In which order should I consider having a rhinoplasty and genioplasty done to maximize results?

If it is a decided fact that you will have a genioplasty, do that first. When I do a rhinoplasty, I'm also looking at the chin, so the nose can be balanced to the chin, and the rhinoplasty is by far the more delicate operation, so we want the chin in its final position before doing the rhinoplasty.

Also, say you have the nose done first. For the genioplasty, the anesthesiologist might want to intubate you through your nose. That means that she would put the breathing tube down one of your nostrils into your lungs, and I don't think you want that *after* the rhinoplasty. So there are lots of good reasons to have the genioplasty first.

The other thing to consider is that a genioplasty is a big deal operation, in my opinion. It'd be nice to get a couple of opinions, from someone who would NOT be doing the operation, as to how useful or how necessary or how meaningful it is. If the asymmetry or other issue of the chin really is too small to take on the risk and expense of a genioplasty, then don't have it, and just the rhinoplasty might make you happy enough with your face to avoid the chin surgery altogether.

We can help figure that out with morphs. 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 better just 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 really 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 the surgeon has that information and judgment best.)

Finally, 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. It's just not the case that every plastic surgeon is competent to perform a rhinoplasty. It's much better not to have surgery than to have inexpertly performed surgery.

Hello and thank you for your question. You could do either one first or alternatively safely do these two procedures at the same time in one procedure. 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