Reduction Rhinoplasty with Dr. Steven Denenberg (Warning Graphic Images)

Always disliked my nose, especially when I caught...

Always disliked my nose, especially when I caught a profile view at age 12 of myself in a hotel mirror for the first time. I barely recognized myself, and it was nothing like how I pictured my nose looking. Inherited my grandma's nose, but worse because it drooped down and became a hook nose when I smiled. I didn't notice this so much (or maybe it became worse as I got older) until about sophomore year of high school. Eventually I just stopped smiling entirely when I was in public, so people thought I was depressed or unfriendly when in fact that was not the case at all. Was thrilled to find a surgeon whose before/after photos I liked and who lived somewhat close to me!
Still not entirely sure if it was worth it or not, though. When you change one thing about your face, other things are bound to change as well. For me, it was my upper lip. It now appears longer and covers more of my upper teeth at rest and during speech. The fullness at the base of my nose is also gone and I now have a sharper angle between my nose/upper lip. Also, everyone heals differently and for me, I still have persistent swelling in the supratip region.
The pros? I'm no longer self-conscious about smiling and I think others view me as a friendlier person now as a result. My nose is no longer the center of attention and it doesn't look like a completely different nose when I smile now. Another huge thing is that I now wear my hair pulled back. I used to hide my face behind my long wavy hair like it was a curtain because I was so self-conscious about my nose. Now I wear my hair up a lot. My nose is also no longer bulbous (except due to swelling) and the hump is gone. My eyes now look bigger too, and my dad agrees.
Funny story: I didn't tell anyone about my surgery (only my parents knew, but neither of my siblings did), and the day my sister got back from Africa, she didn't notice my surgery. She and I were sitting in the swing set and she actually told me, "You know, you seriously do not need surgery. You look beautiful the way you are". That was not even a week after surgery if I remember correctly, and my nose was still really swollen. She finally noticed later that night when she was looking at my nose from the side and talking to me at the kitchen table. But my own sister didn't notice, and she told me I didn't need surgery, but I already had it!


Starting to thing I should change review to "not worth it". Really, strongly dislike the change to my upper lip and I think I look very unnatural. Also seem to have some sort of polly beak deformity as well.


Photos to show upper lip changes.

More photos

Sorry I had to post these images in separate posts because they weren't getting added in the correct order for some reason.

Request for before/after smiling pics

Here are some photos (upon request) of my smile shortly after surgery and over a year later. You can see that I could hardly smile at all after surgery, and this has persisted for MONTHS. Has it gotten better? Yes, but it has taken a VERY long time and I think it still takes more effort than it used to, but it's definitely better than it was.

Computer image

Just thought I'd show you guys the before photo and the computer image of how my nose was expected to look after surgery. Dr. Denenberg and I went back and forth tweaking the images until we agreed upon one. Quite a difference if you ask me!

Some more photos

Here are a few more before/after photos.

Some more photos

I thought I'd post a few more photos to show different lighting , angles, etc. and the upper lip changes I dislike (including differences in tooth show).

View of nostrils; tip definition; etc.

Here are a few more photos. I've posted a base view of my nose before surgery and after surgery so can see how my nostrils look. Clearly, they were never even, but they seem more prominent now since my nose was shortened significantly.

Also, you can see how bulbous my nose was before surgery, and I had zero tip definition. Now I have a sharp white line/reflection at the nose tip (I don't know if that explains it very well, but hopefully you'll see what I mean).

Cast on, early post-op photos, etc.

Thought I would post some photos of when I still had the cast on, how the bruising looked, etc. and how my nose looked immediately after getting the cast removed. I'm also posting a few photos of how I wanted my nose to look. I will have to do separate posts because some of them aren't loading..

Continuation of last post

Confused about the "like" button

I just realized some photos have been "liked" but I don't get notified when this happens. I'm confused, though. Does "liking" the photo mean the person agrees with the caption (for example, a caption that says upper lip now looks longer, or no tooth show after surgery) or does it mean the person somehow actually thinks the "after" result looks good? Or that likes on before photos mean it looked better before surgery? I personally think the lips/tooth show looked superior before surgery and I really sort of regret it. I didn't like my nose, but had I known it would change my other features and now there's nothing I can do to correct it (other than a lip lift, which I do not want because of the scar and often poor results), I'm not sure I'd ever do it again if I had it to do over..

Photos taken during surgery

I really wish I could post the photos Dr. D. took of my nose during the operation so you guys could see how much the underlying framework was changed before vs. after. I think it is so interesting! But I'm not sure if I'm allowed to post the photos because I suppose it's sort of gory and not everyone can stomach it. But you can look at similar noses during surgery on his website but I'm not sure you can actually compare the before and after. I think he only shows the before nose, but I really wanted to see what my nose looked like during surgery after he made the changes, is that's why I asked him to send me the photos.

Photos taken during surgery

Here are some of the photos taken during surgery so you can see how my nose looked and it's underlying framework before and after the operation.

Changes in lip movement/tooth show not worth it

I really appreciate how supportive you guys have been, but I just really don't think it was worth it. It may look good in some photos, but as I mentioned, the upper lip/tooth show changes are most noticeable during speech. My upper teeth do not show at all anymore and only my lower teeth do now, and it's not only extremely unattractive, but it's also very, very aging. The tooth show I used to have was one of my features I used to like, and my mouth is what I hate the most now. I feel hideous. You guys say I look way better now, but if that's the case, I must have looked absolutely dreadful before surgery because I think I look so strange and unnatural now. Yes, I had a huge nose that hooked down when I smiled and was really bulbous, but I'd much rather look like that again than the way I do now. At least that was the real me, the way I was born. A long upper lip is not an easy thing to correct and lip lifts rarely turn out well. I am flattered by your comments, but just please realize what you're getting yourself into if you should decide to go through with a major reduction rhinoplasty. I just don't think noses are meant to be reduced that much because that excess skin has to go lips now have a duck-like appearance.

Almost a year and 10 months (photos)

Thought I'd post an update with a few more recent photos to show how my nose looks at almost a year and 10 months. Still lots of supratip fullness. And to show my scar. And my nostrils (uneven, but not that big of a deal). Possibly a retracted columella but also maybe noticing some slight alar retraction?

More photos the day the cast came off

Here are a few more photos of how I looked the day the cast came off. One thing I forgot to merino is that the tape ad splint made my skin break out like CRAZY and I had red pimples and blackheads all overt entire nose and they took FOREVER to go away and I couldn't use pore strips. But you can't really tell from these photos.

Considering revision

The more time goes by, the more serious I've been getting about considering a revision. I think my nose was deprojected too much and made too short for my face. My main goal would be to add length and projection back to my nose, which is unfortunately one of the hardest things to do in rhinoplasty, apparently. I made some simulations of my goals, but they're not great--just a general idea. You guys may think my results look good, but they were far from what I'd hoped for. I did NOT want a short, cutesy nose. I mainly just wanted to refine the nose I had and not alter its length.

Before/after comparison

I really dislike the change. It's hard not to want a revision, but I know it gets more and more complicated with each surgery. My nose is so turned up now compared to how it used to be and the upper lip area is completely different, and not in a good way (at least in my opinion, and I did the surgery for myself not for others).

Original nose--Desired outcome--Actual result comparison

To clear up any confusion as to how I wanted my nose to look and why I'm unhappy with the actual result, I'm posting photos of my original nose from profile view (my main complaint was when I smiled and the tip would droop down, giving me a hook nose, not my resting face); a computer image I made of how subtle I wanted the change to be and what I'd envisioned (not Denenberg's computer image), and then my actual result. Notice how my upper lip changed drastically. I used to have fullness at the nasal base and I wanted to maintain my nose's length and projection for the most part. I just wanted the bump smoothed just slightly and the tip refined to be more pointy and less bulbous. Now, my upper lip is more sloped and straight, and no longer has the curve it used to have. I used to have a more obtuse nasolabial angle, and now it's more acute and retracted in appearance. I also have less tooth show at rest and when I talk. The tip is now short and blunted.

Some more before/afters to compare

Skype consultation with Dr. Fleming today

Today I had a skype consultation with Dr. Richard Fleming in Beverly Hills. He understood my concerns, and said he could do a septal extension graft to lengthen my nose vertically, and remove the scar tissue causing the pollybeak. I really like him, I just an worried that a septal extension graft alone won't do it because it might throw off the relation and proportion of some other part of my nose.

Before photos taken by Dr. Denenberg

Here are the official "before" photos taken by Dr. Denenberg (approximately 1 month before surgery, if I remember correctly).

Early post-op photos/swelling

Someone had asked how long it took for the swelling to go down. I think I still have some swelling, but it certainly looks a little better than it did in the early post-operative phase. The tip came down a bit, but I would have liked for it to have dropped even more. I still have the slight pollybeak, but not quite as dramatic. Most of the photos were taken less than or around 1 month or so post-op.

Very strange swelling--comes and goes

It seems my nose is much more swollen than usual for some reason. I think the swelling comes and goes, or perhaps maybe it's been this bad all along but these angles just really captured it! I will be exactly 2 years post up in exactly 16 days. I feel like this shouldn't still be happening :(

Very unflattering (but accurate) candid photos

These photos were taken by my mom while I was home and they were candid photos, but they are accurate, unfortunately. I was in my pajamas still and eating breakfast, which the dog was trying to steal from me (he's not even a year old and was about to jump on me in one of the pics, hence the frowning face). They really show how long my upper lip is now and how my teeth don't show and my nose looks too small/short for my face. I have the photos in their actual size and then zoomed in so you can see what I mean.

Normally, I would never in a million years post such unflattering photos, but I don't want to embellish my results and I don't want someone to make the same mistake I did and regret having had surgery. I want you guys to see all the pros/cons and trade offs that come with having such a procedure that you wouldn't normally see on a surgeon's website with standard before/after photos.

Another non-selfie

Here is another non-selfie photo my mom took. I was horrified when I saw it. My nose looks SO small to me and my mouth/nose look so strange :/

And for comparison..

Forgot to put a side-by-side comparison with my original nose to show how strange my new nose looks..

For those who still don't see a difference in my upper lip

To those of you who say you cannot see the change in my upper lip, maybe these photos will help. Maybe the *lips* themselves do not look different, but the *upper* lip (area where base of nose meets red vermillion border of top lip) looks longer now because of how the nasolabial angle changed. It used to be more obtuse but now looks more acute and "sloped" if that makes sense. I used to have a lot more curvature to the upper lip, and the nasal spine area had much more fullness. And of course, my upper teeth also don't show like they used to because the tension was released (the over projected nose was pulling the upper lip forward) and that caused my upper lip to relax and get longer.

Small noses with prominent nasal spine/tension nose

I was having a conversation with a couple other members that it's usually only larger noses that have tension nose/prominent nasal spine where the upper lip looks like it's being pushed forward and has lots of curvature, but that doesn't explain my sister's nose. I wouldn't call her nose big by any means, although it's bigger than mine in the sense that the septum is probably longer and she has a very slight hump, but it seems fairly small and not too projected, yet she has what appears to be a prominent nasal spine. She has hardly any space between her nose and top lip, and it's very curved. Her upper lip looks very, very short because of this and she has a lot of tooth show at rest and during speech. Her smile is a little gummy, too.

What's strange, though, is that her upper lip looked much longer as a child and looked a lot more like mine does now. But perhaps her caudal septum became overgrown as she got older? I feel like my upper lip after surgery makes me look more childish in this sense and that I used to have a more mature, adult look. But at the same time, I have less tooth show, which is a youthful characteristic. It's weird and hard to explain.

More photos from last post

For some reason it wouldn't let me upload them in the last post

Some other pics

I used to have a HUGE nose but a short upper lip. Now I have a small nose and a long upper lip. It's all about the trade offs with surgery, I guess. I was expecting my nose to change, not my upper lip. My nose actually kind of looks like my mom's now, I think, so at least I still look like other members of my family..

Today's nose/swelling (afternoon)

My nose is still very swollen, even in the afternoon.

Me with cousin's nose and my pre-op mouth using app

Thanks to lerickson1 for discovering this app. I'm now obsessed. I used my face but with my cousin's nose, then my face with my current nose with my pre-op mouth, then my cousin's nose with my pre-op mouth, and then the original photo for comparisons.

What Dr. Denenberg said today

I emailed Dr. D. yesterday asking him 'how much is still swelling?' as opposed to just the new shape of my cartilages, and if it was still swelling, how much could I expect it to go down and for my nose to keep refining. I also showed him the morph of me with my cousin's nose, asking what makes hers so much different and why she has a bifid nasal tip (very thin skin, cartilage a different shape, more projection? etc.) and if I could ever expect my nose to become anything close to that refined as the swelling continues to go down, and this was his reply:

"Hi Mariel,

Actually, I don't think there is any significant swelling in your nose right now. It should have been long enough for all the swelling to go away.

I think there are a number of reasons that your cousin's nose shows that bifidity and the thinness of the tip. I took another look at your "before" photos., and even before surgery, your cartilages were round enough, and your skin was thick enough, to not allow the edges of the cartilages to show. Then, after surgery, there is always a tiny layer of scar tissue that is deposited on the undersurface of the skin, and that works against seeing the cartilage edges or seeing an extremely narrow tip. I don't think that tip of your nose will ever look that defined. Even if matching your cousin's nose was the highest priority at the time of surgery, it would still be very difficult or even impossible to make it look that defined.


Unfortunately, it sounds like I'll never have a pointy little nose like that :( I'm not surprised, though, honestly. Hers is very unique and her skin must be extremely thin.

What Dr. D. said about my skin thickness/kenalog injection

Just thought I'd share with all of you what Dr. D. said yesterday in an email when I'd asked about my skin thickness and about kenalog injections thinning the skin:

"Hi Mariel,

The dermatologists tell their patients that topical steroids on the face can '"thin the skin" in a bad way, making the texture poor. However, I have never actually seen that happen, and when we use Kenalog in a nose, we are trying to make something thinner by, for example, a millimeter or two or even three, which means we are seeking much more thinning than the dermatologists are worried about. If I am not being too confusing, that means that we never really worry about thinning the skin too much when we inject Kenalog into a nose. Rather, we are hoping to get enough thinning to make a visible change that we are seeking.

After surgery, there is a thin layer of scar tissue underneath the skin, and that scar tissue effectively makes the skin seem like it is a little thicker, so that gets in the way of seeing the cartilages well. It happens more on some patients and less on others. I think initially your skin was not really thin, as in particularly thin or worrisomely thin, but rather it just wasn't so thick that we thought it would get in the way of a good result. It seems to me that your skin thickness is still somewhere around average, but there is still that little swelling that we haven't been able to get rid of with the Kenalog.

I hope I haven't been ridiculously confusing here!


Before/after comparisons

Thought I'd post some more before/after comparisons to show how drastically this rhinoplasty changed my face. No--I am NOT fishing for compliments by posting all these photos. Rather, I'm trying to keep others from making the same mistake I did. I do not like the way my face (nose/lip area in particular) looks anymore. It's not me. I feel like I have a more childish looking face now while before I had a more mature, adult face. I really do not like the change. It's not at all what I wanted.

How rhinoplasty has changed my life

I thought, on a positive note, I'd share some of the ways in which rhinoplasty has changed/affected my daily life for the better. It's sort of a tie between the two, but I'd say first and foremost I can SMILE now without being self-conscious about my nose drooping down and widening like it used to, so I think I come across as more friendly to others now. I always have been friendly, but I was always too self-conscious about my nose to smile so people probably thought otherwise, unfortunately.

Second (but almost equal to the first reason), I can wear my hair up finally. I always used to wear my hair down (I never once wore it up at school for two years straight!) to hide my big nose (although it never worked because my nose stuck out further than the curtain of hair trying to block it!). LOL.

Third (and this may come as a shock to many of you because I'm always posting about it--"it" being the nose), I rarely think about my nose anymore (for the most part, that is--except for the swelling which hopefully will go down eventually, either on its own or with the help of another kenalog injection). I used to think about my nose constantly but now I hardly ever do. My main issue is the lip thing. And even if I do still think about my nose, it's nothing like how I used to think about it. I realize that aside from the pollybeak issue, there's nothing about my nose to be self conscious about, really. Nothing about it really stands out anymore, and I guess that's partly why I'm not crazy about the change--my new nose seems a bit cookie-cutter to me now and totally lacks character. But at least I don't have to feel self-conscious about it in public anymore and I can smile and wear my hair up at last!

Fourth (and this could honestly go either way--positive or negative, depending on how you think about it), people look at me differently and treat me differently, I think. I have a more feminine appearance now (aside from the loss of tooth show, since tooth show is a feminine characteristic) and have a "cuter" look now. Guys seem to find me more attractive now and approach me or talk to me more than they used to. I think I had a slightly intimidating look before with my strong and rather masculine nose. On the downside, however, I read an article about how women with cute, feminine features are often targets for men looking for flings rather than settling down! I don't think guys take me as seriously as they used to or respect me as much now, as crazy as that sounds, and I sort of recently fell victim to one of those guys who was just looking for a fling (he was the guy friend I mentioned and it turns out he just wanted to sleep with me but fortunely I never did!). It may have absolutely nothing to do with the new nose, but I can't help but wonder if he still would have approached me initially and been attracted to me had I still had my original nose. It's not just attention from guys, though. In general I seem to get more compliments even from other females or older women.

In general, I've just had a more positive attitude and outlook on life since my surgery, and in many ways it has changed my life for the better. I must not forget that.

Something that makes swelling worse

This is going to sound kinda gross, but I noticed that whenever I get a pimple on the top of my nose (like on the tip), my whole supra tip area gets extremely swollen. Unfortunately, I don't have much control of this :/ But once it heals, the swelling goes down pretty significantly.

Some non-selfie photos

To help give a more accurate, everyday representation of my nose, I'm posting a few more candid/non-selfie photos, just for another perspective. I blacked out the eyes of people who aren't me for others' privacy and so they don't get taken down from realself.

Tip drop/tooth show

Someone had asked about my tip dropping (if it had/how much) so I thought I'd post some comparison photos of early post op versus now (2 yrs post op). I suppose it's dropped a little bit, but overall I honestly don't feel my nose has changed much since the cast came off.

I also felt like posting some photos of what I consider "ideal" tooth show, something I no longer have (but I've never had as much as she has and never will, unfortunately). I don't know if it's just a shorter upper lip or if she has slight vertical maxillary excess. But I love tooth show at rest and a smile that exposes some of the gums and the whole crown of the tooth.

Old photo I found

I just found a bunch of my old drivers licenses and I realized how much different I used to look. My features somehow looked softer (at least from the front view) before surgery. You can tell how wide the bridge was in this photo.

Before/after comparison

Here's another before/after side-by-side comparison from earlier this year. And yes, my nasal spine was indeed altered.
Omaha Facial Plastic Surgeon

You will not find a more compassionate, honest, caring, down-to-earth surgeon anywhere else, in my opinion. Always responded to my emails, even when it seemed like I was an unhappy patient concerned/unhappy about my result. Never dismissed me and was always honest both before and after the procedure about what was possible/not possible. Never rushes visits/consultations, or post-op appointments. The first consultation I had with him, he spent the first 10 min. or so just talking to my parents and me and showing all the different ways he could rearrange his middle name, Miles, to read "slime", "smile", "limes", etc. He's full of good jokes and stories to tell. Goes above and beyond the call of duty. Went back and forth with emailing & altering the computer images to make sure he understood the result I wanted. Even came in on a Saturday and and then the day after Thanksgiving on another occasion to give me a kenalog injection to help with swelling. Very humble person--definitely not your typical surgeon. More like someone's dad or friend.

5 out of 5 stars Overall rating
5 out of 5 stars Doctor's bedside manner
5 out of 5 stars Answered my questions
5 out of 5 stars After care follow-up
5 out of 5 stars Time spent with me
5 out of 5 stars Phone or email responsiveness
5 out of 5 stars Staff professionalism & courtesy
5 out of 5 stars Payment process
5 out of 5 stars Wait times
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