Does my New Nose Fit my Face? (photo)

Question

I had rhinoplasty 4 years ago, but I've never been completely thrilled with my results. I told my surgeon at my 1 year that I was concerned too much was taken off the bridge, and the tip looked a little bulbous. He said I was over analyzing it and kind of got frustrated with me when i was upset my nose was dipped when we discussed keeping it straight. Here are my questions: is my tip bolbous, or does it fit my face? Is my nose still long? Does the profile view fit my face and look good dipped?

Aaron Stone, MD · Answer

I do not think you are over analyzing it. You see things you do not like and are justifiably looking for answers and an accurate description of the situation. Your posted photos show a cloverleaf shaped asymmetric tip that is projected too far forward out of the plane of your face. You perceive the over projected tip as a dip in the bridge but I do not think the bridge was over resected or that you have a true ski slope.
	
	A revision consisting of shortening the inner limbs of the tip cartilages and suture reshaping/realignment of the tip cartilages with or without minor trimming of the tip cartilages may give you what you are looking for. Enough time has passed for you to have the revision if you wish. I think most surgeons would want to use an open approach for that type of revision. If you decide to go to another surgeon for the revision it would be in your best interest to bring copies of preoperative photos and the previous operative report to him/her.
	
	I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.
	
	My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship in order to know if this assessment is valid.

Steven M. Denenberg, MD · Answer

Hi,

	You absolutely are not over analyzing your nose; there are some real issues, and your doctor should be able to recognize them. Click on the "Web reference" link in my answer for a morph showing a correction of the main part of your issues.

	The problem is not that your bridge was over-resected; I don't think it was. The problem is that the tip of your nose is still over-projecting. That is, it projects too far forward, away from your face. Also, when a bridge is carved, and then when the tip's projection is lessened by bringing it closer to the face, the tip should be elevated. That is, raised, to make the nose look shorter.  "Shorter" means that the distance from where the nose begins between the eyes, down the length of the bridge to the tip, is less. As you'll see in the morph, when the tip is brought back closer to the face, the bridge no longer looks over-resected!

	The problems that you have are not unusual, because deprojecting and raising a tip involve complicated work on the tip cartilages. An over-projecting and drooping tip are two of the most common issues I see in patients who are considering revision surgery.

	The good news for you is that, in competent hands, bringing the tip of the nose back toward the face, and elevating the tip, are two of the most predictable changes that are made in rhinoplasty, even in the much-more-difficult revision rhinoplasty. Also, the techniques that elevate and deproject the tip often also work to narrow the tip.

	As revisions go, I would be optimistic for a good result for you.

Donald B. Yoo, MD, FACS · Answer

Each surgeon will have his/her preference on what represents an "attractive" nose.  You raise some valid points regarding the appearance of your nose, though it sounds you and your surgeon are not on the same page aesthetically.

Pablo Prichard, MD · Answer

Dear Boston,

	Thank you for your question.  Some of what you are describing is preferrence.  This is why it is important to go over many photos with your surgeon so that you are he are clear to what your desire is.  Also, computer simulation also helps in this respect.  In my opinion, a little less projection of the tip will decrease the slope that you talked about.  Also, I would consider a chin implant to bring better balance to your face.

	Best Wishes,

	PAblo PRichard, MD

William Portuese, MD · Answer

When performing a rhinoplasty for the overly projecting knows it is important to adjust the projection of the tip backwards in relation to the remainder of the nose. This can be accomplished with a combination of cartilage grafts, suturing techniques, de- projection of the entire tip to balance with the remainder bridge line. Please see the link below for examples similar to your own nose

Does my New Nose Fit my Face? (photo)

Answers (6)

Answer: Does my New Nose Fit my Face?

Answer: Does my New Nose Fit my Face?

Answer: Revision rhinoplasty for bulbous nose and shallow dorsum

Answer: Revision rhinoplasty for bulbous nose and shallow dorsum

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Does my New Nose Fit my Face? (photo)

Answers (6)

Answer: Does my New Nose Fit my Face?

Answer: Does my New Nose Fit my Face?

Answer: Revision rhinoplasty for bulbous nose and shallow dorsum

Answer: Revision rhinoplasty for bulbous nose and shallow dorsum

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Recommended reading

Everything you need to know about Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.