Why do my side profiles differ so much? What type of nose do I have? (photos)

Question

I recently went to an ENT who told me I have a deviated septum that will require surgery. She said I can add a rhinoplasty to my procedure and so before going to consultations I wanted to learn more about what type of nose I have/what result examples I should be asking surgeons and what needs to be fixed. I've also long wondered why my side profiles look so different from another. Any insight would help a lot, thank you!

Steven M. Denenberg, MD · Answer

When a nose looks asymmetric from the frontal view, the two sides, or more usually, the two three-quarter views can look very different.

The two cartilages that form the tip of your nose are broad and strong, and they make the tip look wide. Improving that feature is technically difficult, and you must see your surgeon's before and after photos of similar noses, with wide tips, before allowing the surgeon to operate.

How *much* to change 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 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 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.)

I'd love for you to see some excellent morphs of what could possibly be done with your nose. It might make you feel better about the possibilities. Morphs help you plan your ideal goal, and help the surgeon understand what you need in order to be happy, and correlate that with what he thinks is possible in his hands. These morphs should be made by the surgeon.

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 for those who have had previous surgery, it also discusses how to tell whether your first surgeon should be performing your revision. And it also discusses how to take photos that are best for online evaluations.

Eric M. Joseph, MD · Answer

Based on your photos, you appear to have a crooked nasal appearance, and that can cause your photos to appear different, depending on the angles. Rhinoplasty may be considered for achieving a narrower, straighter, and less distracting nasal appearance. Hope this helps. Dr Joseph

Ronald J. Edelson, MD · Answer

You are an excellent candidate for rhinoplasty. However every surgeon will do something different so it's worth going on a few different consults to learn more about the many options.

Steven J. Pearlman, MD, FACS · Answer

A deviated septum often goes with a crooked external nose. However, septoplasty will have no affect on you nose externally. We often perform rhinoplasty with functional septoplasty. I can list all the things I see on your nose, but what is most important is what you don’t like. The difference between the two sides are from having a crooked nose. There is no “type” of nose but to list some of the most prominent issues are your crooked nose, a hump on the bridge and a wide tip. I find that computer imaging, both 2-D and 3-D Vectra helps a lot to visualize potential results and show what your nose might look like. It can also help demonstrate subtle or more invasive results.

Robert Ciardullo, MD · Answer

Rhinoplasty along with septoplasty: The septoplasty that you discussed will hopefully improve the breathing but not significantly change the appearance of the nose except perhaps to make it look straighter. You do appear to have a dorsal hump and a bulbous tip. These can be addressed in a traditional rhinoplasty if they bother you. This can be performed along with the septoplasty if you desire. The two profiles look slightly different because of the asymmetry of the bridge.

William Portuese, MD · Answer

A septoplasty is performed in the back of the nose for improvement of air flow, while cosmetic rhinoplasty is performed to change the shape of the nose. Cosmetic rhinoplasty is one of the most difficult procedures to perform correctly in the entire field of cosmetic surgery, so choose your rhinoplasty surgeon wisely based on extensive experience. A closed rhinoplasty approach can accomplish refinement of the nasal tip, shaving down the dorsal hump, and placement of a spreader graft underneath the patient's right upper lateral cartilage that is collapsed. This will give significant improvement and symmetry to your nose

Why do my side profiles differ so much? What type of nose do I have? (photos)

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