Possible upper lateral cartilage reduction? Thoughts? (photos)

Please take this advice with total respect.  You clearly have thought alot about your nose.  I think you are thinking TOO much about.  Rather than trying to figure out what needs to be done surgically to your nose, i recommend that you think about what changes you would like to make to your nose, then let a rhinoplasty expert take care of the specific surgical moves necessary to achieve those changes. When you go see a rhinoplasty surgeon and say you want to get your rotation to 106 degrees, that's a major red flag.  First off, that is WAY too rotated for your nose.  Second, rhinoplasty is not engineering (i bet you are an engineer).  It's living tissue modification.  There's a lot of art to it.  There is no way to achieve specific angles in real life.  Go see an expert and do computer morphing and go from there.  Good luck!

Hello and thank you for your question. Based on your photographs, you may benefit from a tip refining rhinoplasty and a cephalic rotation of your tip to turn up your tip slightly.  Tip rotation is performed with angulated caudal septal trim and placement of a columellar strut graft rather than suturing the upper lateral cartilage.  Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and not just a computer animation system.  You should be able to view numerous pictures of actual patients with noses similar to yours performed by your surgeon.  If you cannot find enough real before and after pictures, then consider continuing your search for a surgeon.

Best wishes and good luck.


Richard G. Reish, M.D. FACS

Harvard-trained plastic surgeon