What would you do to straighten my nose? (Photos)

Question

What would you do in surgery to get me close to my desired look, and how close can I get to a straight nose? I can't breath through my nose and it's causing issues for me and most impactful is the affect having a broken nose has on my confidence. Just curious what I should communicate to my surgeon and what you guys would recommend? Thank you :)

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photograph, you may benefit from a tip refining rhinoplasty, a cephalic rotation of your tip to turn up your tip slightly, and a conservative dorsal hump reduction.  Septoplasty and spreader grafts can be performed at the same to help straighten your nose and improve your breathing.  Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and not just a computer animation system.  You should be able to view numerous pictures of actual patients with noses similar to yours performed by your surgeon.  If you cannot find enough real before and after pictures, then consider continuing your search for a surgeon. 
 Best wishes and good luck.

Richard G. Reish, M.D. FACS

Harvard-trained plastic surgeon

Gary Linkov, MD · Answer

Rhinoplasty requires exceptional skill on behalf of the surgeon and great communication with the patient about realistic goals and expectations.
Common cosmetic concerns include a dorsal hump, wide nose, sunken nose, irregularities, and asymmetries. Functional concerns include difficulty breathing through the nose, which can and should be addressed at the same time as your rhinoplasty.
Make sure to seek out the care of a board certified surgeon with extensive experience in rhinoplasty. Find someone you connect with, who will listen to your concerns and provide you with a framework for what is possible. You might benefit from tip defining procedures using either cartilage grafting or suturing techniques that would harmonize your nose and create a more natural, elegant look. 
Gary Linkov, MD
Rhinoplasty Specialist
Manhattan

Steven M. Denenberg, MD · Answer

*Only* correcting frontal asymmetries of the nose is just extremely difficult, and usually not very predictable. We can usually make a nose straighter, but never put it right in the middle of the face.But when there are *other* areas to work on, that helps greatly. I'll explain.You might have a very crooked septum affecting your breathing. Straightening the septum can sometimes help in straightening the appearance of the nose.Your nose is 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, and the techniques that accomplish the de-projection can also help in straightening your nose. I see the width of the tip. That area can be addressed. The woman in the short video that I posted with this answer had the tip of her nose narrowed in her operation.Then, just overall, when a nose is being made smaller in various ways, any remaining asymmetries sit on a smaller nose, so they are smaller themselves, and thus they bother us less after surgery.How *much* to narrow the tip, or deproject the nose? 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 what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. (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.)
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.
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?

Adam Bryce Weinfeld, MD · Answer

open rhinoplastyseptoplasty (can involve a lot of little things - scoring, mustarde sutures, pds plate, flat straight ethmoid bone graft, etc etc) septal rotation sutures / clocking suturesspreader grafts (perhaps differential widths)may need lateral crural transection and shortening on the side that the nose is currently devaited away from

Toby Mayer, MD · Answer

You need a septorhinoplasty done by a very experienced rhinoplasty surgeon. You should not have to tell the surgeon anything other than bring a few photos of noses you like. Choose a surgeon who does natural noses you like!

Pejman Aflaki, MD · Answer

Hello and thank you for the question and sharing your photos. I believe you are a good candidate for septorhinoplasty (rhinoplasty with correction of septal deviation). You have a small dorsal hump and a bulbous nasal tip, as well as what seems to be a deviated septum. You will benefit from reduction of your dorsal hump and nasal tip refinement. My best advice is that you discuss your concerns and aesthetic goals with a board-certified plastic surgeon with extensive experience in performing rhinoplasty. I would ask to see before and after pictures of their real patients. It's important that you trust your surgeon's skills and ability to achieve the results you are looking for. In particular, pay attention to your surgeon's experience with rhinoplasty. Best,
Pejman Aflaki, M.D.
  
Johns Hopkins-trained double board-certified plastic surgeon

Gerald Minniti, MD, FACS · Answer

Your nose needs straightening and the internal opening of the airway near the bridge.Your tip needs modification to straighten, rotate, and reduce nostril arching (which exposes the inside of your nose when looking from the side). Structural rhinoplasty allows for all these things to be performed with predictability and accuracy using cartilage grafts from the septum and permanent sutures that re-shape your tip, septal, and sidewall cartilages.

Daniel Barrett, MD · Answer

Dear Kyley741,
it is hard to tell for sure without an examination, but based on your photos, you look like a good candidate for a rhinoplasty. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

William Portuese, MD · Answer

A closed rhinoplasty approach can accomplish straightening the nose with osteotomies placed in the nasal bones,  a spreader graft placed on the concave side in the midportion of the nose, and adjustments of your nasal tip cartilages with asymmetrical cartilage grafting and cartilage removal applied to the tip itself. The hanging columella can also be reduced which accentuates the twist and crookedness. It's extremely important to remember that there is no perfect nose due to facial asymmetry. There will be an improvement to your nose, but it will not be perfect.... It is very important to have realistic expectations. A septoplasty can be performed simultaneously to improve airflow dynamics in the back of the nose as well.

Robert Singer, MD · Answer

Every nose is different and unique to that individual. If the appearance of your nose concerns you enough to do something about it, it can be improved with a natural artistically performed rhinoplasty and possible septoplasty.  What would be the best option and exact procedure would depend on an in person examination (not just an online consultation) and discussion about desired outcome. Excellent results can be achieved with either a closed or open technique.
 
 Keep in mind that following advice from a surgeon on this or any other website who proposes to tell you exactly what to do and how technically to do it based on limited photos without examining you, physically feeling your tissue, assessing your desired outcome, taking a full medical history and discussing the pros and cons of the operative procedure would not be in your best interest. Natural appearing results need to be individualized and what is appropriate for one patient is not necessarily the best for someone else. I would suggest that you find a surgeon with extensive rhinoplasty experience certified by the American Board of Plastic Surgery and one who is ideally a member of The American Society for Aesthetic Plastic Surgery (ASAPS) that you trust and are comfortable with. You should discuss your concerns with that surgeon in person.  Robert Singer, M.D., FACS
 
 La Jolla, California

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