Over rotated and over projected nose (Photo)

Had rhinoplasty with a leading surgeon two years ago. This was my second rhinoplasty, and I have had a break, so I was a tough case. He's a very nice guy. He did a great job getting the nose straight, and it looks great from the front. He improved my breathing. I like him and won't say his name, but am I wrong to think that he also greatly over projected and over rotated my nose? I cringe when I see my nose in profile now. To me, it looks like a guy who is in deep need of a nose job. Thoughts?

Doctor Answers 8

Over projection and over rotated nose

You are correct about your analysis. You also have retracted nostrils and slightly hanging columella (the central column) that are contributing to the surgical appearance.

Cleveland Plastic Surgeon
4.7 out of 5 stars 22 reviews

Over projected?

Thanks for your question. You are clearly an experience nasal surgery patient but it sounds like you would agree that you had a successful surgery, at least the second time. The fact that you breathe well from your nose is not to be taken for granted. In addition you are happy with your frontal appearance which is paramount. The frontal view is by far the most important aesthetically for the simple reason that social interaction takes place front to front, typically. The profile view is one that is rarely on display, and has regained focus mainly due to the pictures of social media. In my opinion you are not over rotated at all. While you do have a strong projection, it a masculine feature that actually is rather well balanced with your chin. I think your positive feelings toward your surgeon are an important insight into your overall assessment of the work done. Seems like it was a job well done. Hope this helps

Julian W. Dixon, MD
Chicago Facial Plastic Surgeon
5.0 out of 5 stars 7 reviews

Tension nose

The nose appears to have a tension tip. It can be brought down but every revision surgery carries a higher risk. If you decide to undergo a third rhinoplasty, stay conservative and get only mild tip work. Sometimes just reducing the front bottom end of the nasal septum can release enough tension to pull down the tip. 


Dr. J

Tanveer Janjua, MD
Bedminster Facial Plastic Surgeon
5.0 out of 5 stars 107 reviews

Over Rotated and Over Projected after Rhinoplasty

Your projection can be decreased and the columella lifted with a revision rhinoplasty. I suggest you share your concerns with the surgeon who did your revision surgery; you have confidence in his work.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 38 reviews

Overprojected and overrotated

I appreciate that you have waited this long for your nose to completely heal. I don't think that you are being unreasonable to think that your nose is overprojected and slightly over rotated. It sounds like it is bothering you considerably so I would recommend scheduling a consultation with a revision rhinoplasty specialist to see what your options are and if you are willing to undergo another surgery. Best of luck.

Michael T. Somenek, MD
Washington DC Facial Plastic Surgeon
5.0 out of 5 stars 30 reviews

Your nose can be de-projected

I think it's more over-projected than over-rotated. See the "Web reference" link, just below my response. I made a computer morph of your nose, and an animation of the morph, to show the changes that are possible for your nose in truly expert hands.

You only posted the one view but often, when a nose is deprojected, brought back closer to the face, it looks longer: it looks less as though it's upwardly rotated.

Making a large deprojection to the nose involves complex work on the tip of the nose, which is why many revision patients that I see still have over-projected noses. The good news is that deprojecting a nose, when done with proper technique, is one of the more predictable changes to make in a rhinoplasty, even a revision.

You should understand that the changes I demonstrated in the morph require advanced techniques, techniques that most plastic surgeons cannot handle.  Be sure to read the section in the "Web reference" link on how to determine whether your primary (and secondary) surgeon should perform your next operation.

Your nose is also a good example of why computer imaging is mandatory in rhinoplasty. You need to know exactly what the surgeon is planning to accomplish -- what features he thinks he can change, and by how much he thinks he can change them. When you see his goals, you'll know whether he has an eye for a beautiful nose, and whether he shares your opinion of what constitutes a beautiful nose. You'll also know whether the changes he proposes are enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. Then, he must show you before and after photos to prove that he can actually accomplish what he draws on the computer.

Steven M. Denenberg, MD
Omaha Facial Plastic Surgeon
4.8 out of 5 stars 41 reviews

Post Rhinoplasty

Thanks for your post and thoughtful comments. Unfortunately I agree with your assessment that your nose appears somewhat overprotected in the tip area and the infra tip lobule is slightly too rotated. There are rhinoplasty techniques designed to deproject your tip and improve the overall profile rotation and related issues. These are advanced techniques and typically require an open approach revision rhinoplasty for the best results. Have you shared your concerns with your physician? Your respect and kind comments about him suggests that he would be open to discussing your interest in additional improvement for your nose. I recommend you start with a follow up consultation to get recommendations about deprojecting your tip and other enhancements you wish to consider. Hopefully he will share your concerns and offer additional correction. If not, consider another opinion with a reputable revision rhinoplasty expert. Best wishes. 

Fred J. Bressler, MD, FACS
Houston Facial Plastic Surgeon
5.0 out of 5 stars 7 reviews

Post operative results

Thank you for the picture! That being said, without seeing your before picture, It is hard to say how much of an improvement you obtained with your surgery. What did your operating surgeon think? Where you both on the same page as far as what the operative plan was? I guess my point is that without knowing where you were, it is hard for me to assess your outcomes in an objective manner.  It sounds like you have a great relationship with your operating surgeon, so I suggest letting them know about your concerns.  

Miguel Mascaro, MD
Delray Beach Facial Plastic Surgeon
5.0 out of 5 stars 8 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.