Are the results I'm hoping for achievable? How extensive of a surgery am I most likely looking at? (photos)

When I smile, the tip of my nose hooks downward in the most unattractive way... I've attached a few photos of the before and after I'm hoping to achieve and was wondering if it's even remotely possible? How extensive of a surgery am I looking at if I want to decrease the size of my nostrils and tilt the tip of the nose upwards so that it remains straight when I smile? I'm worried that this might not be possible without altering the overall size of it and changing my face drastically. Thank you!

Doctor Answers 18

Septal depressor muscle

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One of the reasons your nose turns downward is there is a muscle called the septal depressor muscle that pulls downward on the nose when someone smiles making an individual with a prominent hump more noticeable. The best way to communicate with your doctor is to go through the process of computerized imaging which we do with all of our rhinoplasty patients. Attached is a video that describes this process and I hope you find this useful. Good luck in your research.

Latham Facial Plastic Surgeon

Correcting a hanging nasal tip

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It is very possible to slightly tip the nose upward and reduce the size of your nostrils without altering the majority of your nose. Typically, by shortening the septum in the front and slightly reducing the hump this will allow your nose to naturally raise up without overall altering the majority of your nose. Good luck in your area.

Scott Trimas, MD
Jacksonville Facial Plastic Surgeon
5.0 out of 5 stars 20 reviews

Totally realistic.

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See the "Web reference" link, just below my response. I made a couple of computer morphs of your nose, and animations of the morphs, to show the changes that are possible for your nose in truly expert hands.

I elevated the tip. On your profile morph, I'm not sure you'd be happy with the amount of elevation you simulated. You kept some of the bump on the bridge, as I tried to do in my morph, too, which is fine. The problem is that you don't want to have surgery and then want a little more later. The amount of elevation I simulated isn't as much as a person of northern European descent might want, but you need to get the tip high enough that it doesn't bug you any more. Maybe I'm off base here, but see what you think.

You should understand that the changes I demonstrated in the morph require advanced techniques, techniques that most plastic surgeons cannot handle. You have a difficult nose, because making controlled changes to the tip like that is difficult. Also, perhaps surprisingly, leaving some of the bump on the bridge is more difficult than removing all of the bump. Be sure to read the section in the "Web reference" link on how to stay out of trouble while searching for a rhinoplasty surgeon.

Your nose is also a good example of why computer imaging is mandatory in rhinoplasty. You need to know exactly what the surgeon is planning to accomplish -- what features he'll change, and by how much he'll change them -- so you know whether it's enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. Then, he must show you before and after photos to prove that he can actually accomplish what he draws on the computer. 

Steven M. Denenberg, MD
Omaha Facial Plastic Surgeon
4.8 out of 5 stars 42 reviews


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An experienced plastic surgeon or facial plastic surgeon whose rhinoplasty results appeal to you should be with whom you consult. I recommend more than one consuktation if you are not completely confident after your first. Best of luck. 

Ram Kalus, MD
Mount Pleasant Plastic Surgeon
4.8 out of 5 stars 24 reviews

Are the results I'm hoping for achievable

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Absolutely. The goals you have shown are achievable with standard rhinoplasty techniques. See a board certified plastic surgeon for you options. Computer imaging should help define the problems and the solutions. Good luck.

Robert Graper, MD
Charlotte Plastic Surgeon
4.4 out of 5 stars 27 reviews


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Hello and thank you for your question. Based on your photograph, you may benefit from a tip refining rhinoplasty. Your surgeon can accomplish this by trimming, suturing, and reshaping the cartilage in your lower nose. Cartilage grafts may also be used to help improve tip refinement. You may also benefit from a cephalic rotation of your tip to turn up your tip slightly and a conservative dorsal hump reduction. The most important aspect is to find a surgeon you are comfortable with. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified plastic surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Richard G. Reish, MD
New York Plastic Surgeon
5.0 out of 5 stars 174 reviews

Rhinoplasty Consultation

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You would benefit from a comprehensive rhinoplasty consultation with an experienced, reputable Facial Plastic Surgeon with special interest in natural appearing rhinoplasty. Overall length and tip support are often improved with primary rhinoplasty and cartilage grafts through an open approach. A droopy tip while smiling is a common concern for patients interest in nasal improvement.  Computer imaging studies by your specialist will likely show an even more balanced appearance than you have demonstrated in your posted images. A well performed rhinoplasty could enhance your natural facial features and not drastically change your face at all. Select a physician with whom you feel most comfortable and shares your vision/ goals for your nasal appearance. You are on the right track. Best wishes. 

Fred J. Bressler, MD, FACS
Houston Facial Plastic Surgeon

Rhinoplasty candidate

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 Photographs demonstrate a dorsal hump, a downwardlyp rojecting tip and a long nose. A closed rhinoplasty approach can accomplished shaving down the dorsal home, lifting the tip and slightly narrowing the bridge line. Releasing the depressor septi ligament will prevent the tip from drooping when smiling. Rhinoplasty is the most difficult procedure to perform in the entire field of cosmetic surgery, so choose your surgeon very wisely based on extensive experience.

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


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What you have illustrated is certainly achievable- partial hump reduction while retaining slight convexity to dorsum, lessening tip projection i.e. bringing closer to face while rotating the tip upwards.  Seek out a board certified surgeon experienced in rhinoplasty surgery.

You should expect a result close to what you have shown above.

J. Andrew Bartlett, MD, FRCS
Vancouver Facial Plastic Surgeon

What can you expect from a rhinoplasty

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Hi Mckenzie,  I have looked at the fotos you sent and the results you are interested in are realistic and achievable.  During your consultation you should show these pictures because it will give the surgeon an idea of what you want.. I think that the bridge should be brought down more than you show and the tip will be slightly smaller but the change does not have to be drastic.  The surgeon will explain what he need to do to your nose to achieve a natural result. 

William H. Sabbagh, MD
Detroit Plastic Surgeon
4.6 out of 5 stars 41 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.