Getting Nasal Spine Removed, Should id Not be Messed with? (photo)

please see my previous answer..   this spine should absolutely be addressed with your rhinoplasty. this is fairly basic

Not everyone needs to have the nasal spine removed.  However, there is a significant portion of patients for whom it is very appropriate and wise.  Typically those are patients who have an indefinite junction between the upper part of the lip and the base of the nose.  When there is a web-like appearance on profile, this suggests that there is plentiful tissue taking up space and that is usually the nasal spine and perhaps the nasal septum just above it. 

The combination of a prominent nasal spine and generous nasal septum often creates what we call a “tension nose” in which the tip of the nose over-protrudes forward.  It can also be caused by a high septum, whether straight or deviated, just above the tip of the nose.  In any event, a complete examination always includes looking and feeling and determining if in fact the nose deserves sculpture at that nose-lip angle.  In your photograph, there is a suggestion that, in fact, a careful evaluation of that portion of the anatomy be examined. 

As far as the surgeon saying that he “doesn’t like to mess with removing that bone because it can cause drooping of the nose later on,” my comment is: he is correct in that what he calls "drooping of the nose" may well mean the nasal tip recesses, which of course is desirable.  The long-term effects are never absolutely certain.  Generally, if certain technical measures are followed, the nose will not necessarily droop downwards, therefore narrowing the nose-lip angle.  But all of this is sophisticated and complex and should be addressed by an experienced nasal surgeon. 

Many years ago, I gave a paper at one of the medical meetings entitled “The Importance of the Nasal Spine in Rhinoplasty.”  I was inspired by studying the anatomy of that area, as well illustrated in one of the original and classic textbooks of cosmetic surgery, written by the late Tom Rees.  That was my bible early in my study of rhinoplasty, and his illustration of the anatomy there suggested that this was an area that needed to have further understanding and hopefully mastery. 

Regarding the chin implant: your chin appears to be minimally “receding.”  Your head position also determines how the chin looks.  I suspect if your head position is just tucked a bit down your chin would look less prominent. 

One practical means by which you can evaluate the benefit of a chin implant would be to have the surgeon do the KOTLER SALINE DEMO by which a sterile saline solution is injected underneath the skin in front of the bone; thats plumps up the soft tissue of the chin, mimicking the effect of a chin implant procedure.  This is very helpful for you to see the result.  I recommend that you consider that. 

I hope this information is helpful to you.  You are thinking along the right lines, you are getting good advice, and I think you need to continue your study further before making a final decision about what components of the rhinoplasty should be performed and, of course, if chin augmentation is a wise undertaking for you. 

Robert Kotler, MD, FACS
Nasal and Facial Plastic Surgeon
Author, SECRETS OF A BEVERLY HILLS COSMETIC SURGEON
Author, THE ESSENTIAL COSMETIC SURGERY COMPANION