Q: Dr. Eppley, I am interested in rhinoplasty surgery.There are two main things I would like to change about my nose, that you will see from these photos. I have a small bump on the bridge as my nose, but I also really want to change the tip of my nose. My nose isn’t too wide or anything, but the tip and the bump are my two biggest concerns. The tip is the part I am most worried about and have been hesitant about rhinoplasty in general for fear that it won’t look natural after surgery.

A: Here is some imaging for your rhinoplasty. Your rhinoplasty is not quite as simple as ‘just take away the bump and lift the tip’. One of the reasons you have a bump on the bridge of your nose is because you have a very low radix or frontonasal junction. (the area above your bridge) This is part of your overall more recessed mid facial development. The bump is actually a pseudohump. It appears to be a hump because the bone above it is deficient. Just taking down the bump will make your nose look too low in this area. While some hump reduction is needed, the area above the hump must be augmented with carriage grafts as well. (radix augmentation) Your nose is also long with a hanging columella. The end of the nasal septum must be shortened to allow for any tip rotation upward as well as retraction of the hanging columella. With the hump reduction the tip absolutely must be shortened and rotated upward otherwise your nose will look even longer.

Dr. Barry Eppley
Indianapolis, Indiana