What can be done for my nose bridge (literally flat and wide) and tip?

Question

It's been a year since my primary rhinoplasty. I have voiced my concerns but he says he sees nothing wrong even after originally agreeing. No contour lines because I'm pretty sure it's over-resected. There are two holes on both side of the cartilage like /|\ that he filled with filler because he said it was bad. Bridge is literally FLAT and wide while the tip is point and way over projected. It is such a sloppy job. I have been looking for new surgeons now but no luck. Any recommendations? What can be done?

Thomas A. Mustoe, MD, FACS · Answer

Looking at your pictures,  your dorsum was lowered significantly without apparently bringing in the sidewalls with osteotomies, or at least not optimally. Your nasal tip was not set back at all, and over projects in relationship to your nasal bridge.  With a revision rhinoplasty, you would benefit from osteotomies to bring in the nasal bones, and , and setting the tip back.   The dorsum could be augmented, but if the tip is setback, that might  not be necessary.   It should be  possible to get improve the result but that would require, but an in  person consultation and discussion would be required., to make sure your expectations meet what could be achieved.  For a nose like yours, 3-D imaging would be helpful.  Overall,  there are many aspects of your nose that look very good.  I would talk to your surgeon again.

Steven M. Denenberg, MD · Answer

I'll tell you what I can from these photographs, although I can't really tell much. In order to evaluate a nose, we need photos that show the entire face, and not just close-ups of the areas of concern.But it does look as though your nose is still strong in its forward projection from your face. The tip could be brought back closer to your face. We call that "de-projecting" the tip. The tip looks like it's hanging down, too, and could be elevated. Maybe quite a bit.'The woman in the short video that I posted with this answer had the tip of her nose shortened and narrowed in her revision operation.And as you say, the bridge is flat. It could be that the nasal bones were not adequately narrowed, and that could be accomplished as well in a revision.
How *much* to elevate the tip, or deproject the nose, or make the other changes? We figure that out with morphs, well before surgery. I'd love for you to see some excellent professionally-designed morphs of what could possibly be done with your nose. Morphs could also help you identify what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. Profile and three-quarter views would be particularly important in morphing your nose. (Side note: in my opinion, morphs should always be done by the surgeon, or he should direct an assistant as she makes the morphs. Morphs should be made with a constant eye to what actually *can* be done in surgery, for that particular nose, and only the surgeon has that information and judgment. Another aside: I also recommend that you not show morphs made by one surgeon to a different surgeon. If a surgeon makes his *own* morphs, you get to see whether he understands the important issues of your nose, and how your nose should be changed. But if you show the surgeon someone else's morphs, and he says "Of course I can make your nose look like that," then you don't really know if he fully understands, or even recognizes, the important changes shown in those morphs. And you don't know if he can make those changes during surgery.)
Remember that rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The changes that your nose needs require advanced techniques, and skill that most plastic surgeons don't possess with expertise. For most noses, it's much better to not have surgery than to have inexpertly-performed surgery. Read my essay on how to stay out of trouble while selecting a rhinoplasty surgeon. And for those who have had previous surgery, it also discusses how to tell whether your first surgeon should be performing your revision. And it also discusses how to take photos that are best for online evaluations.
Your nose is also a perfect example of why computer imaging by the operating surgeon is mandatory in rhinoplasty. You need to know exactly what the surgeon is planning to accomplish -- what features he thinks he can change, and by how much he thinks he can change them. I always email morphs to my online rhinoplasty consultations. When you see the surgeon's goals in the morphs, you'll know whether he has an eye for an attractive nose, and whether he shares your opinion of what constitutes an attractive nose. You'll also know whether the changes he proposes are large enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. How would you ever get that figured out without the morphs?

What can be done for my nose bridge (literally flat and wide) and tip?

Answers (2)

Recommended reading

Everything you need to know about Revision Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.

What can be done for my nose bridge (literally flat and wide) and tip?

Answers (2)

Browse related questions

Recommended reading

Everything you need to know about Revision Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.