Q: Dr. Eppley, Would it be possible to do the rhinoplasty to straighten asymmetry but keep some features of my nose? I would like to take down the small hump, but I honestly kind of like how the tip of my nose flicks upward. I know that is usually undesirable, but for some reason I’ve always been attracted to upturned noses and “ski-slope” noses versus a traditional straight nose. I feel like if the hump was reduced and kind of sloped inward more to match curvature of the tip of my nose, it would give my nose a “ski-slope” appearance from the side view. We can still even narrow the tip, as long as we keep a slight curvature versus having my nose look like a straight line from the side. I added a few pictures as examples of “ski-slope” type noses. Also my eyes are quite deep set, and I feel like reducing the bridge of my nose and maybe even a little up at the top of it between my eyes might make my eyes appear less shadowed. I like what you did with the chin however I’ve always felt self conscious because I have what people consider a “butt chin”. I was wondering if that too could even be smoothed out because we would already be doing work on my chin to correct the asymmetry. Thanks so much for your help! Sorry if I seem really nit picky, I just want to feel good in my skin.
I would like to reduce the bridge/dorsum and radix. I don’t really want anything done with the tip except whatever has to be done to correct the asymmetry. Maybe making the tip a bit smaller because making the bridge of my nose smaller might make the tip appear large… It’s weird I’m okay with my nose from a front facing view with a neutral expression, but whenever I smile it seems to appear at least twice as wide… maybe we should do something about that as well but I’m not sure what it would be. I want my nose to look like my nose afterwards, just a more visually pleasing version. I don’t want it to look completely different. As for the chin goes I don’t want any implants or fat grafting. I think my butt chin is caused mostly by bone, although you’re probably right that there is also soft tissue causing it. I think if we dealt with the bone though it would help, I am okay with having a slight butt chin but anything we can do to reduce it through the bone would be helpful.
A: In interpreting your nose shape change objectives I have attached an imaging prediction of what you want. This would be reduction of the dorsal line and bridge including the radix. This will create an increased concavity to the dorsal line. Without changing the tip of the nose this will give it a more scooped out appearance. Without changing anything the tip this will make the nose tip see longer and more upwardly rotated. While this nose shape change would not be common, I believe that is what you want and the patient’s aesthetic goals is all that really matters.
For the chin what you have imaged is a vertical reduction of the chin and back along the jawline. This is best done through a submental approach. Some of the bone that is removed can be placed over the cleft in the chin one as a graft to help minimize the cleft chin look.
Dr. Barry Eppley