Shortening the projection without raising the tip.

Question

I’m looking into surgeons for a rhinoplasty with my main concern being projection. With years of research I have yet to find any photos where a surgeon’s shortened the length of the nose without raising the tip. Is this possible? I’d like a shorter nose but I don’t want the tip raised.

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, among other maneuvers. 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

Steven M. Denenberg, MD · Answer

Pardon if you already know this! But: "projection" refers to how far forward the nose (usually the tip) projects away from the face. Pinocchio had a very "projecting" nose. "Length" refers to the distance along the bridge: picture putting a ruler along the bridge of the nose, and you measure the length from where the ruler begins, approximately between your eyes, down along the bridge to where the tip is. So "raising the tip" is the most common way of decreasing the "length" of the nose.

So. You can have a *short* nose with a *huge* projection if the tip is very high but the nose comes out forward from the face a lot. Or you can have a *long* nose with a *tiny* projection if the tip is very droopy, covering part of the upper lip, but the nose doesn't "project" forward away from the face on profile view very much.

The view in the sleeveless top shows a nose that might be somewhat strong in forward projection, but really isn't a "long"-ish nose. The view with the hat makes it hard to evaluate the projection, but the nose does look long-ish. Most surgeons, as you've probably discovered, would want to raise that tip.

But the patient gets to be the dictator of the goals of the operation. Seems to me that what you need is for a surgeon to take well-posed photos of you and make the changes that *you* request, and *not* make changes you don't want, and show you morphs of what that might look like. You say Well that's close but tweak this or that, and eventually you come up with a final goal for the operation. The surgeon tells you whether that's possible to accomplish, and how predictable it would be to accomplish. That's how rhinoplasty *should* be done, IMO, even if you don't think your tastes run counter to the average.

Sometimes something surprising happens. For example, if you reduce the projection by a lot, it tends to make the nose *look* longer, as if the tip had actually drooped, and in that case the patient might say, "Well, show me that same deprojection with the tip up just a teeny-tiny bit." But at least from these photos, your nose doesn't seem to require a huge deprojection.

Jeffrey H. Spiegel, MD · Answer

This can be done. We've done, through my office, research studies on how to deproject very projected noses and this can be done without rotation.

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 definitely is possible to shorten the nose without raising the tip. 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.

Eric M. Joseph, MD · Answer

That said, based on your photos, you appear to have a bit of a long nasal appearance, and your second photograph may reveal that your tip is a bit droopy. In our experience, the best way to communicate with your perspective surgeon what you are looking to achieve, is with computer Imaging. Inspirational photos are helpful as well. Please meet with a reputable rhinoplasty specialist who has many favorable before and after photos in his Gallery, along with positive online consumer reviews. I hope this helps, and I wish you all moving forward. Sincerely, Dr Joseph

Waylon Zeng, MD · Answer

Hi there, thank you so much for your question. To answer your question, yes, it is possible to deproject the tip of the nose without rotating (raising) the tip. This typically involves cutting and shortening the lower lateral cartilages and the caudal septum, followed by supporting it with a type of cartilage graft. This is typically done in patients with excessively long noses. Often times just performing a rhinoplasty will lead to about 1-2mm of nose deprojection even without doing any cartilage work. 
I think your nose fits your facial proportions quite well. I think the shape and tip position compliments your face shape, so I don't think such a procedure would be very beneficial.

Shortening the projection without raising the tip.

Answers (6)

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