Q: Dr. Eppley, For my projected rhinoplasty resultsI have redone the computer imaging superposition to represent a lesser overall nasal reduction. I would still be very happy with this result, perhaps even happier.

The main objective for me is to reduce nasofrontal angle and get a proper ‘break’ in the forehead-nose junction, as well raise the tip to an obtuse angle with respect to 90 degrees, somewhere between 95-105 degrees, and ofcourse get a straight nose with perhaps the slightest outward curve. I have a preference for feminine leaning noses (even on males) rather than masculine, and of course my nose at the moment is very masculine! 

Regarding the chin, is there any way to get that added projection and reduce the dimple? Perhaps with a filler such as radiesse or can fat grafting achieve both these goals? The extra projection really improves the profile to my eye. 

A: Thank you for sending your revised superimposition of a hopeful rhinoplasty result. It probably is still a bit optimistic particularly at the upper dorsal line reduction/nasofrontal angle. The nasofrontal angle is the hardest structure in the nose to reduce during a rhinoplasty because of its remote access from even an open rhinoplasty. There is no good way to get bone reducing instruments up that high although I have that a combination of a horizontal dorsal line osteotomy combined with a percutaneous vertical osteotomy can help carve out a more defined nasofrontal angle. Again probably not quite as good as you have shown on your images but a lot better. When you speak of a feminine as opposed to a masculine nose you are referring to the shape of the dorsal line. Specifically you would not mind a slightly conceive dorsal line profile as opposed to a straight or even a slightly outward curved one which is more desired by most men.

Fat grafting can be done to achieve some minimal chin augmentation and some moderate chin dimple reduction. The success of either one depends on how well the injected fat survives.

Dr. Barry Eppley
Indianapolis, Indiana