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

Question

I’m interested in a rhinoplasty , I’ve been diagnosed With having a deviated septum a few times due to daily nasal pressure and stuffy nose with swelling. While fixing my septum, I’m wondering if my nose can be slimmed and my columella reduced. Given my nose is cartilage heavy, would I see Significant improvements ?

Kyle Kimura, MD · Answer

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

Andrew Miller, MD · Answer

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.

Semih Yildiz, MD, FEBOPRAS · Answer

In the five patient photographs, the bridge appears mildly convex, the tip has moderate width and projection, and there may be some excess columellar show. These features can often be addressed during a septorhinoplasty, but “reducing the columella” should not mean simply cutting away support. Columellar show may come from a long caudal septum, the position of the medial crura, tip rotation, or retracted nostril rims, and each cause requires a different correction. Over-resection can weaken the tip, worsen nostril asymmetry, or create retraction.

Strong lower lateral cartilage can be an advantage because it provides material and support for reshaping. Conservative cartilage sutures, selective reduction, repositioning, and structural support can refine the tip; dorsal contouring may improve the profile. Skin thickness still limits how sharply the new cartilage framework will be visible, so improvement is realistic but the exact degree cannot be predicted from photographs.

A deviated septum and cosmetic changes can usually be treated in one operation. However, pressure, variable stuffiness, and swelling may also reflect turbinate enlargement, allergies, sinus disease, or nasal-valve narrowing. An in-person internal and external examination, nasal airflow assessment, and sometimes endoscopy are needed before attributing every symptom to the septum. The plan should preserve or improve the internal and external nasal valves.

Consult a surgeon experienced in both functional and cosmetic rhinoplasty. Bring standardized frontal, basal, profile, and smiling photographs and clearly separate your breathing goals from your appearance goals. Computer imaging may help communication, but it is a planning tool rather than a promise of the final result.

Erin Smith, MD · Answer

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!

Eric M. Joseph, MD · Answer

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

Gary M. Horndeski, MD · Answer

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.

Jeffrey H. Spiegel, MD · Answer

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.

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. 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

Best wishes and good luck.

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

Tanveer Janjua, MD · Answer

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

Paul E. Chasan, MD, FACS · Answer

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.

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

Answers (14)

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