I'm interested in narrowing my wide nose & fixing my tip. I've not had previous surgery. The first surgeon I consulted, a general PS, expressed that my nose was abnormal & he felt uncomfortable performing on me. (He subsequently referred me to an out-of-town rhinoplasty specialist). Apparently, my nose is mostly cartilage - even the upper 1/3. The pictures provided outline my "nasal bones." Outside the line = bone. Inside = cartilage. Considering this, what advice do you have? Any concerns?
Is it Possible to Narrow Nose W/ Short Nasal Bones? (photo)
Doctor Answers 13
Rhinoplasty is generally successful for all anatomic situations.
The photographs you submitted are quite interesting and helpful, and indeed you have a disproportionate amount of cartilage in your nose versus bone. However, the principles are the same: You need to have a reduction rhinoplasty in which some of the cartilage is removed, allowing the nose to narrow. Typically in this case, it is the upper lateral cartilages that must be dealt with, since that tissue is occupying the midsection of the nose.
At the time of surgery, the surgeon will be able to see the anatomy and make the appropriate surgical decisions and execute the proper technique.
Remember that it is going to take time for Nature to complete the mission. Do not expect your nose to look fabulous in 5 or 10 days. But over a period of weeks and then months, it should continue to narrow and improve. Typically, the middle and lower parts of the nose take longer to “shrink down” than the upper third; the upper third, of course, is generally nasal bones. In your case, with the disproportionate amount of cartilage relative to nasal bones, expect it to take a little longer, but have faith Nature will do the job.
Robert Kotler, MD, FACS
Facial Plastic Surgeon
Author, SECRETS OF A BEVERLY HILLS COSMETIC SURGEON
Author, THE ESSENTIAL COSMETIC SURGERY COMPANION
Short nasal bones
Short nasal bones, thick skin, excess width, poor projection etc. are all problems that experienced rhinoplasty surgeon deal with on a regular basis. You can have a nice result if you see someone with experience and comfort using a variety of techniques, not someone who does the same procedure on every patient. The surgeon you saw should be complemented for referring you on to someone with a greater interest in rhinoplasty. Don't obsess about your anatomy, let your surgeon decide how to improve it for you.
Is it Possible to Narrow Nose W/ Short Nasal Bones?
Until I examined you or see a CT scan of your nose, it would be hard to believe this diagnosis! Even if this is true, rhinoplasty can be done. The principle of this procedure is the same. You do have a nice profile except for your tip, so, the dorsum need not be reduced too much. If the concern is with lateral osteotomy, spreader grafts will stabilize the upper nasal vault.
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Possible to narrow nose w/short nasal bones
It is certainly possible to narrow short nasal bones by performing both medial and lateral osteotomies. Look for a rhinoplasty specialist who has extensive experience in the field of rhinoplasty and revision rhinoplasty and the short nasal bone should not be a problem.
Your posted photos show a typical thick skinned, wide bridge nose with a polybeak due a bit of excess septal cartilage at the lower front aspect of the cartilage. You say the general plastic surgeon referred to a rhinoplasty specialist because of anatomical concerns but you do not say if you saw the specialist or what he/she said.
The nasal bones are considered short when the lower edge is less than half the distance from the radix to the septal angle. The outer lower ends of the lines you drew is below the half way point therefore you do not have short nasal bones if the extent of the line is correct. The concern with short nasal bones (which you do not have) is if you have an open roof, separated lateral cartilages from the septum and an infracture you will get airway collapse. Spreader grafts are required in those instances to prevent the collapse.
Secondly you write that within the outline is cartilage and outside of it is bone. That is not normal human anatomy and is not consistent with your photos that show a keystone area (cartilage bone junction) almost at the midpoint of the bridge.
What your post does corroborate is the danger that a little knowledge in the wrong hands can be warped into something that it is not and that this situation is more come in a world with an internet. Your case is not so much out of the ordinary and I think any of the surgeons responding to this post could achieve a good result with normal rhinoplasty modalities.
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.
Your nasal bones are probably longer than you think, and you may be a candidate for nasal narrowing with Rhinoplasty Surgery.
I read your concerns and reviewed your photos:
I doubt that the outline you drew on your nose is accurate. Only an examination could determine the extent of your nasal bones, but I doubt your entire nasal bridge is cartilaginous.
Consider consulting several rhinoplasty specialists to see what you might expect to achieve after well-performed Rhinoplasty Surgery. My hunch is that you might achieve adequate narrowing and tip refinement.
I hope this is helpful.
Rhinoplasty in Patient with Short Nasal Bones
With all due respect, while doing rhinoplasty for over 35 years I have seen patients with short nasal bones, but in your picture your markings suggest there is basically an absence of nasal bones. This is extremely unlikely - I've never seen this. With short nasal bones grafts must be used to maintain support of the middle 1/3rd of your nose.You need to be evaluated by an experienced rhinoplasty surgeon.
It is certainly possible to perform a rhinoplasty on your nose. I thinhk that you have to be realistic with expectations because at least from the photos, your nasal tip and tissues appear wide. An exam in person is cirtical.
Is it Possible to Narrow Nose W/ Short Nasal Bones?
I have performed Rhinoplasty and complicated Revision Rhinoplasty for over 20 years and I'm not sure that your nasal bones are indeed as you have outlined them. Even with short nasal bones, the nose can be narrowed, so this may be a moot point. It rather becomes a matter of "what technique" is best to accomplish the desired goal. Closed Rhinoplasty with medial and lateral osteotomies and Tip Plasty to thin the nasal tip would be required IMHO.
Revision rhinoplasty for the wide nose.
Revision rhinoplasty for the wide nose can be done even if you have short nasal bones. The bridge, mid vault and tip can be narrowed and properly supported even if you have underdeveloped nasal bones.
For 35 years I have done noses like yours with the open approach which allows the surgeon to have a better view of the problems and suture grafts in place, etc.