Rhinoplasty to narrow nose, refine tip, build up bridge, and possibly turn tip down a bit. Is this possible? (photos)

Question

I've never wanted a plastic surgery more than a rhinoplasty in my entire life. I've always hated my nose. looking to correct: 1. too wide, especially near the tip 2.especially bulbous near the tip 3. may also be too upturned, giving me a pig-like effect (and large nostrils) 4. My bridge just below brows is mostly skin where others have bone. I would like a more gradual slope I was told my only option to build up my bridge is a rib graft, is this true? My dream nose is Kim K's current nose.

P. Daniel Ward, MD · Answer

I think that the goals for your nose could definitely be accomplished with rhinoplasty. Refining the tip, narrowing the nose, derotation of the nose, and building up the bridge would be the main goals, in your case. Look for an experienced rhinoplasty surgeon.

Jag Chana, MD, FRCS(Plast) · Answer

Your goals are achievable but you will need rib cartilage grafts to augment the dorsum of the nose with a satisfactory amount of material. This is best achieved using a technique where the rib cartilage is diced and placed inside a tube of fascia. As you say, the lengthening of the nose would also improve the aesthetics and is achieved by using pieces of cartilage from the septum as extension grafts. The tip refinement is a standard technique. Be sure that you seek the opinion of an experienced plastic surgeon who has experience of using rib grafts. Rib grafts are commonly used in revision techniques and so a surgeon who regularly performs revision rhinoplasty would have the necessary experience .Good Luck

Gerald Minniti, MD, FACS · Answer

Hello,Your bridge is low and it's take off from your forehead (the radix) is low too. Rib is the only donor site with sufficient cartilage to use for diced cartilage grafts, as well as sufficiently long and strong caudal septal extension grafts. Best of luck!

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your
photograph, you may benefit from a tip refining rhinoplasty.  You may also benefit from a nasal tip derotation to lower your tip.  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. FACS
Harvard-trained plastic surgeon

Toby Mayer, MD · Answer

Rhinoplasty for the short upturned nose. Yes, this can be done with your septal cartilage for the bridge without a rub graft and a septal extension graft etc. See a very experienced rhinoplasty surgeon who can show you many photos of his results with noses like yours.

Philip J. Miller, MD, FACS · Answer

One of the biggest limitations to improving the tip is simply the skin. Unfortunately, we can make the inside of the nose as small as possible but the overlying skin needs to contract around the cartilage underneath. I would recommend starting with a consultation with a board certified facial plastic surgeon that specializes in rhinoplasty surgery to discuss your desired results. 
Sincerely,
Philip J. Miller, MD, FACS Double Board Certified Facial Plastic Surgeon

Jeffrey Jumaily, MD · Answer

The improvements that you want to make are realistic. I do understand your concerns about the rotation and the bridge. It's hard for me to say without a detailed examination whether you require rib graft or not. If there is a lot of septal cartilage then may be rib is not required and ear cartilage can used instead. But if you wish for more notable changes, perhaps rib graft is needed. We would be happy to consult with you if you want another opinion on the best way to proceed. Best wishes

William Portuese, MD · Answer

Yes, it is possible to make the refinements in your nose that you're asking for. The bridge line can be built up with the patient's own cartilage harvested from inside the nasal septum, the bridge line can be narrowed with osteotomies, the  nasal tip cartilages narrowed, and tip can be rotated downwards. This can all be accomplished with a closed rhinoplasty approach, whereby all of the incisions are placed on the inside of the nose. No external incisions are required. For many examples, please see link and the video below

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

Your nasal tip desires are right on the mark; all the changes you are desiring are exactly what is needed to make your nose more proportionate and refined; a rib graft is in fact what you need; the dorsum will be augmented with a diced cartilage burrito graft and your nasal tip with a septal extension graft to make it slightly longer and down turned. A consultation with a nasal specialist will help you appreciate the changes you are seeking.

Frederic H. Corbin, MD (license restricted) · Answer

Thank you for the photos and question and I would go on some complimentary consultations with experts who use digital photography to show you what is possible and how it might be accomplished and then look at photos of similar patients and find your surgeon Dr Corbin

Rhinoplasty to narrow nose, refine tip, build up bridge, and possibly turn tip down a bit. Is this possible? (photos)

Answers (13)

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