My nose is doing some strange things and changing in my late 20s. Am I able to get my old nose back? (photos)

Question

It is becoming a lopsided misshappen foreign object instead of the imperfect-but-acceptable nose I had just a few years ago.

Steven M. Denenberg, MD · Answer

The reason, is that we're never able to make *all* the changes we want in a nose, so we never have to worry that it'll be perfect. If you can identify some things about your original nose that you'd be okay if they were improved, too, you're more likely to get your nose to a place where you really like it after surgery.Get it? Don't *just* go to have the nose identical to its appearance before it started to change.The photos aren't great for an online consultation, but what I see is the width of the tip, and also the length of the nose -- maybe elevating the tip a touch would be nice. And then of course the asymmetries.
The woman in the short video that I posted with this answer had the tip of her nose narrowed and elevated in her operation.How *much* to elevate the tip, or narrow the tip? 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 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.)
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 it also discusses how to take photos that are best for online evaluations.
Your nose is also a perfect example of why computer imaging by the operating surgeon is mandatory in rhinoplasty. You need to know exactly what the surgeon is planning to accomplish -- what features he thinks he can change, and by how much he thinks he can change them. I always email morphs to my online rhinoplasty consultations. When you see the surgeon's goals in the morphs, you'll know whether he has an eye for an attractive nose, and whether he shares your opinion of what constitutes an attractive nose. You'll also know whether the changes he proposes are large enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. How would you ever get that figured out without the morphs?

Suleyman Tas, MD, FEBOPRAS · Answer

Hello,Thank you for your question. A physical examination by an experienced Board Certified plastic surgeon can provide best options for you. Changes might be caused by various reasons. Based on your pictures you may benefit from the alignment of your crooked nose and refinement of your bulky tip. A natural looking and suitable with your facial features nose can be achieved by the Closed Atraumatic Approach. To find out more before and after pictures please click on the attached link. Best Regards

Lucian Ion, FRCS · Answer

The shape of the nose can change for a variety of reasons, but in your situation it seems more likely to be driven by some thinning of the skin. There may be associated slight drop in projection of the tip but this is harder to evaluate.
The simplest approach to restore a softer look and camouflage some of the imperfections that you are seeing more at present than a few years ago would be to use injectable fillers to produce slight increase in thickness of the layers above the cartilage.
The alternative would be to use rhinoplasty procedure to address the contour  irregularities and stabilize the shape.

Lydia Badia, MD · Answer

Hello, with time the nose can change its shape. This is given by multiple factors such as hormonal change, thickening or thinning of the skin, loosing or gaining weight or simply growth factors. I suggest a physical examination/consultation with a rhinoplasty specialist to consider which is the best option for your case.

Pejman Aflaki, MD · Answer

Hello and thank you for the question and sharing your photos. It would be useful to see your true profile image as well. Based on these photos, I believe you are a good candidate for rhinoplasty. You do have a bulbous tip and a deviated septum. You will benefit from a rhinoplasty procedure, focusing on nasal tip refinement and correction of deviated septum. My best advice is that you discuss your concerns and aesthetic goals with a board-certified plastic surgeon with extensive experience in performing rhinoplasty. I would ask to see before and after pictures of their real patients. It's important that you trust your surgeon's skills and ability to achieve the results you are looking for. In particular, pay attention to your surgeon's experience with rhinoplasty. Best,
Pejman Aflaki, M.D.
  
Johns Hopkins-trained double board-certified plastic surgeon

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