Q: Dr. Eppley, thank you for your time in creating these  rhinoplasty images.  I now feel a bit hesitant in performing the procedure though, because I just don’t see a very substantial result from the before and after pics.  I still feel like the bridge of my nose might be too broad, as well as the tip, and the nostrils.  I suppose that I am expecting an end result to be that I don’t have a big nose. Of course I don’t want to go the Michael Jackson route, but do want a bit more significant reduction. I am not sure if I am adequately expressing my interests, so please let me know if I need to elaborate more.  I also feel like the jaw line may not be what I was hoping for.  I really wanted a hypermasculine, chiseled jaw look, but I am not sure if that’s possible in my scenario.

A: The purpose of computer imaging is to serve as a point of discussion about realistic goals and expectations as well as the type of changes the patient is seeking. It is not necessarily an exact replica of what the final outcome may be. (it is just Photoshop and pushing facial contours around on the computer) That being said, it has served its initial purpose in regards to your nose and jaw as follows:

1) A reductive rhinoplasty result is always heavily influenced by the thickness of the skin on the nose. It is always going to be less than most patients want particularly in the thick skinned nasal patient like yourself. It doesn’t matter what is done to the underlying osteocartilaginous framework, those effects will be blunted by the thick layer of overlying skin. This is particularly true in the nasal tip. While you can achieve some further reshaping of the nose you have, it is not going to be dramatically different and you can not have much of a smaller nose. Therefore in any type of rhinoplasty you may undergo, the result is always going to less than what you ideally want. if you approach any further rhinoplasty with that concept in mind, you will not be disappointed. Any expectations higher than a mild to moderate reshaping result will be result in dissatisfaction with the outcome.

2) Conversely, any augmentation procedure like the jaw angles is exactly the opposite of that of the nose. That result is controlled by the style and size of the implant. Such a result can be modest or dramatic depending upon the implant chosen. For the sake of the initial imaging I have chosen a modest widening jaw angle implant. Much larger and more dramatic implants can be used. But it still remains unclear to me, at this point, what your visual representation of a hypermasculine jaw look is. What I do know is that you don’t have the face for a ‘chiseled’ result because that takes a very thin face with little fat which is not the type of face you have. That is likely not a realistic outcome.

Dr. Barry Eppley
Indianapolis, Indiana