I like my nose overall, but I'm not happy with the front view. I think it's too wide from base to nostril. Also it spreads and droops when I smile. I would like a narrower nose, a pointier tip and smaller nostrils, more like Monica Bellucci's nose. Is it possible, or do I run a high risk of it looking too fake?
Rhinoplasty to Improve Front View of Nose?
Doctor Answers 33
Narrowing the nose through rhinoplasty
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.
Rhinoplasty can improve the front view of your nose
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...
Tip Definition in an otherwise nice nose
Tip definition should be easily accomplished in your case with some onlay tip grafting. Using cartilage from your septum (or your ear if you have had previous surgery), your tip cartilages can be strengthened and projected so you get a narrower, prettier tip that looks less wide when you smile and doesn't plunge. Of course there is no such thing as a simple rhinoplasty, but a skilled surgeon should be able to give you a result that is prettier and natural looking. Preoperative photo imaging will be a must to make sure that your surgeon and you are on the same page with the plan and outcome. Good luck!
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Your Goals Sound Reasonable
The specific changes you are considering seem achievable and realistic.
Find a well reputed and experienced Rhinoplasty surgeon. Get consultations with two or three different surgeons to find the right one for you.
Nasal reshaping can result is a more pleasing frontal profile
Surgery can narrow the nasal base and reshape the tip to a more favorable position. The most important aspect of the procedure is to make sure the surgeon has a good sense of the balance and proportions in order to change the nose to most effectively improve your front view.
Narrowing the base of the nose
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.
Ali Sajjadian, MD FACS
Improving the appearance of the nose is variable from patient to patient. Ideals seen in some individuals may not be possible in others. A thorough exam is critical.
Options for improving appearance of your nose.
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.
Achieving Your Goals with Rhinoplasty
A “done” look is not necessary, even when rather extensive work is done on the nose, when performed by a skilled and aesthetic-eyed surgeon. So many maneuvers in rhinoplasty are connected: strengthening of the columella (that midline portion on the bottom of the nose that divides the 2 nostrils) complements the refining of the tip, which also prevents dropping of the tip on smiling. This dropping can be further reduced by cutting what is called the “depressor septi” muscle which serves no other purpose than to pull down the tip, especially one that is weak, upon smiling. All this is further complemented by nostril narrowing.
Tip and base of the nose can be narrowed with surgery.
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.