the dorsum-face distance is normal at the radix (upper part of nose), moderately large in the center of the vault and extremely oversized at the caudal or lower end of the dorsum. In other words, the angle between dorsum and Joseph's line is too wide, must be reduced quite a few degrees. Other focus: yes, you DO have a bump, a big one, but is not located in the center of the nose... it is at the END of the dorsum, and is not peak-shaped, it is slope-shaped.

What are the risks associated with such atypical profile as I described above? it is clear: meeting the wrong surgeon. You can't imagine how many catastrophes I had to reoperate to repair after hump-less high dorsum rhinoplasties (like yours) performed by other doctors; seems they try to remove an imaginary bump, and the consequence is a saddle-nose deformity, a trampoline nose, an upturned tip, etc etc a disaster with extremely complex solution. Other surgeons may understand the technical requirement (dorsal lowering without hump removal) but... carry it out with poor quality; let me explain myself: when you remove a central peak-shaped hump located around the middle third of nose, you remove the peak made of bone and cartilage and the attached undelying mucosa lining, this is a routine maneouver and we don't worry about the mucosa attached, since it plays no role in breathing, however... the caudal mucosa of the dorsum and the caudal end of the dorsum do belong to the critically-functional breathing nasal valve, and MUST be preserver, therefore in cases of caudal hump / humpless high profile a mucosa-sparing dissection must be done to meticulously separate the cartilages from the mucosa, so that when the resection is done such cut does not include such functionally-critical lining, otherwise your breathing would be affected and you'd form a pinched dorsum aka V-deformity; this mucosa undermining must be done under both the cartilagenous dorsum and the lateral or triangular cartilages to an extent which exceeed few milimetres the line of dorsal cut, to guarantee a safe outcome. This maneouver, the dorsal lowering with mucosa sparing, may take itself 1 hour, when a normal central peak shaped hump is removed in 10 minutes. You need to find a very good surgeon for this.

According with the caudal dorsal lowering... your tip becomes massively overprojected aka "Pinoccio's nose"; currently your tip does not look overprojected, but once the dorsum has been lowered it will, so another refinement in your case is the ability to match the new tip length with the new caudal dorsum, to achive a very similar balance to the current one but... lower, I hope you get me; this will require radical shortening of both, medial and lateral, cruras of the alar cartilages, secured with sutures (normally it is left floating, risky in your case that may lead to still long tip).

Finally, the difficult but standard part: broad boxy cleft tip, needing cartilage trimming plasties of the domes (Ortiz-Monasterio's alternate incomplete transections), plication of domes and medial cruras, etc, eventually some kind of tip grafting. I also notice a moderate alar rip retraction near the tip, this may require grafting there as well (to hide the exposed septal mucosa / columella).

With all that said let me suggest you a thorough research to find a top-notch surgeon and travel wherever the righ professional might be located, your rhinoplasty is among the most difficult in primary noses.

Finally, let me suggest a superb technique associated in your face: a sliding genioplaty (never ever implants, please), this would make an amazing result for you.

As it may be understood... the specifics as to how this is done could not be more relevant than in your case, both aesthetic and functional in breathing. Of course you need open approach and a 3 hours procedure, with 2 weeks spling on nose and bruising 2-3 weeks, besides auricular donor sites bandages a few days.

Spain Plastic Surgeon

What can be done to make my nose smaller

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Not sure why the prior answers are so vague. Your nose is very straightforward and will require a standard rhinoplasty with trimming and refinement of the shape of the tip cartilages, lowering of the top surface of the nose so it is not quite so rounded , and also slight narrowing of the front profile. The specifics as to how this is done is irrelevant at this point but can be discussed at consult. As long as you have no breathing issues this should be an outpatient surgery lasting about an hour and there would be a splint on the outside for a week. There may be some bruising and swelling which takes one to two weeks to resolve. Your request is quite reasonable and we can show you on the computer what your new profile would look like. I hope this helps. 

Grady B. Core, MD
Birmingham Plastic Surgeon
4.6 out of 5 stars 13 reviews

Reduce size of nose

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The pictures are not appropriate for an accurate opinion. It looks like your radix is low and the tip projects too much. Your chin appears to be undersized. So a complete rhinoplasty is needed ti alter the whole nose, and chin implant, is strongly recommended.

Dennis Barek, MD (retired)
Great Neck Plastic Surgeon

Get a rhinoplasty

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Rhinoplasty will give you what you need. Thus your question is a good statement of your need. Proceed with rhinoplasty.

Vasdev Rai, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 24 reviews

Rhinoplasty and chin implant candidate

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From the very limited photographs, it appears that there is an overly projecting nose, and an under projecting chin.   A rhinoplasty procedure can accomplish shaving down the dorsal hump, decreasing the projection of the nose, and refining the nasal tip and bridge line.  A chin implant procedure is required to augment the weak and recessive chin profile to help with facial balance and proportions, especially with respect to the overly projecting nose.  Performing only a rhinoplasty will still leave the patient with an overly projecting nose due to the fact that there is a weak chin.  Both procedures would be complementary to each other.   For more information and many before and after results of this combination,  please see the link and the video below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 reviews

Rhinoplasty with tip de-projection

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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 nasal tip de-projection to make your overall nose smaller and fit your face better.  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. 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 person.

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 172 reviews

Reduction Rhinoplasty Recommendations

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Thank you for your post. You should consider a reduction rhinoplasty through an open approach. Your profile seems to suggest that your nose is too long and overprotected for your face. In my view, reducing the nasal length and improving the nasal dorsal hump, along with retrodisplacement for your nasal tip projection would enhance your overall appearance. From your front view, you appear to have a nice aesthetic balance, but may benefit from a proportionally small nasal tip. A skilled and experienced surgeon should be able to assist you with recommendations to improve the profile, length and projection while at the same time respecting and preserving a natural view from the front. An in-person consultation may also lead to further recommendations for facial balance, perhaps a chin augmentation. Congratulations on researching your options. Best Regards

Fred J. Bressler, MD, FACS
Houston Facial Plastic Surgeon

Big Nose

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You appear to be a good candidate for rhinoplasty surgery, provided your expectations are reasonable. We don't want to over-reduce and create a situation where the nose is too small proportionally for the face.

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.