I Want a More Refined Nose, Are my Expectations Realistic, or Am I at Too Much of a Risk for my Nose to Look Worse? (photo)

My nose has a little bit of a bulbous tip, as well as a line at the tip and on the columella, a "butt" nose. The columella hangs down as well. I like my profile from the left, angled, but from the right its horrible and hangs so much. I want my nose, but more refined, because I want to look like myself! :) I am generally happy with my looks it's just my nose that makes me feel less confident at times, especially when someone is to my right, or taking a photo from my bad side, or even the front.

Doctor Answers 21

Best Treatment for Rhinoplasty Refinement Without Risk to Nose

Hi Imj,

Your expectations for refinement and improvement of your nose are realistic.  The only way that you are at too much risk is if you choose your rhinoplasty surgeon poorly.  From your right profile view it appears that you have a little extra collumellar show, that is your right nostril edge is slightly retracted and the bottom portion of your nasal septum (the center divider of your nose) is showing an extra millimeter or two.  Your nasal tip cartilages ("butt nose") is corrected by using sutures and very minimal trimming.  

Your most important job is to make sure that you get a few rhinoplasty consultations with expert rhinoplasty surgeons, and then make sure that you choose your surgeon most carefully!  Your nose refinement should look natural and no one should be able to tell that you had surgery done once you recover. Good luck and be well.

MIchael A. Persky, Md, FACS

Encino, California

Encino Facial Plastic Surgeon
4.8 out of 5 stars 36 reviews

Rhinoplasty candidate with realistic expectations


Dear LMJ, Thank you for your recent inquiry. You are an excellent candidate for a rhinoplasty which will address the issues that are bothering you. A rhinoplasty when done with expertise will provide the refinement that you are looking for and address the issues of the bulbous tip and hanging columella while still having a natural looking nose. With the age of Facebook and Instagram it is very common to have many young patients in my office with similar requests in refinement rhinoplasty. I personally use a digital imaging computer during the consultation which allows me to show the patient their proposed surgical results. I hope this is helpful to you and please seek an expert in the field of rhinoplasty and you should have an excellent result. Best regards, Michael V. Elam, M.D.

Michael Elam, MD
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 208 reviews

Tip plasty for columellar clefting and sublobular fullness

The concerns you raise are commonly corrected with suture tip plasty techniques that reshape the cartilages and close the gap in the columella. You should be able to obtain those changes without overly complex surgery. This can be done via closed or open approach. 

You are a great candidate since it is an isolated issue on an otherwise attractive face and you will carry the result nicely. Computer imaging will help you to see the potential change. 

All the best

Richard W. Westreich, MD
Manhattan Facial Plastic Surgeon
5.0 out of 5 stars 51 reviews

Nasal refinement

Refinement of the nose is very possivle with subtle changes to the columella as well as the nasal tip.  Best to go for a consult. Good luck.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Bulbous tip and columellar show

You are an excellent candidate to perform a rhinoplasty.  Adjusting the dorsal esthetic lines to make them more symmetrical, narrowing the bulbous tip, removing the cleft in the tip and reducing the columellar show can all be accomplished.  It is best to seek out a very experienced rhinoplasty surgeon.  Virtual rhinoplasty software is available on our website for you to try

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

Hanging columella

Hi.  Your expectation seem very reasonable.  You do have a significant hanging columella.  I treat this issue with a technique called the tongue-in-groove maneuver, which involves making a pocket inside your columella (groove) and advancing it onto the front part of your septum (tongue).  This leads to a very predicable improvement and also keeps the base of the nose stable after surgery.   The line on the tip (aka "butt" nose) is caused by a shadow between the two halves of the tip.  This is called a "bifid tip" and is frequently corrected with rhinoplasty.  You have beautiful features and would do well with a properly done rhinoplasty.  As we always say, select a surgeon who does lots of rhinoplasty and whose work you like.  Good luck...

Matthew Bridges, MD
Richmond Facial Plastic Surgeon
5.0 out of 5 stars 24 reviews

Refinement from rhinoplasty

One of the dangers of rhinoplasty is using terms such as a refinement, and it is always best if you can identify and point out issues in your photo such as the hanging columella. Computer simulations can be an invaluable way to accurately see just what a 'refined' nose might look like on you.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 42 reviews

Rhinoplasty Expectations

Hi. It seems that you have taken the time to understand exactly what you do not like about your nose.  From what I can see, you have realistic expectations and are a good candidate for the procedure.  Do some research and come up with a couple of surgeons you think you should see.  Then head to the consultation and see how you feel about what they have to tell you. Dr. B

Ramin Behmand, MD
San Francisco Plastic Surgeon
4.8 out of 5 stars 39 reviews

Rhinoplasty for refinement of the bulbous tip, etc.

Refinement of your bulbous tip and hanging columella are realistic. My patients like natural noses that do not change who they are and want a natural, non surgical nose. Subtle rhinoplasty is an art and you need to select a very experienced rhinoplasty surgeon. 

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

Great candidate for rhinoplasty with realistic expectations

Hi lmj123,

I think that you are an excellent candidate for a rhinoplasty that refines your tip. Your columella does hang and there is some bulbosity and heaviness to your tip. These can be successfully surgically modified by surgeons who are experienced in rhinoplasty. The last part of that sentence is key: find someone who does a lot of rhinoplasty and revision rhinoplasty. There are several people in the greater Los Angeles area that can help you.

Good luck,

Michael Kim, MD

Michael M. Kim, MD
Portland Facial Plastic Surgeon
4.9 out of 5 stars 39 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.