Addressing all my problems with subtle results? Is it possible? (Photos)

Question

A few of the issues I'd like to adjust are the crookedness, droopy tip, and nasal hump. My top priority is to lift the droopy tip, although I want a very natural result. Ideally, I like the height of my nose but would just like the bump straightened. I also suspect I have a deviated septum due to the crookedness and not being able to breathe from the right side. Could all of these issues be addressed with a subtle and natural result?

Jonathan Kulbersh, MD · Answer

Thank you for your question and photos. With an experienced surgeon, rhinoplasty can achieve the results you’ve listed while producing a balanced, natural-looking result. The nasal hump can be shaved down and the tip redefined, which may involve cartilage grafting. Your nose can be made straighter by osteotomies, grafts or struts, or a septorhinoplasty procedure to correct a deviated septum.

Keep in mind that rhinoplasty is one of the most complex of all plastic surgery procedures, requiring skill, experience, and artistry to produce the best possible result. I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon, with expertise in rhinoplasty techniques. They will be able to conduct a thorough examination to determine the best steps toward helping you achieve your aesthetic goals.

Steven M. Denenberg, MD · Answer

I agree with your assessment: lower the bump on the bridge, a modest elevation of the tip, improving any asymmetries and correcting internal breathing problems if they present themselves. 
How *much* to elevate the tip, or lower the bridge, or make other changes? We figure that out with morphs, well before surgery. 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. The changes that your nose needs require advanced techniques, and skill that most plastic surgeons don't possess with expertise. For most noses, it's much better to not have surgery than to have inexpertly-performed surgery. Read my essay on how to stay out of trouble while selecting a rhinoplasty surgeon. And it also discusses how to take photos that are best for online evaluations.

Nima Shemirani, MD · Answer

Hi @Reserved6670! Based on your photos, you would be an excellent candidate for a rhinoplasty. I recommend seeing an expert rhinoplasty specialist for an in person examination. There are several options for you that can be determined after examination. In my practice, I utilize piezosurgery. Piezosurgery is a more gentle technique that allows for greater precision. Less bruising and swelling is common with Piezosurgery. In a typical rhinoplasty, a hammer and chisel technique is performed leading to more inadvertent fractures. Best of Luck, Dr. Nima!

Selcuk Inanli, MD · Answer

Hello! Thank you for your question.I have evaluated your case from the photos and information you provided.You are a good candidate for rhinoplasty surgery. Your expectations are realistic since you have thin skin it is achievable. The nasal bridge can be straightened and the tip can be lifted (a little) to avoid the droopiness. Best regards!

Tanveer Janjua, MD · Answer

It can be done in a subtle way. A closed approach to lift the tip a little, remove the nasal hump can be done. A septoplasty to fix the deviated nasal septum can be done at the same time. Overall your nasal aesthetics are good. Any change has to be very conservative. Although yo did not mention the tip, a conservative tip plasty can enhance the overall shape of the nose. 
Regards
Dr. J

Paul E. Chasan, MD, FACS · Answer

Thank you for your question. You are an excellent candidate for rhinoplasty, I think it is one of the most beautifying surgeries that we do as plastic surgeons. A large portion of my practice is dedicated to rhinoplasty surgery. It is important to only see plastic surgeons with extensive experience in rhinoplasty, ie perform at least 6 per month and have performed hundreds of cases. Also, critically evaluate on-line galleries to see if their art form resonates with yours. Rhinoplasty is definitely a grey haired plastic surgeon's sport. Most plastic surgeons like to perform lip lift procedures at a separate time. Best wishes to you.

Zoran Potparic, MD · Answer

There is no doubt that well performed rhinoplasty would address all of the above issues and create more refined nose. In person consultation with a board certified plastic surgeon, expert in rhinoplasty (check before and afters on website), should be your next step. Good luck.

Eric M. Joseph, MD · Answer

Based on your photos, you appear to have a wide and droopy tip appearance along with a hanging columella and a small profile hump. Consider Consulting with several reputable rhinoplasty specialists who offer computer Imaging so you can see what we might be best for you moving forward. Hope this helps! Dr Joseph

Ronald J. Edelson, MD · Answer

All of your desires are reasonable. You are correct in that your nose is long and needed to be shortened . Other changes to your nose would be more subtle. Go on some consults to get various ideas and opinions. Don’t be surprised if each surgeon has a different recommendation

Mehdi Sina, MD · Answer

Hi,

There is definitely as relationship between a deviated septum and a crooked nose and correcting the deviated septum is usually the first step in straightening the nose. Additionally, lifting the nasal tip, as well as reducing the hump are standard requests and are reliably corrected by skilled rhinoplasty surgeons.