Strongly considering rhinoplasty. Would a smaller nose be compatible with my features? (Photo)

Question

Would a smaller nose be compatible with my strong facial features? I am considering bridge reduction, columella reduction, and slight tip raise (as my nose droops when I smile). Thanks all!

Donald Groves, MD · Answer

Hello and thank you for your question. It sounds like your main concern is your long nose which droops during smiling, as you had mentioned. The reason your nose droops during smiling is because of activation of the depressor septi nasi muscle, which pulls the nasal tip down during smiling. Addressing the shape of the nose (particularly the nasal tip) is one of the most common reasons people seek out and undergo a rhinoplasty, and it is good that you are considering nasal size and shape in relation to the rest of your face- you want to make sure to consider the nose relative to the face instead of viewing it in isolation. In your case, you have a long nose, with a prominent nasal dorsum, an under-rotated nasal tip, with associated animation deformity of the depressor septi nasi muscle. An open septorhinoplasty can best address the entire nose, and is particularly effective for addressing all the issues you are concerned with. 
In addition to addressing your aesthetic concerns, your septal cartilage would be harvested (removed) and turned into multiple cartilage grafts, which would then be secured into different areas of your nose for structural support, including in your columella to really support the nasal tip. Also, the depressor septi nasi muscle would be separated from its insertion in the tip so you it no longer pulls down on your tip when you smile. 
The open approach is very effective in facilitating complex, precise maneuvers to refine the nasal shape and size to a particular aesthetic and look. Rhinoplasty is arguably the most difficult procedure to perform in all of plastic surgery. That said, I would recommend only going to see a surgeon who feels very comfortable with both primary and revision rhinoplasty procedures, and who has significant training and experience in these types of surgeries. This is a surgery of millimeters, so if the surgeon you're going to only does 1-2 per month, you are not going to get the best result possible. 
Regarding the anesthesia, my personal preference is similar to most- full general anesthesia to assure the most controlled environment and facilitate the best possible aesthetic results for such a complex procedure. Everything ultimately comes down to surgeon and patient preference, so always have the conversation with your surgeon so you both know exactly what to expect, and so you both feel comfortable with how the procedure will be performed prior to proceeding. 
Of course it is always difficult to provide tentative surgical recommendations, as there is only so much information to be gained from the single photo and description provided. I recommend for you to come see me or another plastic surgeon comfortable with rhinoplasty procedures for a formal consultation to thoroughly discuss your surgical goals, undergo a formal examination, evaluate all your options (surgical and nonsurgical), and decide on the best procedure(s) and type of anesthesia for your specific case. I hope this helps! 
Best wishes, 
Dr. Donald Groves 
Plastic Surgeon

Caner Kacmaz, MD · Answer

Thank you for your question. You are suitable for having rhinoplasty with Piezo technology. In your case, I  would like to narrow the nose base, reduce the projection of your nose, give it some more definition, and reduce the size of the wings and nostrils of your nose to make it smaller and narrower. 
I suggest giving your nose a slight curve to fix the hanging columella and raising the nose tip a little to give it a more feminine look.

Mehdi Sina, MD · Answer

Hi,

One photograph is usually not sufficient when analyzing the nose; however, in this photograph:
1. you do have a slight up on the bridge
2. the nose plunges significantly with smiling
3. the tip appears a bit round

Addressing these areas will certainly add harmony to your other soft features. I recommend a consultation with a facial plastic surgeon specializing in rhinoplasty to discuss your aesthetic goals in further detail.

Best,
MS

Steven M. Denenberg, MD · Answer

Although your big smile tends to make the nose look longer than it does when your face is at rest, it probably wouldn't be bad to elevate that tip. Then, perhaps move the bridge and tip and entire nose back closer to the face. That's called "deprojecting" the nose, because it decreases the nose's forward projection and helps overall to make the nose less prominent.

How *much* to elevate the tip, or deproject the nose, or make other changes? 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. For most noses, 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.

Eric M. Joseph, MD · Answer

Based on your singular photo, you appear to have a droopy nasal tip with smiling that is exacerbating the appearance of a convexity along the bridge of your nose. Depending on your examination, rhinoplasty surgery may be considered. Please consider Consulting with several reputable rhinoplasty specialists who offer computer Imaging. I hope this helps! Sincerely, Dr Joseph

Strongly considering rhinoplasty. Would a smaller nose be compatible with my features? (Photo)

Answers (9)

Answer: I think it would. Elevate the tip, mostly. More ...

Answer: I think it would. Elevate the tip, mostly. More ...

Answer: Rhinoplasty surgery may be considered for correcting the appearance of a droopy nasal tip

Answer: Rhinoplasty surgery may be considered for correcting the appearance of a droopy nasal tip

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Everything you need to know about Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.

Strongly considering rhinoplasty. Would a smaller nose be compatible with my features? (Photo)

Answers (9)

Answer: I think it would. Elevate the tip, mostly. More ...

Answer: I think it would. Elevate the tip, mostly. More ...

Answer: Rhinoplasty surgery may be considered for correcting the appearance of a droopy nasal tip

Answer: Rhinoplasty surgery may be considered for correcting the appearance of a droopy nasal tip

Browse related questions

Recommended reading

Everything you need to know about Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.