Can I achieve refinement with medium thick skin? (Photo)

Thank you for your question. You are an excellent candidate for rhinoplasty. I agree with your assessment and 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 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.

The nose naturally tends to get longer with age, as gravity pulls on it over the decades, so it's not unusual that you would think it's longer than it was. Also, for many people, the skin tends to get thinner, showing the underlying tip cartilages better, a very subtle change, but we interpret it as the tip getting wider. From these photos, you don't seem to have skin that particularly thick. It's probably more that the cartilages are strong, and that bodes well for the results of a rhinoplasty. The goal might be to elevate the tip a bit, narrow the tip, and lower the little bump along the bridge of the nose. That would also serve as a facial rejuvenation operation, because elevating the tip of a nose back to where it was 20 years ago makes the face look younger.



How *much* to elevate the tip, or narrow the tip, or make other changes? We figure that out with morphs, well before surgery. I'd love for you to see some excellent professionally-designed morphs of what could possibly be done with your nose. Morphs could also help you identify better just what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. Profile and three-quarter views would be particularly important in morphing your nose. (Side note: in my opinion, morphs should really be done by the surgeon, or he should direct an assistant as she makes the morphs. Morphs should be made with a constant eye to what actually *can* be done in surgery, for that particular nose, and the surgeon has that information and judgment best.)

Finally, remember that rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The changes that your nose needs require advanced techniques, and skill that most plastic surgeons don't possess with expertise. It's much better to not have surgery than to have inexpertly-performed surgery. Read my essay on how to stay out of trouble while selecting a rhinoplasty surgeon. And it also discusses how to take photos that are best for online evaluations.