I always assumed a simple hump reduction would suffice, but I'm now thinking that things are more complex. (photos)
Doctor Answers 16
Thank you for providing so many photographs! That being said, a thorough physical exam is going to really help solidify a good evaluation, but I can understand the need to get as much feedback as possible.
You do have a prominent dorsal hump, and from the look on the pictures this is a combination of both the nasal bones and cartilage of the septum. You also seem to have what's called a "ptotic" tip. This just means the tip of the nose droops just a bit. Accentuating the drop in your nasal tip is the excess show of your septum on the profile view. The lower half of your nose isn't shapeless, but the cartilage in the tip of the nose is splayed. This is leading to the cleft in the tip of your nose and can also be addressed during your rhinoplasty. You would be best served by getting both of these aspects addressed to create a more harmonious aesthetic. Your surgeon will also likely examine the inside of your nose to determine if you have a septal deviation and evaluate you for any breathing difficulties. Above all else you want to make sure your nose functions appropriately!
The nose has thin skin which will not hide any irregularities. The surgery must be done precisely.
The hump needs to be removed and the tip rotated upwards. If the nose projects too much, it need to be deprojected. All the steps needed to accomplish this goal, a good surgeon would know, because it looks like a straight forward rhinoplasty, with no warning signs, save the thin skin.
You should also consider a chin implant for facial balance.
The photographs demonstrate a large dorsal hump which composed of both bone and cartilage. This will need to be shaved down in order to remove it. Osteotomies will be required to be placed in the nasal bones to close the open roof deformity created from the hump removal. Spreader grafts may also be required to hold open the upper lateral cartilages and prevent them from collapsing inward. The lower lateral cartilages need to be adjusted and slightly lifted to get rid of the crease between the two of them in the tip of the nose. Also important to release the depressor septi ligament which pulls the tip down when smiling. For more information and many examples, please see the link and the video below
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I think it is good that you have evaluated your nose to determine what concerns you (as well as what does not). It is important that you relay this information to your surgeon at the time of consultation. It may also be helpful to find photographs of noses that you like as well as those you do not so you can give your surgeon a good idea of your ultimate goal.
thanks for your question. I agree with you that you will need more than just a hump reduction. This is the case with most noses. Although the hump is what bothers you, everything needs to be balanced. In your case the tip is long and pointing down which need to be redefined. See a rhinoplasty surgeon for a full assessment.
Hello and thank you for your question. Based on your
photograph, you may benefit from a tip refining rhinoplasty. Your surgeon can
accomplish this by trimming, suturing, and reshaping the cartilage in your
lower nose. Cartilage grafts may also be used to help improve tip refinement.
You may also benefit from a cephalic rotation of your tip to turn up your tip
slightly and a conservative dorsal hump reduction. 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. The most important
aspect is to find a surgeon you are comfortable with. I recommend that you seek
consultation with a qualified board-certified plastic surgeon who can evaluate
you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon
Yes, I think that you need more than a hump reduction. It looks like tip refinement would be reasonable as well.
Changes to the Nose
Thank you for your question! Yes, you are correct that the appearance of the nose can be quite complex. Sometimes, a 'small' or minor procedure is all that is needed to help with its appearance. However, most often to change the appearance of the nose, the procedure is more involved which is called rhinoplasty. The best way to know what and how the appearance of your nose can be refined would be to have an in person consultation with a board certified facial plastic or plastic surgeon who specializes in rhinoplasty. Rhinoplasty is a complex procedure, and best performed with someone who has experience with the procedure.
I hope that this helps!
Hump reduction will necessitate other balancing maneuvers.
Each nose is unique in what must be done to correct the patients concerns and leave the nasal shape balanced and proportional for that patient. Large nasal hump reductions usually require some repositioning of the nasal bones inward to create normal dorsal lines. Various trimming and suturing techniques can reshape the cartilage of your nasal tip so it is more refined and balanced. During your consultation, your plastic surgeon will take into account your tissue characteristics and anatomy and combining this with your desires, create an operative plan to create a nasal shape you find more pleasing. Always see a board certified plastic surgeon.
Every nose is
different and unique to that individual. If the appearance of your nose
concerns you enough to do something about it, it can be improved with a natural
artistically performed rhinoplasty. What would be the best option and exact
procedure would depend on an in person examination (not just an online
consultation) and discussion about desired outcome. Excellent results can
be achieved with either a closed or open technique.
Keep in mind that following advice from a surgeon on this or any other website who proposes to tell you exactly what to do and how technically to do it based on two dimensional photos without examining you, physically feeling your tissue, assessing your desired outcome, taking a full medical history and discussing the pros and cons of the operative procedure would not be in your best interest. Natural appearing results need to be individualized and what is appropriate for one patient is not necessarily the best for someone else. I would suggest that you find a surgeon with extensive rhinoplasty experience certified by the American Board of Plastic Surgery and one who is ideally a member of The American Society for Aesthetic Plastic Surgery (ASAPS) that you trust and are comfortable with. You should discuss your concerns with that surgeon in person.
Robert Singer, M.D., FACS
La Jolla, California