Wanting to fix facial harmony - Chin implant or reduction and rhinoplasty? (Photos)

Question

I understand faces are assymetrical but I’m unsure as to what is throwing off my facial harmony - I’m considering a chin implant or reduction with rhinoplasty but unsure if this will target the asymmetry. My face looks completely different on each side!

Lexie Wang, MD · Answer

Everyone looks asymmetric side to side. You are not more asymmetric than anyone else. I actually think you have great facial harmony (gratned, we don't have side pics). There is nothing I would recommend for you nless you bring up a specific concern.

Alejandro Nogueira, MD · Answer

Firstly the chin: it seems a tad strong for a feminine woman, I'd not say it is a bad one, maybe we are being over critical with it, you can just do the nose and see how you feel, because the chin itself is not a problem for your beauty. However, if you decide to go for the chin, never ever chin implants, they are very very problematic and lead, sooner or later, to their removal. You'd be a case for a slight reduction genioplasty, but never shaving, at all! only with well planned reductive osteotomies allowing reassembling the natural dome of the chin and preserving the mentalis muscle attachments.

Nose: I recommend you get it done, would be a great plus for you, however you have to be aware the risks and complexities of your case, should you be operated by a surgeon unaware or unexperienced on the challenges your nose presents, which otherwise are routinary in the hands of a talented and experienced structure rhinoplasty surgeon. Bear on me, this is your technical diagnosis and technical indication:
-verticalized or malpositioned lateral cruras (MLC) aka parenthesis tip deformity: this si essential to be diagnosed and treated, without its correct treatment you'd get a mayor deformity, you are NOT a case for simple reductive maneuvers. Essential this problem happens when the lateral leg (lateral crura) of the horseshoe shaped alar cartilages is too vertical, leading to series of chain events described below
-boxy tip: the MLC always create a typical square shape of the tip, a quich research of images may tell you this
-overly high tip: also derived from severe degrees of MLC, like in your case; you do not have a piggy nose or an upturned tip, that's a different condition, just your tip is located overlapping the caudal dorsum, this differentiation is essential technical regarding how to approach to its treatment
-retracted nostrils or overly high lateral alar rim: the MLC makes the cartilages ectopic (out of the place they should be), hence they fail to push down the nostrils and the alar rim, leading to their elevation which increases the size of the nostrils (fake increase) and the annoying visibility of the vibrissae
-nasa valve collapse: the MLC make the cartilages supporting the functional breathing of the nasal valve fail to carry out their function, therefore the easy collapse with air intake at breathing, normal or sports
-pinched nose/tip: the aesthetic side of a nasal valve collaps is the typical look of a nose like having a peg pinching the sides of the tip, again because the MLC do not play their functional and aesthetic role
-infratip lobule protrusion: that's not actual, but a indirect effect of the overly high tip and alar rims, derived from the MLC
-"hanging columella": this condition ONLY happens in very old people, it is a legend running on the Internet that less than 70 yr old people have hanging columella, all these cases are only patients with overly high alar rims or nostril/alar rim retraction, derived from MLC too

This kind of compex tips and alae are rarely treated properly, actually they are often ignored by surgeons who, even performing a irreproachable basic rhinoplasty, get in surprise and shock when they see the calamitous, if not catastrophic, results they obtain even "acting correctly" but insufficiently; it is a MUST applying invasive and complex modern structure rhinoplasty grafting and maneuvers, keep this concept clear: no way you should accept a "mini procedure", a conservative technique, a minimally invassive rhino, etc, run as fast as your legs allow, you are born with a very difficult type of nose, well known and perfectly described in textbooks, it is not your problem, fault or responsibility but the surgeon's.

The management of these noses cover these essential principles:
-open approach
-graft harvesting, either septal (most of the times) or ear concha, no need for rib at all
-repositioning maneuvers of the MLC
-grafting at alar rim (batten, tutor, articulated, etc several choices here)
-tip grafting
-columellar grafting (strut, shield, etc)
-eventually a septal extension graft

Adding a plus of exigency, you have thin skin, so... any small error or defect is going to be noticed by you, therefore the surgeon has to be of excellency.

Finally, your brige needs work too, lowering it a tiny bit and probably correcting the pinched middle vault with spacer grafting.

Do research well.

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