Does my New Nose Fit my Face? (photo)

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.

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.  

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

 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

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.

Rhinoplasty results are very subjective.  Let's assume you had not had a rhinoplasty, and evaluate what I see on your photos from that point of view (understanding that I would really need to examine your nose in person to really evaluate it well).  Your nasal tip over projects, sticks out too far, relative to the height of the rest of your profile.  It could be brought closer to to your face, but perhaps what you want is for the rest of the profile to come out more.  Through morphing of your images in the office a plan can be developed.  Also, it is important to have photos from before surgery to morph to get an idea of what you wanted originally; because I would not have your original nose sitting in front of me.   "Bulbous" is kind of a nebulous term, but generally most patients think of it as being a tip that is too wide and lacks definition. Your tip could probably stand to have some more definition and be a bit narrower.  From the views you sent, your chin looks also a bit short.  Adding a bit more length to your chin might help with the overall profile of your face.  I think your nose "fits" your face but is just not what you want.  I have attached a link that might provide some information.  It is a mini-website that walks you through different types of changes in rhinoplasty.