Over Projected Tip, Over Reduced Bridge? (Photo)

Question

It’s been 2 years since my rhinoplasty. I had a very high bridge and projected tip before my surgery and after it seems as my tip was not reduced

Eric M. Joseph, MD · Answer

The easiest solution might be to have your bridge raised several millimeters. In our practice we utilize microdroplet Silikon-1000 to Fill indentations and to raise a nasal bridge. Temporary fillers may be applicable as well depending on your examination. I hope this helps! Sincerely, Dr Joseph

Steven M. Denenberg, MD · Answer

Although the bridge does look a bit low, to my eye it looks low mostly, perhaps exclusively, in *relation* to the position of the tip. So if the tip were de-projected further, the bridge wouldn't look too low, and the tip wouldn't look as though it stands out. Although you have a nice strong chin, and thus can have a tip that is more projecting, I think the current projection of your tip allows for moving it closer to your face and leaving a strong profile to match your chin. A plan like that would also keep us from augmenting your bridge, which imo would be a bad idea. Bridge augmentations are frought with asymmetries, or the edges of the implant being visible, or ending up too big, or a million other consequences, so avoiding them is good. One other consideration: when the tip of the nose is brought back closer to the face, it can make the nose *look* as though the tip had dropped, even if it didn't, so sometimes we consider elevating the tip a tiny amount, to avoid the nose looking too long after surgery.

How *much* to deproject the nose, or make other changes, and how to tell if the tip should be raised some? We figure that out with morphs, well before surgery. I'd love for you to see some excellent professionally-designed morphs of what could possibly be done with your nose. Morphs could also help you identify better just what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. Profile and three-quarter views would be particularly important in morphing your nose. (Side note: in my opinion, morphs should really be done by the surgeon, or he should direct an assistant as she makes the morphs. Morphs should be made with a constant eye to what actually *can* be done in surgery, for that particular nose, and the surgeon has that information and judgment best.)

Finally, remember that rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The changes that your nose needs require advanced techniques, and skill that most plastic surgeons don't possess with expertise. It's much better to not have surgery than to have inexpertly-performed surgery. Read my essay on how to stay out of trouble while selecting a rhinoplasty surgeon. And it also discusses how to take photos that are best for online evaluations.

And for those who have had previous surgery, it also discusses how to tell whether your first surgeon should be performing your revision.

Jeffrey H. Spiegel, MD · Answer

Reducing the dorsum (bridge) of the nose is usually easier than addressing the tip and it may be that this is what the surgeon focused on. Your result looks quite good overall, however, if you want to have further reduction of the tip you need deprojection. This can readily be done through a number of different maneuvers.

William Portuese, MD · Answer

From the one limited side profile, it appears that you do have an over projected tip, but you also have a mildly under projected mandible and chin projection. Consider placement of a very small chin implant to augment your chin forward for better facial balance and proportions, especially with respect to the projection of your nose. Adding additional projection to your Chen will help make your nose look less projecting.  Best to leave your nose alone, since it's fairly well balanced other than the projection of it itself, and you can get into all kinds of other three-dimensional healing issues.

Mats Hagstrom, MD (license on probation) · Answer

To make an accurate assessment regarding the outcome of a plastic surgery procedure we always need to see a complete complete set of proper before and after pictures. I’m assuming the last picture is your before picture? And the first pictures are your after pictures?
Rhinoplasty surgery is fairly complex work and is best done by those who have extensive experience with the proven track record. For those who not had surgery I recommend patient start the process by having multiple in person consultations. During each consultation, ask each provider to open up their portfolio and show you their entire collection of previous patients before and after pictures who have similar facial characteristics to your own. Male rhinoplasty surgery is approached differently than female surgery and it’s important for providers to understand the differences.
At this point, I suggest you get a complete set of before and after pictures and a copy of your operative report from your provider. You can then schedule in person second opinion consultations if you’re motivated enough to have revision surgery. Revision rhinoplasty is many times more complex and difficult than primary rhinoplasty surgery. The choice of providers is Paramount. There’s no correct number of consultations needed to find the best provider. Generally speaking and experience plastic surgeon should have no difficulty showing you the before and after pictures of at least 50 previous patients. Being shown a handful of pre-selected images, representing only the best results of the providers career or seeing on the female results should be warning science that the provider may not have sufficient experience. 
You should, of course, follow up with your provider and share your concerns with him or her. Whether your current provider is the right surgeon to do any follow up revision work is another question. You didn’t include a desire to have revision surgery in your post.
Best,
Mats Hagstrom, MD

Over Projected Tip, Over Reduced Bridge? (Photo)

Answers (5)

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