Rhinoplasty or recessed maxilla? (Photos)

Question

I have a big nose and pretty flat cheekbones. I’m not sure if it’s due to a recessed maxilla or just poor nose development. I used to have an underbite that was fixed with orthodontic treatment but feel it only masks the issue now then fully correcting it like it might have with jaw surgery. All they did was pull my lower jaw back to fix it. And now that I consider a rhinoplasty, am wondering if that is even the right thing to tackle.

Semih Yildiz, MD, FEBOPRAS · Answer

Your photos show a prominent, projected nose with a dorsal convexity, while the cheek and midface support appears relatively flat in the profile and oblique views. However, photographs alone cannot determine whether you have true maxillary deficiency or simply your normal facial anatomy. Orthodontic treatment moves teeth rather than an adult jaw, so your previous underbite may have been treated with dental camouflage.

Before rhinoplasty, consult an orthodontist and an oral and maxillofacial surgeon for an examination of your bite and cephalometric imaging. If there is a meaningful skeletal Class III relationship or maxillary recession, jaw planning should generally come first because maxillary advancement can change the nasal base, tip position, alar width, and overall profile. Rhinoplasty can reduce the hump or projection, but it will not restore skeletal midface support. After the jaw assessment, a facial plastic surgeon can determine whether rhinoplasty alone would create balanced proportions or whether it should be staged after orthognathic treatment.

Eric M. Joseph, MD · Answer

Based on what we see, I do not see any significant issues with your maxillary bones. I believe you have a distracting nasal appearance since you have a large dorsal hump, and a droopy nasal tip appearance. Rhinoplasty may lead to a tip lift, with bump removal, for a straight, masculine, and less distracting nasal profile appearance. Wishing you well moving forward. Sincerely, Dr Joseph

Marcos Salazar, MD · Answer

Hello!
Rhinoplasty can be an excellent option to refine your nose and create better overall facial balance. By improving nasal proportions, we can enhance harmony between your facial features in a very natural way.
If there is underdevelopment of the midface or lack of cheek projection, this can often be improved with fat transfer to restore volume and create better contour and balance. Small adjustments in the midface can make a significant difference in overall facial harmony.
I would be happy to discuss the different options with you during a consultation, evaluate your facial structure, and recommend the approach that best aligns with your goals.
Warm regards,Dr. Marcos Salazar

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. 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

Ayhan Isik Erdal, MD, FACS, FEBOPRAS · Answer

Looking at your photos, I can say you're a good candidate for rhinoplasty. If your orthodontic treatment is complete, you don't need to question the shape of your maxilla; everyone's is different, what matters is 'normal occlusion/bite'. You can have rhinoplasty. Best wishes.

Rhinoplasty or recessed maxilla? (Photos)

Answers (5)

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