Which surgeon to choose? what is needed - Rhinoplasty (photos)

I have been to 2 plastic surgeons and 2 ents regarding getting a Septo and rhinoplasty. I have got mixed feedback. Plastic surgeon 1 told me he will elevate the tip remove the hump and straighten the nose. the other told me that he would remove the hump and narrow the tip and straighten the nose. ETN 1 - straighten nose, narrow the tip and remove the hump. ENT 2 - straighten the nose and remove the hump, he said he wouldn't touch the tip. I am confused and would like some profession advise.

Doctor Answers 9

Wow. Confusing to get such different opinions. Some of those doctors don't understand rhinoplasty.

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See the "Web reference" link, just below my response. I made a computer morph, and an animation of the morph, to show the changes that are possible for your nose in truly expert hands. I elevated the tip of your nose, lowered the bump, and brought the entire nose back closer to your face. Certainly you need at least all three of those changes.

You do not need increased projection to the tip. "Projection" means how far forward, away from your face, the nose sits. Your strong hump makes the tip look weak in its forward projection, but really the tip is strongly projected already. In the morph, I moved the tip closer to your face, "deprojecting" it. Perhaps it should be moved even a closer to your face than in my morph.

If your tip is not elevated, to make the nose look shorter, your nose will look awful. Your nose is long now, and lowering the bump will make it look even longer, so the tip needs to come up. Your tip must be elevated, so if a doctor said not to do that, stay away! And elevating the tip *is* lots of work on the tip, so the doctor who said he wouldn't touch your tip is also off base.

From the front, your nose seems off center, and that can be addressed at the same time as making the other changes.

You should understand that the changes I demonstrated in the morph and discussed here require very advanced techniques, techniques that most plastic surgeons cannot handle. Be sure to read the section in the "Web reference" link on how to stay out of trouble while searching for a rhinoplasty surgeon. And you **MUST** see the doctor's before and after photos, finding other patients with changes somewhat similar to what you want for yourself. You have a very difficult rhinoplasty, and you don't want to be looking for a revision later.

Omaha Facial Plastic Surgeon
4.8 out of 5 stars 42 reviews

The chosen one, some advices:

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Thank you very much for sharing your concerns with us.
I usually tell my patients that the first step for a safe plastic surgery is to choose a board certified aesthetic and reconstructive plastic surgeon.
This should have a personal website containing details of his professional biography and some photos of the procedures performed.
Your plastic surgeon should be transparent and a honest person with you, with ethical and human values, and especially with good reputation and history. Also, it's much better if this doctor have special training and experience in procedures like the one you're interested.
Kind regards,
Dr. Emmanuel Mallol Cotes.-

Emmanuel Mallol Cotes, MD
Dominican Republic Plastic Surgeon
4.7 out of 5 stars 334 reviews

Goals of Rhinoplasty Surgery

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On the basis of these pictures I would recommend removal of the obvious hump, define the tip and increase tip rotation shortening the nose, and straighten and narrow the entire nose from the front view.To achieve the ultimate goal of a natural feminine nose consult with a rhinoplasty specialist, that is a surgeon who devotes most of their practice to this surgery. A small chin implant should be considered.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 42 reviews

Best rhinoplasty for me?

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From the answers you described you need another opinion from a very experienced revision rhinoplasty specialist. The reason for this is you have a large hump, bulbous tip, insufficient to projection, etc. all of these can be corrected but the tip needs to be advanced to increase projection. See an experienced rhinoplasty surgeon who can show you examples of his work in noses like yours and don't rely on imaging.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 36 reviews

Rhinoplasty recommendations

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Hello! It can be confusing when talking to different surgeons, as each surgeon has his/her own approach. It is important to look at before/afters the surgeon has performed, ensure the surgeon is performing a good number of COSMETIC rhinoplasty (at least 50 a year) and perhaps even ask to talk to former rhinoplasty patients about their experience. Photo morphing is also very helpful in guiding the decision making process and virtually all surgeons who do a large number of rhinoplasties can do this for you. Experience matters- it is best to make sure you go to someone who doesn't just do the occasional rhinoplasty between many breast augmentations. Ask pertinent questions and take your time in proceeding. Revision rhinoplasty is much more difficult and costly, and often avoided by careful selection of your primary surgeon. Good luck!

Catherine Winslow, MD
Indianapolis Facial Plastic Surgeon
4.7 out of 5 stars 43 reviews

Rhinoplasty surgeon

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Hi maru88,
Rhinoplasty is partly mechanical and partly artistic. There are certain mechanical aspects of rhinoplasty that need to be performed to ensure that breathing is not compromised. However, apart from that, it is definitely an artistic pursuit. You should go with your gut feel of the surgeon who you think has the greatest ability to improve your nose artistically from your point of view.
Warwick Nettle


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Hello Maru88,
Thank you for your question and pictures.  You have some complex issues with your nose and obviously they are all interrelated and interconnected.  I think it is a mistake not to address your tip because the deviation of your nasal septum involves your tip.  I would go with the surgeons who recommended addressing tip, hump reduction, and attempting to straighten your nose.  You will likely need spreader grafts and not all surgeons place these grafts in the nose.  These grafts decrease the possibility of collapse of the midportion of your nose, after surgery.  Go with your gut instinct when choosing and an experience rhinoplasty surgeon.  Best of luck!

Elbert T. Cheng, MD
San Jose Facial Plastic Surgeon
5.0 out of 5 stars 1 review

Which surgeon to choose? what is needed - Rhinoplasty

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You need to find a surgeon who is certified by the American Board of Plastic Surgery and very experienced in rhinoplasty. It looks like you need a hump reduction and correction of tip ptosis based upon the limited photos. There are several board certified surgeons, like myself, who are certified in both plastic surgery and otolaryngology (ENT). That might be your best choice. Good luck.

Richard Chaffoo, MD, FACS, FICS
Triple Board Certified Plastic Surgeon

Rhinoplasty and chin implant

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 A closed rhinoplasty approach can address shaving down the dorsal hump, straightening the nose with a spreader graft, and osteotomies will narrow the nasal bones. Releasing the depressor septi ligament will prevent the tip from drooping when smiling. A full examination of the internal portion of the nose is required to make the diagnosis of a deviated nasal septum. Only a minimal amount of tip rotation is required, but  some type of tip surgery will the required due to the asymmetric and bulbous tip that is present. Also important to consider a small chin implant which would bring  the chin forward to help with facial balance and proportions, especially with respect to the overly projecting nose. Chin implants are placed through this small incision underneath the chin, and the size and shape are determined again at the time of the consultation

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 155 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.