Is Rhinoplasty Customized for Each Patient? (photo)

I am thinking of Rhinoplasty (my nose is pointed at the tip, larger than I would like with a bump & crooked from the front. Overall I like the length (want to keep the length - don't want a small upturned nose).

I just want to minimize the angle between my nose and face. I would also like to fix the bump, and tip. Do all nose jobs follow the same standards or can I get the results I want? Do Rhinoplasty results look natural?

Editor's Note: See related question, How can I get natural-looking rhinoplasty results?

Doctor Answers 9

Every Rhinoplasty Patient is Unique

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Every rhinoplasty patient is unique and so should thier rhinoplasty. For the nose to look natural, it must be in balance and harmony with the other facial features.

One way to gain a better understanding of how rhinoplasty would change your appearance is to visit with a rhinoplasty specialist who utilizes computer imaging software to simulate the rhinoplasty results. Recently, 3D imaging (see link below) has become availalbe and has dramatically changed the way that patients are able to realistically visualize the surgical goals -- before undergoing surgery.

Dallas Facial Plastic Surgeon
4.7 out of 5 stars 149 reviews

Good Rhinoplasty always personalized for each patient

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There are several factors contributing to patients achieving satisfactory results from their Rhinoplasty surgeries. It’s a combination of science and art influenced strongly by the goal the patient is striving to achieve. You don’t select noses from a box or a magazine ad. Your nose needs to be in harmony with the rest of your face to achieve a pleasing, attractive look.

There is a certain mathematical relationship between the different structures of the face. A careful and detailed analysis of the relationship of those structures is one of the most important factors in considering what should be done during surgery. Those numbers don’t mean much to most patients, nor should they. Most patients know how they want to look and don’t care what the numbers are.

We do a series of pre-operative photographs of the patient’s face, some with rulers, and then adjust those images and e-mail them to the patient to show them what the post-op results will most likely look like. The numbers tell us what to do, and the pictures tell the patient if we got it right or not. Each patient is able to analyze those results before ever setting foot in the operating room. They have a clear picture of what to expect post-operatively so both the patient and I are absolutely certain that we’re on the same page, speaking the same language and striving for the same result!

I look at the pictures as a type of insurance policy that essentially guarantees that I have clearly understood what the patient wants. It also guarantees that the patient understands what is possible to achieve with surgery. If you can’t achieve that type of understanding with the surgeon you’re interviewing, it’s time to find another surgeon who will hear and understand what you’re saying.

Steve Byrd, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 22 reviews

Rhinoplasty Customization

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Ideally, every surgeon should have a large repertoire of techniques to work from and choose the right set o procedures based on your anatomy.  (open, closed, finesse, structural, etc).  

In reality, most surgeons have a limited set of rhinoplasty techniques and may be good at one type of nose versus another.  Your goal should be to find a surgeon with good before and afters, a wide range of techniques, who will work with you to achieve a nose which works for your face and your aesthetic goals.

Anil R. Shah, MD
Chicago Facial Plastic Surgeon
4.8 out of 5 stars 177 reviews

Nose Surgery

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Dear Tizely,

Your requests based on the side view photo you provided are quite reasonal.

I would suggest you pick an experienced Plastic surgeon that you are comfortable with and present him/her with photos of noses you like and, more importantly, that you do NOT like.

Then, analyze several views of your nose. The terminology rhinoplasty surgeons use is different than lay English and you and your surgeon need tto be on "the same page" as each look of the nose would require a custom set of surgical maneuvers.

As regards your particular circumstances, I would suggest:
1. smooth the nasal hump - this would require side fractures of your nose to make it less wide than it would be if the hump was taken off and nose left alone ( an open roof deformity)

2. Nasal tip refinement - I WOULD recomment that your tip be rotated slightly upwards. It does NOT have to be upturned button nose you referred to BUT a slight rotation with slight refinement

3. Reduce Columellar show - lessen the amount of the septum showing from a side view

4. Consider liposuction of your chin for a much more attractive side view.

Other procedures may need to be added if you have difficulty breathing / deviated septum or a gummy smile.

BUT, the key is to pick a surgeon you can really speak with who will understand your wishes.

Good Luck.

Peter A. Aldea, MD
Memphis Plastic Surgeon

Rhinoplasty is customized according to the existing conditions of the nose and facial features

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A rhinoplasty is customized according to the existing conditions of the nose and facial features. Not all nose jobs follow the same standards, and not all surgeons do rhinoplasty in the same fashion. It is important to find a rhinoplasty surgeon that has many years of experience, done thousands of rhinoplasties and can show the patient examples of previous rhinoplasties that he has performed similar to your own.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 reviews

Rhinoplasty and final result

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The goal of rhinoplasty surgery is to create an improved natural appearance, but also to maintain function. Every single rhinoplasty I do is customized for each specific patient. You are right, some surgeons especially, in the past, had a cook book way of doing things. But I would have to say most surgeons today will try to adhere to the same philosophy I do. Most if not all of your concerns can be rectified. Just make sure you go to a surgeon who will spend the time and listen to what you want done. Good luck.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

The Customized Rhinoplasty

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Hi T,

It sounds like you know what you want. It is important to communicate your desires with your rhinoplasty surgeon. Each nose is different and no two operations are exactly alike. Unfortunately there have been and still are surgeons whose rhinoplasties all have a similar post-op appearance (the "Dr. So and So Nose").

You want to find a surgeon who listens to you, carefully examines your nose, and then outlines a realistic plan that can match or come close to your expectations and goals. You want the "Dr. No-Name" nose job, that is natural, subtle, and that doesn't look like the typical "nose job".

I find that for the profile, computer imaging is invaluable as I know what can realistically be achieved, and can let patients see what we can accomplish. If they are happy with the profile image then we can move on. If they desire more than I know I can achieve, then they move on to another surgeon.

In your case, based on your photo, you should consider consulting about a chin implant as well which will harmonize and balance your facial features.

Do choose your rhinoplasty surgeon most carefully as it is your nose, on the middle of your face for the rest of your life. Good luck and be well.

Dr. P

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 39 reviews

A great Rhinoplasty is always customized

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We like to say that the object of a successful rhinoplasty should be to give you the nose you were meant to be born with. The results should look totally natural and completely in balance with your other features. When done properly, your nose should blend into the background and no longer attract the eye. When done poorly, a rhinoplasty can really change your look in a way you may not have wanted, so you are absolutely right to explore these questions. Your rhinoplasty should be tailored individually to your features and goals, and should never rob you of your character.

Your goals and desires are very reasonable and achievable in the hands of a rhinoplasty specialist. If you have a longer face, keep the length; it will look good on you. Your surgeon should be able to help you decide on what can be accomplished using computer imaging. Remember, this is an operation of millimeters. It is not and should not be an all-or-nothing procedure.

You can have the angle between your tip and upper lip improved by lifting the tip slightly without giving you the cutesy, too-upturned nose you don't want. A series of subtle changes can give you the improvements you desire while still preserving a longer, elegant, and sophisticated look.

All the best for your procedure and let us know if you have any more questions.

Jason Litner, MD
Beverly Hills Facial Plastic Surgeon
4.5 out of 5 stars 52 reviews

You can have Rhinoplasty without looking abnormal

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You can have a nose that you like, and not what the doctor likes if you are very careful in your selection of the doctor. If you don't like the doctor's before and after pictures of his patients, see another doctor. See an experienced rhinoplasty expert who has the same goals as you do, not one who wants to do everything to your nose. You are the one who will live with it, not him.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 38 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.