How do I decide between 2 surgeons that have 2 different opinions? (Photo)

Based on your photos, I agree that you appear to have relatively thick and oily nasal tip skin. This is associated with a wide nasal appearance, a dorsal hump, and a droopy tip. Personally, I do not love your profile nasal imaging. I believe that your tip is not rotated high enough, and your bridge may look less distracting with a delicate feminine curve rather than being completely straight. If your surgeon is not exuding confidence, please keep looking for a reputable rhinoplasty specialist that makes you comfortable. Thank you for this question and I wish you well moving forward. Sincerely, Dr. Joseph

In person exam is essential. You appear to be a good candidate for Rhinoplasty preferably performed through a closed technique. Your wish pics seem to be realistic provided you have an experienced Surgeon (there's no substitute for experience) , and your healing goes well . We always tell patients to look at Surgeon's before +after gallery to see their style of work, and thoroughly discuss your goals pre-op. Keep in mind it takes months to a year or longer for final refinements to occur especially with patients who present with thicker skin

It is possible to achieve the results you desire. However, no surgeon can guarantee the results. Revisions occur in about 15% of rhinoplasty patients.

Best Wishes,

Gary Horndeski, M.D.

Hello and thank you for your question.

I highly recommend that my patients focus much more on real longterm before and after photographs rather than 3D imaging.   I encounter so many patients in my practice who see me for revision rhinoplasty who previously had surgery elsewhere who feel like they were mislead into surgery by surgeons who relied heavily on 3D imaging without adequate real before and after pictures to back it up. Photoshop is easy but real surgery is very different.

I always recommend that you carefully evaluate your surgeon’s online before and after gallery on their website for both quality and quantity of results. Make sure that there are hundreds of real before and after pictures which demonstrate long-term follow up results. If your surgeon is posting mostly on table results without real long-term follow up results, that is usually a major red flag. If a surgeon is posting mostly just splint removal day videos without longterm follow-up pictures, that can also be a red flag. Long-term results are much more meaningful than on table results or 1 week post-op results.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

From these photographs, it does appear that you have thick skin which will hinder refinement in the nasal tip. Because of the thick skin, you may need several steroid shots in the tip of the nose to reduce swelling in that area after the surgery, so follow ups with your surgeon will be very important. Carefully study your prospective rhinoplasty specialist's before and after rhinoplasty photo gallery, which should be extensive with lots of natural looking results. In our practice, we perform closed rhinoplasty with all the incisions placed on the inside of the nose, and no painful packing is placed inside the nose either. It's also important to release the depressor septi ligament which prevents the tip from drooping downward when smiling after the surgery.

Personally, I don’t think working with morphed images is very useful when it comes to choosing a provider.
The type of work you’re looking to have done is pretty standard reduction rhinoplasty work.
Sufficiently experienced surgeon should have plenty of before and after pictures of previous patients with very similar facial characteristics, giving you an idea of what can and cannot be accomplished along with the experience of each provider.
Bring pictures of your face to use as reference during each consultation.
During each consultation, ask each provider to open up their portfolio And show you their entire collection of before and after pictures of previous patients with similar facial and nasal characteristics.
Experience provider should have more before and after pictures for you to look at then you have time for during the consultation.
This is much better than looking at morph images, which has a little to do with what can or cannot be achieved during surgery.
It shouldn’t be that difficult to get the results you’re hoping for.
Did either of the surgeon talk about adding a Cartlidge graft to your tip?
I suggest patients look for plastic surgeons who specialize in rhinoplasty surgery, either exclusively, or as a major part of their practice.
Look for plastic surgeons were members of the rhinoplasty society.
Personally, I would probably schedule quite a few consultations before selecting a provider.
Most patients don’t have much experience consulting with plastic surgeons.
The more consultations you have the better you’ll be at the process, including the ability to vet providers correctly.
Best,
Mats Hagstrom MD