Need a Second Opinion Before Rhinoplasty? (photo)

Hi, I recently got a consultation. The doctor showed me a simulation of the end result, noting that the tip wouldn't be as pointed. My issue with this end result is that it looks abnormal, as you can probably tell. The end of the nostril (opposite the tip of the nose) still looks as large as before while everything else is reduced. The doctor said that he can't do anything about that because I have thick skin. Is this true? Is it impossible to horizontally flatten the nostril/reduce the size?

Doctor Answers 14


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Computer imaging usually doesn't give you an exact photo of what you can expect from the surgery, but is intended to give you a general idea of the changes you are seeking.   Your surgeon is correct I telling you that if you have think skin on the tip of your nose, it will limit the degree of definition or refinement you can expect on the tip of your nose.  This is often an issue with male rhinoplasty so I'm glad he mentioned it to you before surgery so you will know what to expect.  Overall ,however, you appear to be an excellent candidate for the procedure.  If you go to an experienced surgeon, you should be able to get a nice result.  Just don't get too hung up on the computer imaging .  I don't even use it, because it can give munrealistic expectations.  Good luck!

San Diego Plastic Surgeon
5.0 out of 5 stars 29 reviews

Rhinoplasty limitations due to think skin

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Thick, oily, olive complexion skin is very difficult to deal with in the field of ethnic rhinoplasty surgery.  Shaving down the dorsal hump and osteotomies are relatively straight forward.  A pointed tip would be very difficult to produce in this type of nose where there is very thick olive skin.  Nostril size cannot be reduced, only narrowed through alarplasty.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Alar Base Reduction

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Dear Sheen,


The thick nasal skin you have makes your alar base reduction challenging but rewarding.

That being said, commendable results require an exceptionally skilled surgeon to perform the surgery.

Therefore, I recommend that you seek multiple opinions from board certified surgeons of extensive experience who will guide you to make a well informed decision.

I hope this helps.

Thank you for your inquiry.

The best of luck to you.

Dr. Sajjadian

Ali Sajjadian, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 205 reviews

Alar base reduction is an additional option

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I agree with your doctor that you have thick nasal skin especially in your alar base. A reduction of alar base in addition to reduction of dorsal hump will help soften your nasal appearance. However there is a limit on how much of alar base can be reseceted in order to maintain a natural looking nose. Please have another consultation with a board certified facial plastic surgeon.

Kevin Sadati, DO
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 224 reviews

Second Opinion in Rhinoplasty

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I think it is always good to get a second opinion in any type of elective cosmetic procedure if you so desire or if you do not feel comfortable. Certainly, in rhinoplasty it is important to try and optimize the result the first time by choosing a plastic surgeon who has expertise and experience in rhinoplasty.

Rod J. Rohrich, MD
Dallas Plastic Surgeon


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Rhinoplasty is the most complicated surgery in the realm of cosmetic procedures. A second opinion is always valued, just be sure you visit a certified plastic surgeon.

John S. Poser, MD
Gainesville Plastic Surgeon
3.8 out of 5 stars 11 reviews

Need a Second Opinion Before Rhinoplasty?

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 I have performed Rhinoplasty for over 25 years and the bridge reduction seems realistic however you appear to be focused upon the outside shape of the nostrils as they attach to the face.  They are quite thick.  Re-shaping these can cause unsightly scars as well as deformities of the curved lateral nostrils and should not be done IMHO.  Aesthetically, the nose doesn't need to be perfect (not every nose has that is your case) but rather a more refined, naturally attractive one.

 So if you were my Rhinoplasty patient I would have mentioned this to you at the time of your consultation.  Aesthetically, I do feel that your profile is weak due to a recessed chin that should be balanced with a Chin Implant.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews


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In my opinion the simulation is a quite realistic idea of what your should expect your results to be. You have provided only a profile view so it is difficult to further advise. It is more difficult to get refinement on a person who has thick sebaceous skin.  It never hurts to get a second opinion. I would advise a second opinion with a Board Certified Facial Plastic Surgeon. 

David Alessi, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 18 reviews

Decreasing nostril size during Rhinoplasty

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I think that your simulation images are not bad. Alar base reduction (decreasing size of the nostril) is a common procedure performed during rhinoplasty .I perform this as a second stage procedure after one year of first surgery.The reasons for splitting the surgery into 2 stages is that if the surgery is perfoemd as single stage surgery the blood supply to the tip of the nose may be compromised specially in thick skin individuals who may suffer from skin complications over the tip of nose area and this is very difficult to treat and is a major complication.

Decreasing nostril size during rhinoplasty

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I think that your simulation photos are fairly reasonable.  Alar base reduction (decreasing size of the nostril) is a common procedure performed during rhinoplasty, the goal of which is to decrease nostril flare or to decrease the size of the base of the nose.  However, this is not what you are concerned about.  Your alar-facial crease is very prominent because that alae are thick; unfortunately, the thickness of the alar skin is not changed during rhinoplasty so most likely the appearance of this particular area will stay the same.  I have to complement your prospective surgeon for giving you realistic simulation photos and a truthful and correct answer about the nostrils.

Alexander Ovchinsky, MD
New York Facial Plastic Surgeon
4.9 out of 5 stars 32 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.