Is my midline or my nose the problem?

Question

I feel like my midline does not line up, but I am planning to get a nose job soon so I'm wondering if my nose is not aligned right....my orthodontist has not mentioned anything about my midline but should I bring it up?

Steven M. Denenberg, MD · Answer

Click on the "Web reference" link, just below my response, or go here:

FacialSurgery.com/RealSelf/RealSelf_xosunnyca.html

I made a computer morph of your nose, and an animation of the morph, to show the changes that are possible for your nose in truly expert hands.Of course, you only posted that frontal view, but it shows strong tip cartilages, which show a dent between them. Strong tip cartilages also tend to hold the tip of the nose low, so in the morph, I narrowed the tip, elevated the tip a bit, and then filled in the dent between the tip cartilages.I'd love to hear what you think of the morph.If I could see a profile view, I'll bet that the strong tip cartilages also are holding the tip of your nose out farther forward from your face than it needs to be.

You should understand that the changes I demonstrated in the morph require advanced techniques, techniques that most plastic surgeons cannot handle.  Be sure to read the section in the "Web reference" link on how to stay out of trouble while searching for a rhinoplasty surgeon.

Your nose is also a good example of why computer imaging is mandatory in rhinoplasty. You need to know exactly what the surgeon is planning to accomplish -- what features he thinks he can change, and by how much he thinks he can change them. When you see his goals, you'll know whether he has an eye for a beautiful nose, and whether he shares your opinion of what constitutes a beautiful nose. You'll also know whether the changes he proposes are enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. But remember, you're not hiring him for his skills with the computer. The doctor must then show you his before and after photos to prove that he can actually accomplish what he draws on the computer.At the *very* bottom of the Web reference page is a link to instructions on taking photos that are most useful for online consultations like this, in case you'd like a more complete evaluation by submitting profile and three-quarter views.

Juan Carlos Fuentes, MD · Answer

In everybody, there is an asymmetry between the right and left side, and for that reason, some patients perceive that there is a nasal deviation. In your case the asymmetry on your nasal tip and also the shape and size of the nostrils, makes you see a nasal deviation, but there are also some asymmetries on the face, and a full photo is necessary to evaluate your case better. The right side of the face seems to be longer and wider than the left side, and also  you can see how the teeth on your left side is a little higher than in the right. All these differences contribute for what you see as a not straight midline. The rhinoplasty can improve the symmetry on the nose, but will not affect the asymmetry on the rest of the face. It is very important to be aware of the asymmetry before any procedure, and think that every one has an asymmetry, not just on the face, also on their bodies.

Eric M. Joseph, MD · Answer

Your second photo, not smiling, appears to show the tip of your nose off the midline to your right. You can certainly discuss this with your orthodontist, and rhinoplasty surgeon. Hope this helps. Dr Joseph

Michael Hakimi, MD · Answer

It is hard to give a definitive answer as your photos are not complete and the angles can make it difficult.

However, everyone has a smaller and a larger side to their face. They even age at different pace. Some have it more pronounced than others. In rhinoplasty we try to align the nose to the next adjacent structure. Our eyes at conversational distance will notice the asymmetry of the nose in comparison to the next adjacent structure like mouth or eyes. Sometimes you might benefit from more extensive bony surgery involving you upper or lower jaw.This will be more clear on your examination and the severity of he asymmetry in lower/ mid or upper face.

William Portuese, MD · Answer

Facial asymmetry is very common, therefore a full examination of the nose and face is required to determine whether the top of the nose and the bottom of the nose and the teeth are all centrally aligned. For more information about rhinoplasty, please see the link and the video below

Arian Mowlavi, MD, FACS (license on probation) · Answer

You are a great candidate for an open rhinoplasty which will allow your tip to be refined and have a more aesthetically pleasing shape.

Jon A. Perlman, MD (retired) · Answer

It appears from your photos that your tip cartilages are asymmetric and that the right side of your face is wider and possibly shorter than your left. Most people have facial asymmetries that are similar so focus on options that will make you happier about your appearance while recognizing that some asymmetry is expected even after surgery. Some patients who undergo rhinoplasty also like considering the use of fat grafts or fillers to strengthen their weaker manibular angle, jaw line, chin and cheekbones and these all remain options for you. A good example in my rhinoplasty photo gallery shows a male who received rhinoplasty, and fat grafts while recovering from hair transplant work (done elsewhere) to subtly refine his nose but to improve moderate facial and cheek asymmetry. Best wishes,

Jon A Perlman MD FACS

Certified, American Board of Plastic Surgery

Extreme Makeover Surgeon ABC TV

Best of Los Angeles Award 2015, 2016

Beverly Hills, Ca

Jon A Perlman MD FACS

Certified, American Board of Plastic Surgery

Extreme Makeover Surgeon ABC TV

Best of Los Angeles Award 2015, 2016

Beverly Hills, Ca

Richard W. Fleming, MD (retired) · Answer

It is normal to have some facial asymmetry. You do have a large asymmetrical nasal tip and some deviation which can be improved. The impact of your facial asymmetry will be discussed during consultation with an experienced rhinoplasty specialist.

David Alessi, MD - Account Suspended · Answer

It difficult to fully assess without an in-office exam.  However, the pictures show a slight deviation off midline.  This can be addressed with a rhinoplasty.  In you case, it does not appear that the orthodontia will affect the timing of your rhinoplasty.  Best wishes.

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