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.

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.

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.