Would I be a good candidate for a rhinoplasty? (Photo)

Question

20F I hate how my philtrum is stretched to reach my nose. I don't have a curve like most people do. I don't understand what even is causing this problem? Would a rhinoplasty be necessary here or is there another way?

Steven M. Denenberg, MD · Answer

Check out the link I posted with this answer. That woman also had a projecting nose, and the top of her philtrum, before surgery, pulled up onto the bottom of her nose. Usually, when the tip is brought back closer to the face, that webbing or pull goes away. You can make that happen with anyone's nose: pull the tip out forward and see how the lip follows.

How *much* to de-project the tip, or adjust the nose's length, 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. 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.

Selcuk Inanli, MD · Answer

Hello! Thank you for your question.
As far as I can see from your photos I recommend rhinoplasty operation for a permanent and long-lasting solution, but you must have a detailed examination beforehand, if you have deviation, you should definitely have a rhinoplasty operation, it is important for your breath quality.
It would be better face to face consultation.
Best Regards!

Gary M. Horndeski, MD · Answer

Yes, you would be a good candidate for a rhinoplasty. Your nasal columella angle is about 145 degrees and it should be no more than 110 degrees. This can be corrected by using a septal graft to bring your tip down lower to change the angulation.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Zoran Potparic, MD · Answer

You seem to be a good candidate for a conservative rhinoplasty;  lip/columella angle should be part of correction. In person consultation with a board certified plastic surgeon with good reputation in rhinoplasty is recommended. Good luck

Eric M. Joseph, MD · Answer

If you push on that firm area that is causing a bulge between your nose and your upper lip, you will feel that it is bone. Generally this phone is called the anterior nasal spine. To correct this condition, the anterior nasal spine may need to be removed. This is a fairly straightforward maneuver during rhinoplasty surgery. I hope this helps! Sincerely, Dr Joseph

Ruslan Zhuravsky, DO · Answer

Hi, Great question. The nose and face in general has a lot of areas that can be tricky to assess aesthetically. In your case, the upper lip area is a combination of two things. The first is the nose as you pointed out. The nasal base ? nasal spine area is pronounced and the tip is very rotated upward. Due to this you see a lot of the upper lip and bottom of the nose. As part of a rhinoplasty, derotating and deprojecting the nose would be helpful. However, the lip itself would still be long. A lip lift would complete the aesthetic by decreasing the amount of skin below the nose, while also enhancing the lip itself. This is just a general overview and there's more to discuss. I highly recommend having consultations with high quality surgeons that do both rhinoplasty and lip lifts. Have them use computer morphing software to show you the possibilities and to discuss the plan. Good luck!

Ronald J. Edelson, MD · Answer

We often call this a tension nose. The tension from the bridge causes a tight upper. Lowering the bridge can release the tight upper lip to some degree. However we more commonly see this issue in those with a large hump on their bridge

J. Renee Booth, MD · Answer

The photo shows a large angle for the columellar labial angle (which is slightly different from the nasolabial angle). The labial segment of the angle appears to start further forward (anterior) and end further back (posterior). This segment is usually the opposite with the deepest part (the part furthest back) just under the nose (subnasale). It will be important to have an orthodontist or oral maxillofacial surgeon assess your bite and make sure that your maxilla and teeth are in the proper position. In general, skin can stretch (surgeons often use tissue expanders for reconstruction of the scalp and breast, etc.) It is reasonable to try 6 weeks of using massage 2-3 times a day for 5 minutes each time. It would require tucking the upper lip downward and pressing + holding firmly on the skin just under the nose. Rhinoplasty could also be helpful, but if the philtrum is the only issue bothering you, then I would try the other options first.

Mats Hagstrom, MD (license on probation) · Answer

Facial contour is primarily determined by facial bone structure.
I’m guessing in your case your Maxilla is vertically high and this is the underlying problem.
Attempting to treat facial, skeletal problems with soft tissue solutions, tends to leave limited improvements. 
I suggest you consider consulting with oral surgeons in your community or plastic surgeons with craniofacial fellowship training.
Best,
Matt hagstrom, MD