Are my nose goals achievable with Rhinoplasty? (photos)
Doctor Answers 15
Bring the Morphs to an Experienced Surgeon
Your morphs show an aesthetically improved nose that looks very natural and should be achievable in a straightforward rhinoplasty. I agree with your aesthetic vision: A stylized nose with a slope and further shortening and narrowing would be much less desirable. It is important to remember that a computerized morph makes the assumption that the nose is a piece of clay that can be molded into any shape. The nose has structural elements of bone and cartilage covered by skin of variable thickness that then need to heal, all of which place constraints on the final outcome. Nevertheless, morphs are useful. I would consult with an experienced surgeon and look at before-and-after photos of past patients to make sure your surgeon’s aesthetics and outcomes match your own expectations.
To begin with, your nose if of very high difficulty, not a nose to be done by any surgeon, it joins very specific ethnic features and requires high-end techniques full of creativity and skills.
You have morphed a dorsal hump removal and a slight tip shortening, I fully agree with this, feasible and essential for your nose, specially with the second morph (the first one lacks enough tip shortening). But you have missed to comment, detect or require some features of paramount importance in your case.
-short lateral cruras of the alar cartilages: yes, your lateral cruras are short and incompetent, leading to two major issues: a pinched nose effect and alar rim retraction, and the alar rim retraction leads to septal mucosa exposure (aka hanging columella, but the columella does not hang!, it is the rim which is retracted and unable to cover the septal mucosa). This is best treated by means of grafting at the lateral cruras, or even replacing them (intraop decision) by new hand and custom-made lateral cruras, with the goal of lowering your alae and nostrils rims and hide the unsighty septal-columellar exposure; this would also correct the pinched nose effect (that dimple you show at both sides of alae) and improve significatively your breathing in.
-connected with the former, you wish nostril/alae reduction, beware! likely a wrong judgement (I'd need to see images from below to determine); when the alae are imcompetent and retracted, leading to a septal mucosa exposure, the first glance effect is saying "oh, my nostrils are large", but not for real... is just the vertical shortness of the alae but not a real oversized nostril; if nostril reduction is performed in fake large nostrils the catastrophe is guaranteed and almost irreparaible.
-oversized weak triangle: google this issue and get informed; there is a gap between the lateral crura and the tip domes, this can be well grafted to bridge it.
-poorly defined tip: your tip could be better defined and sexier, this would not be a "must" for your case, but a strong recommendation; best done with tip grafting (Sheen graft, pentagonal, etc).
With all that said, you'd rather seek opinions of very well experienced rhinoplasty surgeon with large background on ethnic noses and grafting and, of course, with good cosmetic judgement.
A final note: did you consider an osseous genioplasty? you could be a case (better pics needed to judge) for three-dimensional genioplasty:
-anterior retrocession (move backwards a bit)
-vertical increase (the distance between lower lip and chin is short)
-eventually horizontal narrowing
You are a fantastic case for a major facial surgery, being your other facial features of extreme beauty and feminity, in the hands of the right surgeon.
You may be a great candidate for rhinoplasty.
Judging from your pictures and description, it seems that you could be a very good candidate for a rhinoplasty procedure. Work with a board-certified plastic surgeon with experience performing rhinoplasties, and carefully communicate your goals with him or her during your consultation. The goals you've outlined above should be very achievable, especially in the hands of a skilled professional. Best of luck!
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Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon
Your goals can be achieved with surgery
Are my nose goals achievable with Rhinoplasty?
Are my nose goals achievable with Rhinoplasty?
Keep in mind that following advice from a surgeon on this or any other website who proposes to tell you what to do based on two dimensional photos without examining you, physically feeling your tissue, assessing your desired outcome, taking a full medical history and discussing the pros and cons of the operative procedure would not be in your best surgery. Natural appearing results need to be individualized and what is appropriate for one patient is not necessarily the best for someone else. I would suggest that you find a surgeon certified by the American Board of American Plastic Surgery and one who is ideally a member of The American Society for Aesthetic Plastic Surgery (ASAPS) ) or a facial plastic surgeon (otolaryngologist) that you trust and are comfortable with. You should discuss your concerns with that surgeon in person.
Robert Singer, M.D., FACS
La Jolla, California
Are my nose goals achievable?
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.