Reduction Rhinoplasty

I want rhinoplasty surgery to make my nose a lot smaller, but my surgeon tells me I can't get have a size reduction as dramatic as I want. I am frustrated and don't understand why I can't have the little nose I want.

Doctor Answers 21

We always appreciate patients who present to us having...

We always appreciate patients who present to us having done some homework on their own because it lets us know that they are really preparing for their surgery and, more importantly, because it allows us to spend more time in really discussing the available surgical options.

We find a lot of our patients, men and women, present with exactly this question and the answer largely depends on each particular patient’s anatomy.

Sometimes, patients present with a large hump, which makes their nose look large, and you will often see these pictures on surgeons' websites because, in reality, though they are the most dramatic results, they are relatively easier to accomplish. Occasionally, these patients also have smaller chins, and a chin implant goes a long way in balancing their appearance.

The more difficult cases are those patients who like the overall shape of their nose but feel like their whole nose is just too large. In these cases the tip, middle third of the nose and bridge all have to be reduced equally. While we can and often do exactly this procedure for our patients, it is important in these cases to be very cognizant of skin thickness.

In those patients who have thick skin, we caution that while the nose can be made smaller, it should still maintain definition and refinement. In our patients with thick skin, we always let them know that if we attempt to make the nose too small the tip can lose its shape and appear amorphous. So while we make the nose smaller, we stress the importance of tip definition and refinement.

Finally, and perhaps most importantly, we must remember that the primary function of the nose is to help in breathing and this function is critical. Unfortunately, a lot of times with all the mass media exposure to airbrushed pictures, we are exposed to images of people who are not real and to noses that cannot be reproduced without causing problems in breathing. And it is for this reason that at Profiles, we always admonish that Form must not supercede Function.

Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 3 reviews

Size Limitations in Rhinoplasty

There are three considerations:

  • Aesthetic: what may look right on your face. Too much reduction may be disproportionate, leaving a surgical or unsatisfactory appearance.
  • Functional: over-reducing the nose can result in airway problems, including an inability to breath.
  • Structural: There are limits that are inherent in the quality of your tissues, particularly the thickness of your skin. Thicker skin is limited in how much it can "shrink" to reduce the size and shape of he tip of the nose.

You can always seek second opinions, but be sure you are consulting with well qualified surgeons and resist the temptation to just find someone who will tell you what you want to hear, rather than an honest opinion based on good judgment and experience.

Paul C. Zwiebel, MD
Denver Plastic Surgeon
4.6 out of 5 stars 39 reviews

Limits to a Rhinoplasty

  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

Carlos Wolf, MD
Miami Facial Plastic Surgeon
5.0 out of 5 stars 64 reviews

Making rhinoplasty too small

This is actually a very complicated question -

1. Considerations of aesthetics - finding a balance of your nasal shape and profile for your facial width and length and balancing it with things like the projection of your chin.
It sounds like from this standpoint your idea of a beautiful nose is on the smaller side.

2. Considerations of your health - Reducing a nose too much can have an impact on your ability to breathe through your nose. In addition signifcant nasal reductions can weaken the underlying structures that support the nose to the point where they may collapse. These problems are incredibly difficult to correct and typically require several surgeries with the end result being usually not as good as where you started.

3. Considerations of what is possible - Your nose has three groups of structures that need to be modified in more serious rhinoplasty - the outer skin, the inner mucosa and the structure. Usually with subtle changes that skin and mucosa will tighten over time but large changes can cause excess of skin that may need to be resected and further create an unnatural look.

Take the time to discuss these issues with a board certified plastic surgeon.

I hope this helps.

Steven H. Williams, MD
San Francisco Plastic Surgeon
4.8 out of 5 stars 49 reviews

Nasal surgery Rhinoplasty and Reduction in prominent nasal hump

Rhinoplasty techniques are used to acheive two basic goals:

  • Achievement of nasal harmony
  • Maintenance of a patent and healthy nasal airway

The nose is composed of an underlying structural support that provides an open airway to facilitate breathing. As the structure of the nose is made smaller, the passageway to the nasal cavity is compromised and may cause breathing difficulties.

An experienced plastic surgeon performing nasal surgery will take these two factors into account in order to produce a functioning, and aesthetically beautiful nose.

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 94 reviews

Rhinoplasty and limitations

The results of rhinoplasty are always limited by the underlying patient anatomy.  It can not be made as "small as one always wants."

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Why a nose cannot be made very small

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

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 81 reviews

Reduction Rhinoplasty: Creating the Tiny Nose

Anatomic limits determine how much a nose can be reduced.  These limits affect the aesthetic, structural, and functional aspects of the nose.  A nose that is excessively reduced may be disproportionately small when juxtaposed with the other features of the face.  One that undergoes removal of a significant dorsal hump and narrowing of the nasal bones by osteotomies (to prevent an "open sky" deformity) can adversely affect the airway by narrowing the internal valve.  One that removes too much bone or cartilage can destabilize the bony pyramid or nasal dorsum and result in subsequent collapse.  Finally, removal of too much cartilage from the nasal tip may not allow the skin to properly redrape.  Thus, there are limits to how much the nose can be reduced and an experienced rhinoplasty surgeon should discuss your goals and what can be achieved in your particular case as every one of these is different.

Jeffrey Weinzweig, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 61 reviews

There are limits to how small a nose can be made by a rhinoplasty.

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.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.7 out of 5 stars 35 reviews

Making the nose very small

There is a limit to the amount of reduction of a nose that can be achieved because the principle is that cartilage and bone are removed and the skin must shrink to conform to what has been taken out. There ability of the skin to shrink, while quite satisfactory, is not unlimited.

Howard T. Bellin, MD (retired)
Manhattan Plastic Surgeon
2.5 out of 5 stars 3 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.