Dear pretty1cali in Los Angeles:
The nose does look a little bit operated on. You are correct. If you want less nostril show, then the practical answer is to have filler. There are temporary, as well as permanent fillers available to you. Likewise, you should learn the possibilities to increase the projection through the use of fillers also.
Surgical revisions are very challenging. Many of us have a lot of experience with them, but you need to know all of your options.
You want to do your homework before consultation. Prepare well for your consultation. When you search, look for rhinoplasty super-specialists. These are surgeons whose practice is the majority or entirely devoted to rhinoplasty, septoplasty, and related procedures. This would include both primary and revision rhinoplasty surgery. Why not have the most specialized talent in your service? Consider how much experience the surgeon has doing the procedure you are considering. We all get better at what we do with time and so those surgeons who have a long run of experience are the ones who have learned the most from experience. Residency and fellowship are where the learning begins, but for all of us, time and experience is where the education continues.
Part of your preparation for consultation should be preparing a list of questions beforehand. Bring a notepad or ipad or laptop with you and take notes as the surgeon answers the question you are asking. You should spend more time with the surgeon than with the office administrative staff, because you need to get a sense of whether you are comfortable with the doctor. You should not feel rushed that you are on a consultation conveyer belt. If the presentation by the office staff seems a bit to “salesie” that is a bit of a yellow or red light. Take a friend or relative along since two heads are better than one in gaining information and understanding. In the end, the purpose of the consultation is for you to be educated and be comfortable, not to be “ sold”. Ask yourself two key questions: “Is this surgeon teaching me or selling?” And secondly, “Can I put my life and my face into this particular surgeon’s hands? Can I trust him/her?”
There are excellent books out there that you can read and use to study up. It is worth the homework time you put in up front so that you make the right decision with respect to choosing a surgeon who has the talent, experience, and degree of super-specialization that you certainly want to have.
When you visit doctor’s websites, the most important feature on the site is the before and after gallery. If there are just a few examples of rhinoplasty or revision rhinoplasty, you wonder how much experience the surgeon has performing such surgeries. There need to be dozens and dozens of examples. The more examples there are, the more likely you will see one or more that demonstrate situations similar to yours. Look closely at the photos for natural results. That is what you want. Nobody wants to carry a sign saying “I have had a rhinoplasty.”
Reviews on review sites, particularly RealSelf are very important and should be carefully digested. The larger the number of reviews the most accurate the picture of the practice and particularly the doctor. A consensus is generally correct.
A consultation without computer imaging is, in my opinion, of much less value. Why shouldn’t you see the predicted result of the procedure the doctor is proposing? At consultation, photos are taken of you and loaded into a computer system that morphs your present appearance into the anticipated “after” based on the nasal surgeons input. Imaging is an incomparable learning tool because it provides a forum for doctor and patient agreement on what would satisfy the patient and what is, in the doctor’s opinion, achievable. After all, cosmetic surgery is 100% visual. It is about appearance, so without a visual evidence of what is planned, how can you make a decision as to whether or not you might be satisfied. Talking about it is worthless. To anticipate a successful outcome, there must be a meeting of the minds between surgeon and patient.
Robert Kotler, MD, FACS
Over 4,500 nasal procedures performed
Dear pretty1cali, An in office consultation aided with digital imaging will be very helpful to show you the minor adjustments that can be made with revision rhinoplasty taking into consideration your current nasal anatomy, scar tissue and skin thickness. The hanging columella can be addressed as well as the tip projection which is slightly over rotated giving your nose the unnatural appearance you do not like. The question is whether or not these subtle changes would be worth undergoing revision rhinoplasty. You need to weight the risk and reward when you are consulting with surgeons. Best regards, Michael V. Elam, M.D.
I think your projection is fine. The outline of your nose fits in the normal parameters. Your columella is somewhat low. There may be other things, around the tip, that are off, but just using these pictures I cannot say for sure what else you may need. You need a consultation with an expertise in rhinoplasty.
A revision rhinoplasty procedure can accomplish some minor refinements to the nose. It is very important to have realistic expectations on what can be accomplished with the procedure. The amount of changes but only be measured in millimeters. The hanging columella can be reduced along with decreasing the projection of the tip. For more information and many examples, please see the link and video below
The projection and rotation of your tip can be decreased with a revision rhinoplasty. This would reduce the nostril show and give you a more natural look. An examination will be necessary for me to make recommendations re the specific techniques that I would use. .