Would I require a rhinoplasty and sliding genioplasty?

Question

Hello. So in a nutshell I am not fond of my face and think it looks out of proportion. My nose looks massive and I have no chin or jaw line. To get a more balanced profile that is in proportion, would I require a rhinoplasty and sliding genioplasty? Thank you.

Steven M. Denenberg, MD · Answer

I believe there are a few things that can be done to your nose to make you happier with it: narrow the tip (like the woman in the short video that I posted with this answer), and also elevate the tip upwards, and perhaps move the tip back a bit closer to your face, and then lower the bridge to match the new position and size of the tip.I see that you don't have a sharply-defined jawline, but the purpose of a sliding genioplasty is to bring the front of the chin forward, to make just that part of the chin look stronger. I guess I don't see that your chin is all that weak, and certainly not worth the risk of cutting and moving the bone, as in a genioplasty.Perhaps, given your neck contours, the smallest size chin augmentation would be reasonable, to draw some attention away from the prominent nose, and give the illusion of some small increase in jawline definition, but basically, we don't have an operation that defines the jaw as you might be picturing it.
How *much* to elevate the tip, or lower the bridge, or narrow the nose? 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 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 always 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 only the surgeon has that information and judgment. Another aside: I also recommend that you not show morphs made by one surgeon to a different surgeon. If a surgeon makes his *own* morphs, you get to see whether he understands the important issues of your nose, and how your nose should be changed. But if you show the surgeon someone else's morphs, and he says "Of course I can make your nose look like that," then you don't really know if he fully understands, or even recognizes, the important changes shown in those morphs. And you don't know if he can make those changes during surgery.)
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.
Your nose is also a perfect example of why computer imaging by the operating surgeon is mandatory in rhinoplasty. You need to know exactly what the surgeon is planning to accomplish -- what features he thinks he can change, and by how much he thinks he can change them. I always email morphs to my online rhinoplasty consultations. When you see the surgeon's goals in the morphs, you'll know whether he has an eye for an attractive nose, and whether he shares your opinion of what constitutes an attractive nose. You'll also know whether the changes he proposes are large enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. How would you ever get that figured out without the morphs?

Barry L. Eppley, MD, DMD · Answer

While you would benefit from both a rhinoplasty and sliding genioplasty, the chin augmentation would produce the greatest benefit based on its greater deficiency. But computer imaging is needed to help you see the effects of either nose and chin change alone as well as both combined. That visual information will help make the choice that looks best to you.

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