Rhinoplasty - what would need to be done to make my nose smaller? (Photo)

Doctor Answers 2


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You can achieve a much smaller nose with a straight profile and some features of the photo but not all . It is likely you cannot have a nose as small as the desired one

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.

Alejandro Nogueira, MD
Spain Plastic Surgeon

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