Advice on rhinoplasty additional procedures? (Photo)

Question

Hello, I always had insecurities regarding my nose and face in general as well as breathing issues due to a partially deviated septum. What is your opinion on whether rhinoplasty, under eyelid surgery, and cheek fat grafting as well as lip filling and skin resurfacing is. Those are the parts of my face that I'm most insecure about.

Eric M. Joseph, MD · Answer

Based on your photos, you appear to have an overprojected nasal appearance on profile. That means that the lower 1/3 of your nose appears to stick out too far. Your nose is also a bit wide on front view. Rhinoplasty surgery may be considered for achieving a narrower, less distracting, and more feminine nasal appearance. You do not appear to be a good candidate for fat grafting to your cheeks, since your cheeks appear full. Lip augmentation may be something to consider. I hope this helps! Sincerely, Dr Joseph

Gary M. Horndeski, MD · Answer

If you have a deviated septum then you certainly need a septoplasty and rhinoplasty at the same time. The angle between your nose and columella should be increased to 110 degrees and the tip can be refined. You would also benefit from a lip lift. A lip lift does 4 things: shortens the distance between your nose and upper lip, increases the mucosa of the upper lip, increases the incisor show and pulls up the corners. I also recommend a chin implant. This will give you more neck definition. You may benefit from liposuction of the neck as well.

Best Wishes,

Gary Horndeski, M

Best Wishes,

Gary Horndeski, M

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photographs, you are a great candidate for rhinoplasty. Maneuvers for your surgery would include dorsal hump reduction, tip refinement, nasal tip deprojection, tip elevation, among other maneuvers. If you are looking to have other procedures done at the same time, you may want to consider submental liposuction. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

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

Best wishes and good luck.

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

William Portuese, MD · Answer

The additional procedures that you mentioned will be of no benefit. Just stick to your original plan of performing a septoplasty for a deviated septum and a cosmetic rhinoplasty. Rhinoplasty is the most difficult procedure to perform correctly in the entire field of cosmetic surgery, so choose your surgeon very wisely based on extensive producing natural results. Digital computer imaging would also be helpful to understand what can be accomplished with your nose upon your facial features.

Mats Hagstrom, MD (license on probation) · Answer

Facial aesthetics primarily determined by facial bone structure.
It is the facial skeletal structure that gives each person their unique appearance, whether desirable or not so much.
It is also the facial bone structure that allows to identify individuals using facial recognition soft tissue coverage tends to be much more consistent from person to person.
 if we recognize that the overall facial appearance is based on bone structure, then it can become a little more evident that soft tissue solutions to treat issues that are based on bone structure are going to give partial improvements at best.
I’m not saying this to be pessimistic or negative about treatment options.
It’s simply a good idea in my opinion for patience to understand what the primary underlying ideology is and what each procedure can or cannot accomplish.
 Programs, especially for procedures like a rhinoplasty may be really helpful to understand what changing the shape of your nose for you.
I do think a reduction rhinoplasty would be helpful.
Reducing some of the fullness in your neck and getting a little bit better jawline would help as well.
 When it comes to seeing the whole face as i’m more comprehensive assessment, sometimes a few things a little differently than looking at a single aspect of the face.
You’ll probably find the plastic surgeons opinions will vary significantly under their approach and how they see overall facial aesthetics, which tends to be much more complex than the assessment of an individual and atomic area like the nose by itself or the lips or the chin.
 I recommend you have multiple in person consultations with plastic surgeons in your community.
Bring quality set of facial pictures. Pictures taken the same way plastic surgeons take before and after pictures. Use these pictures as reference during the consultation.During each consultation, ask each provider to open up their portfolio and show you their entire collection of before, and after pictures of previous patients who had similar facial characteristics for whatever procedure they recommend.
This is a good way to get a good understanding of what your results are likely to look like, and it is in my opinion, the best way to vent providers in regards to skill and experience.
 if surgeons don’t have an impressive collection of before and after pictures or can’t find pictures of previous patients that have fairly similar characteristics to your own then perhaps they don’t have enough experience and you may want to keep looking for a better or more experience provider.Number of consultations needed to find the right provider.
The more consultations you have the more likely you are to find the right provider for your needs.
The biggest mistake I see patients make is having only one consultation and then scheduling surgery.
Situations that are not straightforward or more complex are most likely going to have more difference in opinion from each provider so it would not be unusual for different providers to recommend different procedures as having the greatest impact.
 Again, ask them to show you lots of before and after pictures to see what you could expect.
It’s really important to see examples of previous patients who had the same level of candidacy for the procedure.
Results are always going to look better on individuals who are perfect candidates for a procedure.
What you’re looking for is examples of people who look very similar to yourself in the before pictures. 
Best,
Mats Hagstrom MD

Advice on rhinoplasty additional procedures? (Photo)

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