Can I go smaller-Revision Rhinoplasty?

Question

My nose is still crocked and I still have a large tio that bothers me when I smile. Could I go smaller?

Steven M. Denenberg, MD · Answer

In general, when considering a revision, the *more* you want to change your nose, the more likely the operation is to be successful. For example, if you're only looking for a tiny tweak, and the surgery misses the optimum goal by a little bit, maybe you haven't gotten any improvement! But if you're looking for a bigger change, and the surgery misses by a little bit, then you've still gotten a large improvement.Then, the greater the number of areas to change, that also is good for a successful outcome.Your nose is still strong in its forward projection from your face. The tip can be brought back closer to your face. We call that "de-projecting" the tip.Then, when a nose is de-projected, it tends to *look* longer, as if the tip had drooped. So it's important to elevate the tip as well. Even before the de-projection, though, your tip looks as though it would benefit from an elevation.You mention the width of the tip. And I see the crookedness, where the nose seems full on your right side -- narrowing the nose there can help with symmetry and also make the nose smaller.The woman in the short video that I posted with this answer had the tip of her nose elevated and narrowed in her revision operation.How *much* to elevate or deproject the tip? We figure that out with high quality morphs *before* deciding on 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 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 always 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 only the surgeon has that information and judgment. Another aside: I also recommend that you not show morphs made by one surgeon to a different surgeon. If a surgeon makes his *own* morphs, you get to see whether he understands the important issues of your nose, and how your nose should be changed. But if you show the surgeon someone else's morphs, and he says "Of course I can make your nose look like that," then you don't really know if he fully understands, or even recognizes, the important changes shown in those morphs. And you don't know if he can make those changes during surgery.)
And 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 for those who have had previous surgery, it also discusses how to tell whether your first surgeon should be performing your revision. And it also discusses how to take photos that are best for online evaluations.
Your nose is also a perfect example of why computer imaging is mandatory in rhinoplasty. You need to know exactly what the surgeon is planning to accomplish -- what features he thinks he can change, and by how much he thinks he can change them. I always email morphs to my online rhinoplasty consultations. When you see the surgeon's goals in the morphs, you'll know whether he has an eye for an attractive nose, and whether he shares your opinion of what constitutes an attractive nose. You'll also know whether the changes he proposes are large enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. How would you ever get that figured out without the morphs?

Thomas A. Mustoe, MD, FACS · Answer

Yes, you can definitely go smaller.  You have relatively thin skin which is a potential limitation.  In reducing tip projection and tip width you are reducing the size of the cartilage framework and also in revision rhinoplasty reducing scar tissue and then relying on skin shrinkage to conform to the smaller framework.   From your photos that should be very achievable.   Open rhinoplasty gives you the most flexibility in achieving your goals.

Manish H. Shah, MD, FACS · Answer

Hello,Thanks for your question. There are subtle ways to make your nasal tip appear smaller. It is also possible to improve the position of your deviated nasal bones. Blood supply and scarring in the tip will be the limiting factors when it comes to success. All this should be balanced off against the aesthetics of your face to create harmony. I would recommend that you consult with a specialist in revision rhinoplasty to discuss your concerns. An in-person exam to evaluate the nose and its anatomy is essential. Good luck,Dr. Shah

William Portuese, MD · Answer

Revision rhinoplasty can accomplish shaving down the dorsal hump, straightening the nose, and reducing the hanging columella and overall making the nose smaller. A closed rhinoplasty approach can make all those changes with all the incisions placed on the inside of the nose. No painful packing is required.

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Can I go smaller-Revision Rhinoplasty?

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