Can My Thick Nose Be Made Into A Thinner European Nose?
Q: Dr. Eppley, I am seeking revisional rhinoplasty. I have had two prior procedures in 2001 and 2007. I am seeking to make the following changes to my nose. First I want to eliminate the ethnicity of my Middle Eastern nose. I am seeking a more European looking nasal appearance with significant improvement in the nasal tip and narrowing of the nostrils with less nostril show. Second, my septum as a result of my last rhinoplasty is slightly off midline with a deviation to the left. This will need correction. Cartilage from the right ear was used to support my tip in the past. My left ear is intact and can be uaed for further reconstruction. Lastly, my columella requires shortening without flattening my nose. Thank you for your kind assistance.
A: Thank you for sending your pictures. Based on your two prior surgeries (which appear to have been done via closed rhinoplasty ??) and the thickness of your nasal skin, any tertiary rhinoplasty is challenging in terms of achieving your goals. Your skin thickness makes it impossible to truly have a classic European nose which is more thin-skinned. As you experienced, removing cartilaginous structure underneath is not a guarantee that it will be well reflected on the outside. While you have room for some improvement, I am not optimistic that it can ever achieve the degree of tip narrowing and refinement that you desire. The purpose of your ear cartilage graft used in the past is mysterious to me as such tip grafting will only cause it to become thicker not thinner. Columellar shortening is not possible without causing a downward tip pull and is almost never done anyway except in cases of large projecting nose reductions.
While I think certain features of your nose can be improved (septal straightening, some limited tip narrowing) I have concerns about achieving your goals in a nose that is already scarred and grafted.
Dr. Barry Eppley
A detailed description and pictures of your concerns allows for the most informed response.