Heavy nose cartilage - can my nose be slimmed and my columnella reduced while fixing a deviated septum? (Photos)

Preliminary concepts: very one of us has a degree of septal deviation, no one human being has the 3 elements (2 bones and 1 cartilage) forming the nasal septum perfectly aligned, with that said not every septal deviation is the cause of the breathing issues, actually it rarely is, majority of breathing issues are due to other causes and the type of congestion you explain point more to a chronic rhinitis; with that said, the indication for a septoplasty in your case is not only questionably but also highly disputable, I'd not accept to add such extra financial cost and complexity to an already very complex and costly type of rhinoplasty. However, should there exist solid evidence of a causal link between your septal deviation and breathing issues, then yes, a septoplasty can and has to be associated to the rhinoplasty in the same surgical episode.

Your nose is extremely complex and tricky for an unexperienced surgeon, beware of easy solutions and minimally invasive procedures, your nose gathers a compilation of technical problems of high to very high difficulty, among others the following ones:
-boxy and bulbous tip, featuring very large alar cartilages and domes plus strongly verticalized lateral cruras, leading to null nostril support and severe alar rim retraction; this alar ascension produces an unsightly columellar show or exposure which, itself, is not an issue to tackle but a consequence of the poor nostril rim cover over it.
-The tip, the shiny reflection marking the peak of it, is overly high and rotated up, close to be "piggy nose", this increases the visibility of the nostrils, also to be treated in an efficient manner.
-Atypically very broad dorsum with practically no hump on it, this humpless dorsum narrowing is one of the most difficult and risky maneuvers in rhinoplasty, few surgeons dare to do it but if you master it becomes routine; you can't narrow that brige by creating a saddle nose deformity, that'd be the solution for most surgeons, the bridge level is optimal and can't be lower, so you have to remove few mm of bone (upper part) and cartilage (lower part) from the bridge but not in vertical but in horizontal, between the nasal bones and the osseous septum (upper part) and the triangular cartilages and the cartilagenous septum (lower part).

I strongly recommend you consult with 10-20 surgeons until you find 1-2 professionals depicting the aforementioned scenario. Refuse easy proposals, appealing minimalist procedures, tons of blah blah blah and medical pride, etc, stay with the surgeon talking loud and clear about the difficulty of your nose (9/10) and no less than 4-5 hours surgery.

In reality, performing a septoplasty is usually a main component of doing a rhinoplasty. So yes, based on your photos, you are a great candidate for a combined rhinoplasty/septoplasty procedure. The nose and tip can be made thinner and columella reduced as well, all while maintaining a natural result. Be sure to see a rhinoplasty expert for consultation.

Yes, these a very reasonable goals and can each be accomplished simultaneous to septoplasty! During the rhinoplasty consultation process you can discuss these goals further and many surgeons can show you a simulated image of the intended result. Good luck!

Based on your photos, you appear to have very thin nasal skin, and this tends to be unforgiving after rhinoplasty surgery insofar as revealing cartilaginous irregularities. If you have severe dissatisfaction with your nasal appearance, and chronic nasal obstruction, rhinoplasty surgery could certainly be considered. I would suggest visiting with several reputable rhinoplasty specialists who offer computer Imaging so you could see what to expect. It is also important that your surgeon be expert in both functional and cosmetic rhinoplasty issues. Wishing you well moving forward. Sincerely, Dr Joseph

You can undergo a rhinoplasty and septoplasty. The boxy tip can be improved significantly and the dorsum can be straightened.

Best Wishes,

Gary Horndeski, M.D.

In general, stronger cartilage leads to a better result. Think skin can be challenging, and weak cartilage is harder to deal with.
You should be able to get a nose that is easier to breathe through and more balanced for your face without much difficulty.

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. A septoplasty can be safely performed at the same time. 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

Short answer to your questions is yes. You are certainly able to have combined functional (breathing) and cosmetic nasal surgery, though any cosmetic portion will not be covered by insurance.
I would strongly recommend scheduling a consultation with a plastic surgeon who can perform both functional nasal surgery and cosmetic rhinoplasty. It is important that you feel you and your rhinoplasty surgeon have a shared vision and that you feel comfortable with the goals of surgery before scheduling.
I hope this helps and best of luck!Kyle Kimura, MD

To slim your nose the tip needs to be reduced in size with a Tip-plasty. The nasal bones are wide and will need osteotomies to push them inwards and narrow the upper half of your nose. Your nostrils are on the wide side and an alarplasty will help reduce this.
With the three steps mentioned above you should have a nice narrow nose that is well defined.
Regards
Dr. Janjua

Thank you for your question. You are an excellent candidate for rhinoplasty, I think it is one of the most beautifying surgeries that we do as plastic surgeons. A large portion of my practice is dedicated to rhinoplasty surgery. It is important to only see plastic surgeons with extensive experience in rhinoplasty, ie perform at least 6 per month and have performed hundreds of cases. Also, critically evaluate on-line galleries to see if their art form resonates with yours. Rhinoplasty is definitely a grey haired plastic surgeon's sport. Best wishes to you.