Are my expectations of a revision rhinoplasty and chin implant reasonable/possible/realistic? (photos)

Question

I'm considering a revision rhinoplasty and chin implant. I really want my nose thinned and shortened and my chin to project more and come to a gentle point. I've doctored some photos to illustrate what I mean. Is what I want reasonable and realistic?

Alejandro Nogueira, MD · Answer

Such wished chin is only achievable by means of sliding genioplasty; a chin implant, among other major disadvatages, would never ever obtain that sharp and superbly defined chin apex. It is well obtained by means of an sliding genioplasty associated with a well planned and juditiously performed central chin wedge resection of the slided forward fragment in the horizontal plane in order to:
-narrow your chin width (one of your wished goals)
-obtain an less rounded and sharper shape (the second wished goal)
By advancing-only, either by means of implant or sliding genioplasty, you will never get rid of the square look of your chin and obviously neither downsize its horizontal dimension (both well simulated in your morphs and by the way fully agreeable IMHO).
Other major disasvantages of the chin implants, besides their technical and obvious limitations are serious drawbacks: short lifetime, nerve irritation, dislocation (see my Q&A list and you'll see plenty of bad chin implant complications), artificialness, dissatisfaction due to poor goals achievement, fake expression, infection, etc. Without hesitation do seek the advice and hire the hands of a well experienced osseous genioplasty surgeon, the results are simply awesome, for a lifetime, stable overtime, safe and unparalleled.
Regarding your nose revision I'll have you know you'll need even further research to achieve you (again realistic and anatomically judicious) wished results; for two reasons:
-to begin with, any, absolutely any nose revision is a technical nightmare, a major challenge and an ordeal of paramount responsibility, for surgeon and patient, very few surgeons do really handle with mastery revision cases
-but additionally: your nose, not being a perfect one, is a nice one, you've not been victim of a botched work neither do you suffer a deformity, your nose could just be more ambitiously designed, more refined or just meet with precision your high (and respectable) expectations; this means the margin for errors, unfulfillment of goals or technical limitations is tight (if any)
With that said I see your nose as a case for overall downsizing, shaving with better precision your dosrum, and performing a good tip plasty or even grafting; just one advice: think over the degree of tip sharpening, you have designed one that most patients would deem too sharp and upturned, still within margins of good facial balance and human anatomy.Difficulty of the chin 6-7 out of 10 scale of osseous genioplasties (chin implant would be 1 out of 10... guess why so popular?) and 2 hours surgical time (chin implant 15-20 min...); nasal difficulty 10 ouf of 10 scale but not due to its actual difficulty but for your high expectations, surgical time 3-4 hours.
Feel free to request any additional information.

Steven M. Denenberg, MD · Answer

I usually make computer morphs when I'm answering a RealSelf question, to show the changes that are possible for your nose with a rhinoplasty. For example see this page:FacialSurgery.com/RealSelf/RealSelf_Morphs.html
But I wouldn't have done anything different at all with your morphs. Congratulations on having an excellent eye, and a steady hand with the mouse.
The woman in the short video above had a modest hump removed, and here's a link to a patient who had a chin implant for a weak-ish, but not terribly weak, chin:
facialsurgery.com/BAPg1lhk2khn1_psfc_ci04_hbc3.htmlYou should understand that the changes you want require advanced techniques, techniques that most plastic surgeons cannot handle.  Be sure to read the section in the "Web reference" link, just below this post, on how to stay out of trouble while searching for a rhinoplasty surgeon
Your nose is also a good 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. When you see his goals, you'll know whether he has an eye for a beautiful nose, and whether he shares your opinion of what constitutes a beautiful nose. You'll also know whether the changes he proposes are enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. But remember, you're not hiring him for his skills with the computer. The doctor must then show you his before and after photos to prove that he can actually accomplish what he draws on the computer.

Toby Mayer, MD · Answer

Revision rhinoplasty and chin implant for a more attractive face. Yes your goals are realistic IF you go to a very experienced revision rhinoplasty surgeon whose work looks natural and not overdone.

Tom D. Wang, MD, FACS · Answer

Hi SophieMoreau, thanks for your question and sharing your photos.  The edited version shows a reasonable and realistic result from revision surgery.  Please consult with an experienced revision rhinoplasty surgeon to fully explore the options which best match your needs and good luck to you!

William Portuese, MD · Answer

From the edited photographs, it does appear the results are realistic and possible, by a very experienced surgeon. Revision rhinoplasty is one of the most difficult procedures to perform correctly in the entire field of cosmetic surgery, so choose your surgeon very wisely based on extensive experience. The photographs demonstrate an overly projecting nose and an under projecting chin for which this combination can significantly improve, very similar to the edited photographs. Chin implants are manufactured in a large variety of sizes and shapes which is best determined time of the consultation and examination since the implants and the chin are both three-dimensional structures. A rhinoplasty procedure can accomplish shaving down the dorsal hump and decreasing projection of the nose along with refinement of the tip and the bridge line. For more information about this combination and many before-and-after examples, please see the link and the video below

Michael Elam, MD (retired) · Answer

Dear SophieMoreau, I believe that your pictures are nicely edited to a very reasonable projected result. I would suggest that you seek consultation with some experts in the field and you can also have imaging performed at that time to show you the proposed results. This will ensure that you and your surgeon are on the same page. Review the surgeons before and after photographs of noses similar to your own to ensure natural looking results. See examples in the rhinoplasty link below and a combined procedure in the video above. Best regards, Michael V. Elam, M.D.

Richard W. Fleming, MD (retired) · Answer

Your revision rhinoplasty expectations are reasonable/possible/realistic. consult with an experienced revision specialist who has many examples of natural feminine results that you like in patients who had a nose similar to yours.

Are my expectations of a revision rhinoplasty and chin implant reasonable/possible/realistic? (photos)

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