Q: Dr. Eppley, I am interested in a nasal hump reduction rhinoplasty. I have been looking into various options to achieve a straight nose in profile. As you’ll note from my photos this really is VERY minor – I’m under no illusion that this is not the case. Despite that I’m still very apprehensive about any work on the nose due to the complexity of it all and high revision rate. In particular I’m most concerned about affecting the nasofrontal angle negatively, and building up the bridge and radix too high whereby the eyes look closer together. The latter in particular is concerning as I’ll be having a midfacial operation that will widen the area even more. As such even a slight narrowing effect on the eyes could be exasperated later on with this next operation (infraorbital rim advancement).

As such, what would you recommend? As far as I can tell the position of my radix and nasofrontal angles are all relatively ideal. Would it be best then to shave down the dorsal hump? Or would building up the radix be ok given how minor it would be?

I look forward to your response.

A: My advice for you is not to have rhinoplasty surgery. The revision rate in rhinoplasty where patients have relatively major nasal shape issues is around 15%. When it comes to minor deformities the revision rate is higher…much higher. Contrary to popular perception, the smaller the nasal problem in many cases the harder it is to get it right. (perfect) The margin of error in minor aesthetic nose concerns is zero. It is just as easy to overcorrect in minor nasal shape issues as it is to get it perfect. By your own admission the position of the radix and nasofrontal angles is ideal and the hump is very minor. Be aware you will be scrutinizing the after surgery result just as carefully (if not more so) as the preoperative deformity. The chances of a successful outcome is no greater than an unsatisfactory one. Unfortunately rhinoplasty surgery is not a precise science and can not be controlled down to the level of a millimeter or two of structural changes.

In addition if you are going to being having infraorbital augmentation in the future, that facial change can potentially impact how you see other facial structures. Since that will be having a more major impact on your face I would defer any consideration of rhinoplasty until after that procedure.

Dr. Barry Eppley

Indianapolis, Indiana