Can You Shorten a Nose 4mm by Infra Tip? Too Much?

Honestly, I don't think anyone can be that precise. There are too many factors to be able to control something down to the millimeter. The important thing is having a surgeon who understands the relationship between different parts of the nose and how they react to one another. How changes to one area of the nose will create changes in another part. yes, I also think that once your tip projection is shot=rtened you are probably going to have some alar flaring that would benefit from reduction. Good luck.

When you choose a plastic surgery for a rhinoplasty, it is important that you are comfortable with their judgement and the quality of the work they do. I have had patients like you who have expressed concern over the possibility that their nose will be made too short. It is a common fear but I have never had a patient complain that I made their nose too short. I think when you discuss the matter with your surgeon he will be able to resolve your concerns about this.

Certainly, your nose does appear long but not just in the supratip region. You might need some upward tip rotation and narrowing of the alar base as well as correction of the bulbous tip. All corrections should be done in conjunction and just shortening the infratip lobule can exaggerate some other areas of your nose. I would discuss with your surgeon the other aspects of your nose and how they would fit into the overall procedure. I hope this information helps.

I consider it a bit a red flag when patients come in describing what they want done to specific parts of their nose down to the half-millimeter.  I agree with Dr. Schuster that nobody can produce results that precise.  I can take exactly 2.5mm of cartilage off a certain area during surgery, but I cannot predict with that precision how the final result will be.  Unless you are a plastic surgeon, the fact that you are using terms like "infratip", "alar crease/sidewall", etc. makes me think you have been on Google too much.  You should find a good surgeon, tell him/her what you don't like about your nose, maybe even have them use computer imaging to discuss surgical options, and then let him do the work.  Rhinoplasty is just as much (if not more) of an art as it is a science.
 

The infratip region is comprised of the medial crura of the lower lateral cartilages. Rarely, this can be unusually thick and seems to be in your case. Refinement is achieved by directly thinning the cartilage and also by suturing it up to the edge of your septum in a "tongue and groove" technique.

However, I also agree that worrying about your surgeons goal to the millimeter is obsessive and may indicate you will be difficult to please. When you focus on minute and uncontrollable assymetries and differences from expectations, you will lose satisfaction for the expected overall improvement from your surgery.  Overall your nose is long and bulbous at the tip, as well as overprojected. This will required extensive sculpting and reshaping to achieve the aesthetic goals that you and the surgeon agree upon. It is important to realize your surgeon is making dozens of complex, interrelated critical adjustments in millimeters to carry out the rhinoplasty. Don't make the mistake of focusing on one area in the final result.