Is It possible to fix my strongly projecting nose? It pulls my upper lip forward. (photos)

Question

Hello. I think my case is very complicated and to be honest I rarely see such a rare combination of terrible nose, upper lip and ears. I am wondering is my strongly projecting nose the reason behind my upper lip issue and could they be fixed with one surgery? (I mean nose + upper lip) My confidence has been ruined for years! Is it possible to make a normal nose and upper lip out of mine? I often get very depressed and lose hope!

Gurkan Kayabasoglu, MD · Answer

Hello, thank you for your question and provided photos, your projection issue can be addressed to decreasing overall projection and a triple board certified surgeon ı can say that you can benefit from chin implant as well to catch the balance on your face. Your goals are achievable, you need to have a detailed examination to get a clear idea. 
Kind Regards,

Kenneth Hughes, MD · Answer

Hello. Great question. Thank you for your pictures. Based on your images, you can benefit from a rhinoplasty procedure. Please schedule a consultation with a board certified plastic surgeon for a detailed surgical plan to achieve your desired results.

Gary Linkov, MD · Answer

Thank you for sharing your photos and concerns with us. First off, there are solutions here so do not worry. I would have you consider the following procedures:
1. Septorhinoplasty - addresses the nose and strong cartilage
2. Lip Lift - shortens the philtrum and improves balance to the face. I have performed many on men and it does not feminize the face. 
3. Chin implant - projects out the chin to improve balance with the nose and lips
Combining these techniques can be powerful and simulation would be helpful to show you a potential result. 
Gary Linkov, MD
Facial Plastic Surgeon
Manhattan

Steven M. Denenberg, MD · Answer

Your nose, as you know, is very strong in its forward projection from your face. The tip needs to be brought back closer to your face. We call that "de-projecting" the tip.When a nose is this strong in its forward projection.it tends to pull the upper lip out forward, too, since the upper lip is attached to the base of the nose. You've identified that. When the tip comes back closer to the face, the upper lip comes back, too.
The woman in the short video that I posted with this answer had the tip of her nose de-projected a significant amount in her rhinoplasty.You have another issue, too. Your bridge is strong up at the top of the nose -- in front of your eyes, or just below your eyebrows. When the nose is strong there, if the tip and bridge are de-projected (brought closer to the face), it's important to reduce the strength of the bridge up there at the top, or your profile would resemble the profile of a Roman statue, where the profile of the forehead slides right down onto the nose, without that little dip we like to see in front of the eyes. Search for Roman statue profile to see what I mean. Your surgeon must pay attention to that, too.
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 but also 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.)
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. You have an exquisitely difficult rhinoplasty. The changes that your nose needs require advanced techniques, requiring 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. 
Your nose is also a perfect example of why computer imaging 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?

Scott Trimas, MD · Answer

It is certainly possible to improve the appearance of your nose with a reduction rhinoplasty. Specifically, you could reduce the projection of your nose and shorten the angle between your nose and upper lip and retro displace the tip unit, that is, bring it closer toward your face. By reducing the nasal spine where the septum attaches, this will allow the tip to fall and actually give you less upper white lip distance improving your lip profile as well. I would see a board certified facial plastic surgeon with expertise in rhinoplasty and you should be fine. Good luck in your area.

Ronald J. Edelson, MD · Answer

Yes the nose can put tension on the upper lip.  This is referred to as a tension nose and lowering the bridge will drop your lip down a little and make it not feel so tight.  Your case is not really complicated but the bridge needs to be lowered a lot more than you may think to set it back and release the tension from the lip.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photograph, you may benefit from a nasal tip deprojection to shorten the entire length of your nose, a tip refining rhinoplasty, and a dorsal hump reduction. A chin implant can be performed at the same time for improved jaw line contour. I always use a medpor implant with screw fixation, which stays in place over time. A silicone chin implant has a high rate of malrotation over time. Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and not just a computer animation system. You should be able to view numerous pictures of actual patients with noses similar to yours performed by your surgeon. If you cannot find enough real before and after pictures, then consider continuing your search for a surgeon. Best wishes and good luck.

Richard G. Reish, M.D. FACS

Harvard-trained plastic surgeon

Richard G. Reish, M.D. FACS

Harvard-trained plastic surgeon

William Portuese, MD · Answer

The photographs demonstrate an overly projecting nose, and an under projecting chin. A rhinoplasty procedure can accomplish decreasing the overall projection of the nose, shaving down the dorsal hump and reducing the nasal spine which also helps reduction of the projection of the nose itself. All this can be accomplish with A closed rhinoplasty approach with all the incisions placed on the inside of the nose. Strongly consider placement of a chin implant to augment the chin forward for better facial  balance and proportions, especially with respect to the only projecting nose. The chin can be augmented more than the nose can be de-projected.

Joseph L. Grzeskiewicz, MD, FACS · Answer

I can understand your concern about the structure of your facial features, and honestly, it is just that straightforward, not really complicated at all - this all boils down to structure.  While rhinoplasty is a very detailed procedure, and the planning requires a careful personal evaluation, there are a couple of things I can offer just from looking at your images that may give you some hope.  First, I think your actual nasal tip for the most part projects at about the angle and location we pretty much would like.  To me, it's not your tip that is the issue as much as it is the cartilage of your septum.  Not only is it too large on top along the bridge of your nose, but it is very large toward the bottom edge adjacent to your lip.  That is what is causing the tension and fullness in the part of your nose called the "nasolabial angle."  This is the angle created by the bottom of your nose and your upper lip, and in males we would typically like to see it at about 90 degrees; in you it looks like it's about 135 degrees.  This fullness of the cartilage pushes that angle at the bottom of your nose way out, and it distorts the overall shape of the bottom of your nose.  This coupled with the excess of cartilage toward the top of your tip is causing the tension you see in the entire tip region of your nose, so from what I see, some carefully planned remodeling of this part of your septal cartilage alone will go a long way toward refining the shape of your nose, and this will in turn allow the tissues of your upper lip to relax.  This is at least a good start optimistically toward convincing you that there is hope.  There is likely more to be done to fully correct your nose, but that will need to be discussed with an experienced rhinoplasty surgeon who can more carefully assess your nose and adjacent facial features, and make recommendations to change them appropriately.A couple of other things you might consider if you wanted to further improve this area of your face are a small amount of filler or fat transfer in the vermillion (pink part) of your upper lip to provide some balance in your lip volumes, and a chin implant to help balance the proportions of your face.  This will also help balance the relationship of your nose with your face.  Again, these are things that need to be discussed in person with an experienced board certified surgeon, but I hope that I have at least made you feel better about your chances for an improved appearance and self esteem.  Best of luck to you!

Richard W. Fleming, MD (retired) · Answer

While rhinoplasty surgery is the most challenging facial cosmetic procedure that we do, you can achieve a strong natural result if the work is done by an experienced rhinoplasty specialist. Based solely on these pictures i would decrease the projection of your entire nose from the radix (the top of the bridge) to the nasal tip. The nasal-lip angle can be decreased by trimming the septum and reducing the underlying bone. Slight nasal lengthening may be necessary. The nose and upper lip can and should be corrected at the same time.

Is It possible to fix my strongly projecting nose? It pulls my upper lip forward. (photos)

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