Rhinoplasty to Improve Front View of Nose?

Thanks for the question and photos, Mischa. Based on what I can see of your nose, it does appear that you would be a good candidate for rhinoplasty. There are three primary issues that seem to bother you:

1) bulbous tip, 2) c-shaped nose (deviated middle third) and 3) drooping/width of the nose with smiling. 

I would address the bulbous tip by reshaping your tip cartilages with the use of sutures and perhaps cartilage grafts. The idea is to build a narrower and more refined, yet stronger underlying framework. The shape of the nose is determined by this cartilaginous and bony framework as well as the thickness of the skin and soft tissue of the nose. The key with any rhinoplasty to narrow the width of the nose is to ensure that your ability to breathe is not compromised.

The deviated middle third can be corrected by straightening your septum or adding a small graft along the side of the septum to make it appear less deviated.

Finally the issue of drooping of your tip is likely a function of poor tip support. Placement of a columellar strut between your tip cartilages should prevent this drooping and also serve to narrow and refine your tip. At the same time, a small muscle which pulls down on the nose during smiling can be divided. If you push down on your nose, you will notice that the nostrils appear to widen and flare. Supporting your tip should take care of this problem. Another alternative is the septocolumellar suture. By examining your nose, I could determine if you would be a candidate for other nostril narrowing procedures (Weir excision, sill excision etc.). These techniques are quite powerful in narrowing the width of the nasal base and flare of the nostrils, but should be used judiciously. 

Good Luck!

Dr. Mehta

Thank you for your inquiry!



It seems that you are a good candidate
for a conservative internal approach that will address wide base of your nose. Since the nose is the center of your face and the slight changes will add to the appearance of the entire face, a natural look will be secured by a well-experienced surgeon. However, without a physical examination
it is not possible to provide you with specific details. 



It is important to mention that the
finest cosmetic results in any particular case are based on a variety of
factors, including: the unique anatomy of the patient, realistic expectations,
a well-informed and detailed discussion with your plastic surgeon concerning
the best options for you especially covering a deep understanding of the pros
and cons of any given choice you will adopt.



Please keep in mind that following the
advice from a surgeon online who offers to tell you what to do without a
physical examination covering the nature and the status of the tissue,
assessing your desired outcome, taking a full medical history, and discussing the
pros and cons of each operative solution would not be in your best interest.
With that in mind, it is the safest and for your best interest to find a
plastic surgeon with solid experience and certified by the American Board of
Plastic Surgery who is ideally a member of the American Society of Plastic
Surgeons that you will trust and be comfortable with. You should discuss your
concerns with that surgeon in person.



Good luck!!!



Ali Sajjadian, MD FACS

Your nose also has a slight septal deviation with mild indentation on the right. Acheiving the nose you desire should be a somewhat reasonable goal. It likely will require a graft to the tip as well as alar base reductions and a cinching suture to minimize lateral displacement with smiling and animation.

The flaring of your nostrils with facial expression will not be altered by a rhinoplasty.  The base can be narrowed but it is done at the expense of an external incision.  If this is overdone, it can flatten the curve in the nostril and make it look artificial.

Rhinoplasty can achieve very natural results by narrowing a wide nasal tip as well as supporting your nasal tip to achieve natural aesthetic changes.

First of all, when the tip of the nose appears to be too wide, it can be narrowed to provide a natural appearance by performing a variety of maneuvers on the nasal tip such as a cephalic trim, or lateral crural flap.  These are procedures that help to narrow the tip while also rotating your nose upward so that it doesnt droop.

These are very common maneuvers performed by Facial Plastic Surgeons who perform rhinoplasty as part of their daily Practice.  This is commonly performed via an "open" approach, although it can be performed by some Facial Plastic Surgeons via a "closed" approach.

I prefer the "open" approach as it allows for better visualization of these structures and therefore makes it easier to manipulate to achieve optimal results.

The "drooping" can also be corrected easily by using a columnellar strut.  This simply means that we borrow a peice of your own cartilaginous septum (the partition between the right and left side of your nose (on the inside)), and place it in a position to support your nasal tip.

This works very well and allows your nasal tip to be supported for pretty much the rest of your life.

Good luck.  You should expect a great outcome.

  Rhinoplasty or "nose job" is an operation to improve what ever aspect of your nose you do not like, when possible. In patients who have a wide tip an "open" approach may be necessary to narrow the nasal tip and better define the nose. The differences between the open approach and the closed approach can be found all over  the Internet.  You can also narrow the bones by doing an osteotomy( breaking the nasal bones).  You should discuss your desires with your physician and possibly get a computer imaging done so that you have a better understanding of what you are going to get.

Good Luck

Hi Mischa,

After studying your photographs, I believe your nose may be narrowed and refined naturally while strengthening tip support for a life-long improvement. I will describe these changes below:

1) The lower nose (tip and nostrils)

Permanent sutures may shape and refine the cartilages that define the tip of the nose. There are limitations, however, to how much narrowing one can get because of thickness of the overlying skin. The nostrils can be narrowed with incisions that are well-concealed in the crease between the nostril and the face. The key to a natural look is to achieve a fine balance between the width of the nasal tip, the width of the nasal base (nostril to nostril), and the width of your face. 

Dropping of your nasal tip when you smile may be addressed by weakening the muscle that attaches from your upper lip to the nasal tip, and is a fairly easy maneuver..

2) The middle third

This area is important for nasal breathing. A slight deviation here may be corrected with cartilage grafts or suture techniques, but not at the expense of proper breathing!

3) The upper third

The nose should widen slightly at the top and bottom and taper in the middle (like an hourglass) and so I believe it would be necessary to narrow your nasal bones to maintain proper harmony between your upper nose and newly refined nasal tip.

Hope that helps. Visit a facial plastic surgeon for a through evaluation. All the best...

Rhinoplasty (nasal surgery) can decrease the width of your nasal bones and nasal tip to give a more refined appearance in the frontal view.  These changes will also be somewhat noticeable in the lateral or profile view as well.  I find the best and most accurate way of showing these changes to a patient pre-surgery is to perform computerized 3D imaging.  This method will show the patient what they may look like before the surgery to ensure that both surgeon and patient have the same artistic goals.

As long as the changes made are not too drastic and maintain harmony with the rest of your face, you should not look like you had surgery.

Please consult with a board certified plastic surgeon and discuss in detail your specific expectations and desires.

Best wishes,

Dr. Bruno

The changes you describe are possible through rhinoplasty. While most patients ask for changes in the profile, there those that have problems with their front view. This can be accomplished through the use of rhinoplasty techniques to change the shape of the nasal tip acrtilages.

When performed correctly, rhinoplasty can reshape the tip to produce a natural, attactive nose -- from any angle.  The best rhinoplasty is one which produces a nose that both looks good (and functions well) regardless from where it is viewed.

The best way for patient to gain a better understanding of how their nose might look after rhinoplasty surgery  is to visit with a surgeon who uses computer imaging to set the goals for surgery. Recently, 3D rhinoplasty imaging has become available which allows patients to compare their preop picture with a simulated postop picture and look at them from any angle to see how surgery might change their overall appearance. Gaining a better understanding of what the result would look like before undergoing surgery can help make that decision.