Is more augmentation and osteotomy needed to make my nose less flat when looking downward?

Question

HelIo. I had a rhinoplasty with rib cartilage to reconstruct and I like the profile when my head is looking up or slightly tilted up. I noticed when my head is very straight on camera or looking downward, it's very bulbous. Would more bridge augmentation and osteotomy be needed to improve my downward profile to make my bridge appear more thin and more defined when looking downward? Also, what would make the supratip and tip look less flat? Would defatting the tip a bit be overly risky?

Randal Haworth, MD, FACS · Answer

1. **Downward Profile:**
   - Discuss with your surgeon if additional bridge augmentation or osteotomy is recommended to improve the appearance when looking downward. They can assess your current nasal structure and provide insights into the feasibility and potential outcomes.

2. **Supratip and Tip Definition:**
   - If you find the supratip and tip appear flat, your surgeon may recommend refining these areas for improved definition. Techniques such as tip grafting or adjustments to the existing cartilage may be considered.

3. **Defatting the Tip:**
   - Defatting the tip is a delicate process that involves removing excess soft tissue. The decision to proceed with this would depend on your specific anatomy and the balance needed for your overall facial aesthetics. Discuss the potential risks and benefits with your surgeon.

Best of luck !

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