Q: Dr. Eppley, I have attached a before and after computer morph of my desired rhinoplasty changes. I understand that the aim is very ambitious, my question is whether what this change is possible. I would like the following done:

1) Flattening of the dorsal hump and increasing the nasofrontal angle,

2) Decreasing tip projection slightly and dropping nasal tip slightly to prevent nose being too upturned after,

3) Lowering the caudal border of the columella using cartilage grafts and in doing so lower the ‘point of subnasale’ in order to achieve two aesthetics effects: a) Reducing the ‘hooked’ appearance of the nose which is caused by a curved contour of the base of the nose from a profile view and b) Reducing the upper lip length (my upper lip length throws off my entire facial proportions and makes my chin look too short) Would this need to be combined with alar base lowering so that the subnasale isn’t unnaturally low compared to the nostril bases?

4) Nostril reshaping in two components: a) shortening the nostril length in the sagittal plane and b) lowering alar rim using alar rim graft to compensate for the vertical columellar increase and to improve the natural alar rim retraction that I have.

Are all these things conceivably achievable? And if they are, can they all performed in the same procedure?

A: Let me discuss your rhinoplasty objectives as follows:

  1. Eliminating the dorsal hump, smoothing the dorsal line and deepening the nasofrontal angle can be done. The most challenging of these is deepening of the nasofronal angle.
  2. Decreasing tip projection by dome resection and lowering the nasal tip by cartilage grafts can be done.
  3. While the columellar border can be lowered by cartilage grafts, it will not reduce upper lip length. Such upper lip length reduction can only be done by a subnasal lip lift which must be done as a separate procedure from an open rhinoplasty.
  4. While alar rim grafting can improve alar rim retraction, I know of no procedure that can shorten the front to back length of the nostrils.

Performing all of the maneuvers described in a single rhinoplasty procedure is common.

Dr. Barry Eppley

Indianapolis, Indiana