Had a rhinoplasty consultation with imaging. How does this look? Was hoping for a button nose. (photo)

When the tip of the nose comes back closer to the face, it makes the nose *look* longer, as if the tip had been lowered, too, so IMO it's very important to elevate the tip of the nose at the same time.Click on the "Web reference" link, just below my response, or go here:
FacialSurgery.com/RealSelf/RealSelf_christinasmith.html... to see the morph I made. A thing to remember: if the surgeon's goal looks too big to you, then you will certainly think that your nose is too big after surgery. 

You can go a way less projected nose and still keep a perfect and unchanged breathing ability and an "uncompromised structural integrity" (I wonder what your surgeon intended to mean with this...).The simulation posted is not a bad goal, can be a reasonable goal, but IMHO you need a slightly shorter tip and a lower dorsum to fit into your facial balance. Actually I'd say the deprojection planned is minimal!Do seek better opinions and skills; very aggressive deprojections like the one you need (beware! not into flat and collapsed noses) are easy to achieve in patients with filmy and thin skin which has scarce shape memory and will shring and adapt successfully; deprojection happens by trimmint the lateral and medial cruras of the alar cartilages. This can be done closed approach letting the tip float free down to the deprojected support.If there is any fear of cutaneous memory limitation the trimming mentioned above can be done by open approach in order to suture the cruras at the transected point, thus preventing re-floating forwards by any persisting skin shape memory.In cases of thick and strongly supportive skin covers a more aggressive securization is required of such major deprojections, by means of tongue-in-groove securization of the medial pillars to the caudal septum.With either of the former techniques no functional impairment has to occur.Difficult of medium level, 6-7 out of 10 scale, surgical time 1 hour if closed 1-2 hours if open approach. If you, additionally, seek a custom rounded tip (instead of your present sharp one) reshaping this is more into nasal mastery and then few surgeons have skills and boldness to rebuild a custom tailored hand-made tip with grafting; feasible if you wish, at least in my hands. This is 9 out of 10 technical requirement and may add 1-2 hours to the total procedure.

Thank you for your question and images. I do think that predictive rhinoplasty is a valuable tool to help the patient and surgeon in their communication. The predicted nose is actually a very nice nose in terms of balance and proportions. I think in more recent years there is a trend away from button noses that can sometimes look a little upturned and scooped.  Elegant noses with relatively straight dorsal lines and minimal upturning look more natural and less operated. Saying that you need to be happy with the outcome or at least express your desires with the surgeon so you can get their opinion. Deprojecting a nose can have other issues in that it can be harder to create tip definition and can potentially impact further on the function of the nose. Therefore there may be a good reason your surgeon has shown the above prediction. If you feel uncertain a second opinion is also an option for you. RegardsDr Guy Watts 

Hello and thank you for your question. Based on your
photograph, you may benefit from nasal tip deprojection.  Make sure you specifically look at before and after
pictures of real patients who have had nasal tip deprojection surgery performed by your surgeon
and not just a computer animation system.   I would specifically ask to see patients with overly projected nasal tips and evaluate their results.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

I think the imaged photo is nice and probably represents a realistic expectation.   It's possible that the nose could shortened a bit more,  ie rotated upward slightly more.   However,  i totally agree that there is a limit to how much an overprojected nose can be reduced.    It would certainly be reasonable to get more than 1 opinion in person... 

Beauty is in the eye of the beholder.  The photoshop view you've showed looks great, but if you don't like it then it isn't great.  If you don't like the surgeon's thought process, you could always get another opinion.  If you end up hearing the same thing from multiple reasonable experienced surgeons, then perhaps there's something to their thought process after all.

  The Photoshop version of your nose does appear appropriate and aesthetic. It's impossible to give a button nose to someone who has lots of projection to the nose. While the computer imaging is an important communication tool, it's important to know whether or not your surgeon can deliver those results. Rhinoplasty is a very difficult endeavor, such as your surgeon very wisely based on extensive experience producing consistent natural results