Reduction Rhinoplasty - Why can't I have the little nose I want?

  I understand your frustration, but like anything else there are limits to what can be done. The limitations of how small you can make a nose include, the skin envelope, the cartilage and the function of your nose. If you take out too much cartilage your nose will collapse and you will look terrible as well as not breathe well. The good news is that your doctor is being honest with you and is giving you realistic expectations.  The problem I often see is that the surgeon promises results he or she cannot deliver.  At least your physician is honest.

Good Luck

A rhinoplasty is able to refine and enhance the appearance of the nose, but does have anatomical limitations. Skin thickness, bone structure, and cartilage all alter the maximum refinement options. Additionally, the ideal nose is one that harmonizes and balances your features, and an overly reduced nose may not be ideal for your facial structure. Going forward, I would recommend you to discuss your concerns with your surgeon, but also discuss your aesthetic goals with other board certified plastic surgeons. 

Reducing the nose too small can result in functional problems such as sinusitis or compromise of the nasal airway with obstruction

There are anatomic limits to rhinoplasty.  Primarily, as volume of cartilage and bone is reduced, the skin has to go somewhere.  A well shaped nose needs structural support and if this is removed for the purpose of making the nose smaller, the result will be bad.

It sounds like your skin thickness is limiting how dramatic of nasal reduction your surgeon can perform. Surgeons must balance the ideal down-sizing of a nose with the anticipated ability for the skin to take on this new volume.

When the nasal framework is made smaller you still have the same amount of skin that has to redrape over it (no skin is removed during the surgery). Luckily, thanks to scar contracture, the skin will "shrink wrap" to some extent around this new, smaller nose over time. The thicker your skin, however, the less this can occur. If your nose is over-reduced you can be left with an amorphous nasal tip from this excess skin.

Every nose has limits of how big or small it can be made.  The limit is based on the soft tissue envelope of the nose (the skin).  Imagine the skin of the nose being like a dress, and the underlying nasal structure like a person's body.  If you placed too small of a body on a thick, large dress, you would have excess material.  Likewise, in a rhinoplasty making the nose too small can lead to a pollybeak deformity where excess bulk is seen in the tip.  A surgeon with extensive experience will work with your nose to create one which fits with your facial features.

It is possible for correction of a large nose to appear natural as long as the nose is proportional and in balance with the other facial features. But, there are some limits to how small a nose can be made. Skin thickness is the major determinant.  The nasal framework can be made as small as possible, but the skin must be able to redrape around and conform to that framework in order to look attractive.

One way to gain a better understanding of how rhinoplasty would change your appearance is to visit with a rhinoplasty specialist who show you what your potential rhinoplasty resuls would look like. There are several methods that rhinoplasty surgeons use in their practices to help patients understand what their surgical result may look like. Some surgeons prefer to use tracing paper overlying the patient's photographs. This can give patients a rough idea of what to expect from surgery. Computer imaging, frequently called computer morphing, is a very effective way of communicating the intended surgical results and to set goals for surgery.

Most recently, 3D computer imaging and analysis has become available. This new technology allow the surgeon and the patient to view a preoperative image in 3 dimensions. The image can be rotated and viewed from any angle. Morphing tools allow the result to be simulated in 3D and viewed from any angle.

there are technical limits to the reduction possible with Rhinoplasty. The overlying skin is often the limiting factor. Your skin can only shrink so much. If this limit is breached, the skin cannot redrape over the underlying nasal structures. This can cause a poor looking result. Another issue is the underlying cartilage and bone. If these are removed excessively, the function of your nose can be compromised. Its the skill and experience of your surgeon who can tell how much is safe and to tell you what your limits in nasal improvement are.

Rhinoplasty is one of the more difficult procedures for a surgeon to master.  In most cases a significant aesthetic change can be achieved.  There might be a number of reasons why your surgeon can not deliver to you the result you desire.  Most likely it has to do with your specific nasal structures.   The goals of nasal surgery is to create a beautiful nose with nice proportions, not necessarily make nose as small as possible  In my practice we offer computer imaging to our prospective rhinoplasty patients, so that the goals and aspirations of the patients can be communicated. Of course not all surgeons that can created changes on the computer can produce those changes in the operating room. Pick you rhinoplasty surgeon carefully.

You might find it insightful to read my article "The Art of Sculpting the Nose" which can be found on my web site under "publications"

 

Assuming the nose you are envisioning for your face is proportional and balanced, one major reason limiting how small you can go is skin thickness. If you happen to have thick skin and you reduce the skeletal structure of the nose significantly, there is a risk your skin will not shrink down to the new, smaller size. If this occurs, the definition and contour you desire will not be seen. Thicker skin does not shrink wrap down as easily as thinner skin. This is commonly the rate limiting step in reducing the size of someone's nose in rhinoplasty.