How can I achieve my desired nose? (photos)

Question

21F looking to get rhinoplasty done. I'm most bothered by my wide alar base (obvious when I smile) and bulbous flat tip (from the front, looks like something is pressing down on my nose). I hope to get a nose that looks refined from the front, and looks straight from the side profile. I consulted a Korean PS and he said I should do alar narrowing + tip refinement + nose lengthening using donor rib cartilage. Pls kindly advise if that is suitable? I’m not sure if I should do my nose bridge.

Stephen J. Pincus, MD · Answer

Though augmenting your nasal bridge would give it more definition and make it look thinner, it is not 100% necessary to achieve what you desire. I would place an extended tip graft to increase the projection and produce some angularity. It would also bring the nostrils in slightly. However, I would then produce some narrowing by using a stepwise approach. With your particular anatomy, it is somewhat treacherous to excise any tissue from the nasal base, unless it is very minimal. Too much of an excision could produce a "bowling pin" appearance! So in your case I would first detach the lower one half of your nose from its facial bony attachments, which would cause a slight general contraction of the entire lower one half. Then I would place a "cinching suture" to further bring the nostrils in very slightly. At that point, I would see if any minimal excisions are necessary.

Donald B. Yoo, MD, FACS · Answer

The main downside with irradiated rib cartilage is the fact that it is dead tissue and not living, viable cartilage as from your own rib.  This means that it will not become a living part of your nose, but rather will be placed by fibrotic tissue that will eventually resorb.   For permanent results, your own cartilage (autologous grafts) is superior to any homologous grafts.  Especially for dorsal augmentation (building up the bridge) using cartilage that is finely diced and wrapped in fascia taken from your scalp can be made into a custom size and shape for your particular nose (DCF). By dicing the cartilage the problem of warping is eliminated, and since it is tissue from your own body, it quickly becomes incorporated into your nose within 2-3 weeks. Results are certainly surgeon dependent, so it's important to do your research in finding an Asian rhinoplasty specialist. @drdonyoo @asianrhinoplasty

Jacob Tower, MD · Answer

Hello, hope you are well. You have provided very good photos, thank you! I agree with the plan outlined by the plastic surgeon that you saw. An alarplasty narrows the base of the nose. A relatively modest dorsal augmentation (high on the bridge and in the area of the radix) and slight increase in tip projection will help to provide more shape to the nose and provide a slightly longer appearance. The tip can be refined alongside those maneuvers. There will be technical variations and differences in execution among surgeons, but the overall ideas suggested by your surgeon are appropriate.
Best,Dr. Tower

How can I achieve my desired nose? (photos)

Answers (3)

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