Q: Dr. Eppley, I feel my cheeks are a bit large so want to reduce their appearance as well as my upper outer brow bone. From the side my eyes look sunken, not for the front though. I feel that maybe reducing the brow and cheek bone would make eyes stand out and not seem so deep set from side view. However, I also have hollowness on direct sides of nose by nostril and have tried filler but it didn’t help. I also like my nose profile but from front, it looks wide around the tip so also looking into narrowing it from front view. Thank you for your help!
A: In looking at your pictures. I would not disagree with your contention about altering the bone to try and open up the eye area. There are two fundamental approaches to doing it. One option is a tail of the brow reduction through an upper eyelid incision combined with intraoral cheek reduction either done by burring or an anterior body zygomatic osteotomy. The second approach is a coronal incisional approach for lateral brow, lateral orbital and zygomatic reduction. (I think this approach is more than you need) From a nose standpoint you are describing two nasal issue, a paranasal deficiency and a broad nasal tip. Your nose concerns could be addressed by paranasal implants (placed through the same incision as for the cheek reduction) and a closed rhinoplasty for tip (dome) narrowing.
Dr. Barry Eppley
Q: I don’t like the appearance of my nose and want to get a rhinoplasty to fix it. The problem is that the upper part of my nose is not straight or symmetric. There is also a small bump that I want to get rid of as well. Is there any way to really just straighten out the top bone of my nose? The upper part of my nose is diagonal. That is what I believe makes the one side look bigger. Is there any way to shave just a bit off the tip of the nose as well without tampering with the nostrils or performing open surgery? What happens if the surgery does not heal correctly? Will I need to pay to fix it again? By that I mean deformed nostrils of something of that nature. Thank you so much! Sorry for my abundance of questions.
A: You are talking about a closed rhinoplasty versus doing an open rhinoplasty. Through a closed rhinoplasty approach, the hump can be taken down, the nasal bones straightened by osteotomies and the tip narrowed by plication with sutures . With a closed rhinoplasty, there would be limited risk of nostril asymmetry. The more major issue and the real concern is how straight and symmetric the nasal bone area (pyramid) can be made. It is also important to realize that the tip changes through a closed approach would be less significant than that of using an open approach.
Dr. Barry Eppley