How Realistic Are My Secondary Rhinoplasty Goals?
Q: Dr. Eppley, Thank you so much for your response. The imaging is definitely an improvement over what I have now. In the model’s picture, the tip of her nose not only projects outward but also somewhat projects a little bit downward so that her nostrils aren’t exposed. Can we achieve this in my case? I also still think that my nostrils look flared (my nostrils look thick) so I am hoping we can do an alar base reduction as well as a weier resection so that my alar lobules (I think this is what they are called) can be significantly thinned to achieve a further slimming effect. Is there any way we can further slim tip and make it more pointed through removing layers of fibrofatty tissue and then using permanent sutures to retain that refinement? I also think that I’ll require osteotomies for each of the third sections of my nose to bring the bones inward because my bones are so wide I’ll provide a picture. I also think that my columella is both retracted and wide so that the angle between my lip and the tip of my nose is very wide. I believe this causes my nostrils to be overexposed. Is there any way to bring the collumella forward as well as lengthening my nose so that my nostrils are much less exposed? I would also like to reduce the width of my entire nasal base. Do you think my alar base should be lowered or highered since the base of my nostrils are lower than my collumella? My ultimate goal is to not only decrease the size of my nose but to dramatically alter its shape. I am looking for dramatic results and an overall more graceful, feminine, and balanced look.
I apologize for all the questions but this surgery means a great deal to me because my nose is the number one feature that detracts from my face. It’s amorphous and I’ve always dreamed of having a nose like that model’s. Here are pictures of the wide nasal bones in the middle of my nose along the nostrils as well as a picture of the scar on my columella which I hope to be fixed.
A: In answer to your rhinoplasty questions:
1) One of the hardest goals to achieve in rhinoplasty is deprojecting the nose. (making it turn more downward) There are gartfmtung techniques to try and do so but it is still hard to achieve much in that regard.
2) Nostril narrowing/thinning can be done but the results are often more narrowing than thinning.
3) In all revisional secondary surgery I always defat the nasal tip and use an only air closure of surgical with kenalog to try and decrease tip thickening due to scar.
4) The nasal bones are only at the upper third of the nose so osteotomies only affect that region.
5) Your columella is retracted and it will take cartilage grafts to bring it out. That may or may not make it more narrow.
6) There his no good method to reliably raise or lower the alar absence. (attachment of the nostril to the face)
7) As I stated previously, while I can appreciate what your ideal nose reshaping goals are, you have to be realistic with what is possible. Every rhinoplasty maneuver can be done but you are not going to have a ‘model’s thin nose, your natural skin thickness is just not going to allow that to happen. A nose is not like clay where you can just make anything out of it. No matter what is done to the bone and cartilage underneath the eventual result is what the skin that overlies these structures will allow to show through.
Dr. Barry Eppley