Nose is Too Wide and Fat for my Face? Rhinoplasty Options? (photo)

Question

As an 18 y/o musician doing lots of close-up video work, I've always felt very self-conscious about my nose, as I feel it does not proportionally balance well among the rest of my facial features. The main problems with my nose are: -it is much too wide in the bridge bones, in the nostrils, and too wide/fat for my overall face (especially when I smile) -very thick and fat in cartilage, drooping front tip. -dorsal hump from sideview What are some of my rhinoplasty options? Cost in LA area?

Kenneth Hughes, MD · Answer

A closed rhinoplasty could address your tip droop and width along with dorsal width as well as nostril width and hump. The cost will probably vary from $5000 to $10000 or so. Find the plastic surgeon with ELITE credentials who performs hundreds of rhinoplasties each year. Kenneth Hughes, MD Los Angeles, CA

Paul S. Nassif, MD · Answer

It is possible to improve the appearance of your nose with rhinoplasty. The width can be modified with osteotomies (fracturing of the nasal bones), the nasal hump can be reduced, and the nasal tip can be subtly lifted and refined. I would recommend a consult with a board certified rhinoplasty specialist. He/she may use computer imaging software to morph a photo of you and give you an idea of how the final result of surgery may appear. Cost of a primary rhinoplasty can range from $10,000 - $15,000 depending on the individual circumstances of the patient. I hope this helps, and I wish you the best of luck.

Boris M. Ackerman, MD · Answer

Rhinoplasty is one of the more challenging plastic surgery procedures. It takes talent and expertise to execute correctly. A male Rhinoplasty with thicker skin and special attention to male esthetics requires specific techniques. In my practice I often see male patients requesting refinement of their noses. Some of the examples of my work can be seen on my web site. In your particular case a special attention must be paid to create a strong and refined tip structure, otherwise your skin could lead to even more bulbous appearance. Make sure you ask your prospective surgeon about his experience with operating on patients with your type of nose anatomy.

Ronald J. Edelson, MD · Answer

I certainly understand what you are talking about. You would get great improvements with a rhinoplasty to narrow the tip and nasal bones. The width of the nostrils can also be addressed. The only problem is that your skin is somewhat thick, which may limit the amount of fine detail achievable, but overall you are an excellent candidate.

Umang Mehta, MD · Answer

Thanks for the photos and question. Your nasal hump could be removed during rhinoplasty with either rasping (filing) or a straight osteotome. The nasal bones could then be narrowed with lateral osteotomies, which are little controlled fractures made on each side of the nose. As for refinement of your nasal tip, I use a combination of suture techniques and cartilage grafts (take from your septum) to reshape the lower lateral cartilages in a way which maintains their structural integrity but narrows the underlying framework of your nose. This structural approach increases the predictability of your results and helps to prevent issues such as pinching or retraction of your nostrils. The tip can be raised with techniques such as a septocolumellar suture, a tongue-in-groove technique, shortening of your septum, or overlapping of your tip cartilages. Lastly, the nostrils could be reduced with Weir excisions. The thickness of your skin will be an important consideration during your consultation. 

	In my practice, I generally favor an open rhinoplasty approach over an endonasal (closed) approach when there is significant tip work to be done. In my opinion, he trade-off of a tiny, inverted-V incision between the nostrils which heals beautifully and inconspicuously is worth the added benefit of increased visualization of your tip cartilages. I'd also recommend computer imaging, so that you can get a "sneak preview" of your new nose during the consultation. This exercise is a nice opportunity to communicate your aesthetic desires to your surgeon and for him or her to let you know what's realistic and well-balanced with your other features. 

	My practice is not too far from you, in the SF Bay Area. In Southern CA, I would recommend Dr. Andrew Frankel. The price for a cosmetic rhinoplasty is usually in the $7-10 K range though if you have any medical issues (deviated septum, difficulty breathing, large turbinates, narrow valves), much of the cost of your surgery could be reduced by insurance coverage. 

	Best regards,

	Dr. Mehta

Toby Mayer, MD · Answer

Rhinoplasty for the wide nose, with a hump and drooping tip involves removal of the bump, refining the tip, narrowing your nasal bones and base. For 35 years I have pioneered the open approach for most complex noses. The cost is $7500 to $10,000.

Anand G. Shah, MD · Answer

Hi there.  Rhinoplasty (nose reshaping surgery) to address a wide nose is a common request. Most likely, an “open rhinoplasty” (where the soft tissues are gently elevated to allow direct access to the tip cartilages) will be required.  These tip cartilages are then sculpted and sutured to refine the nasal tip.  Osteotomies are required to reposition a wide nose closer to the midline.If you like, please follow the link below.  The article on Nasal Analysis contains many diagrams that you may find helpful.  This may help guide your conversation with your surgeon.Hope this is helpful.  Best wishes.

Kimberly Lee, MD · Answer

Your concerns are common and can be addressed with a rhinoplasty. The width of the nose as well as the nostrils and drooping tip can be softened to achieve more balance with the rest of your face. A thorough consultation with a board certified specialist who will evaluate the inside and outside of your nose, perform computer morphing to show you realistic results, and discuss your options to achieve the results you seek is recommended.

Jeffrey Zwiren, MD · Answer

From your photographs it appears that you would be a good candidate for a rhinoplasty. Your first step would be to get a consultation with a plastic surgeon and together you can review your options. Computer imaging, especially 3D imaging is very helpful in understanding what can be accomplished.

William Portuese, MD · Answer

A rhinoplasty for this nose would involve osteotomies to narrow the nasal bridge, cartilage removal in the tip in conjunction with tip suturing techniques of the lower lateral cartilages, releasing the depressor septi ligament which pulls the tip downward upon animation and hump removal. This can all be done with close rhinoplasty techniques whereby no outside incisions are needed. Cost for a rhinoplasty is between 7000 $8000. Virtual rhinoplasty software as available on our website for you to try out

Nose is Too Wide and Fat for my Face? Rhinoplasty Options? (photo)

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