Q: Dr. Eppley, I am inquiring about a rhinoplasty. I am a 35 year old male in great shape. My nose history is that I played high school and college basketball and probably broke my nose 3 or 4 times so there is an obvious bump on it that is visible from both sides and then I would like it to be smaller or just fit my face better. Also, I think because of the number of times it has been broke it affects by breathing which is heavy through my nose. I have had my tonsils taken out to try to help but it hasn't. I have attached some pictures so you can see the nose problem that I have.
A: Thank you for sending the pictures of your nose. Your story is a fairly classic one and represents what I call the athletic or ‘sports’ nose deformity. This is the result of numerous nasal injuries and presents a story and nose that looks very much like yours. There is a visible nasal hump which is somewhat due to a severe middle vault collapse due to internal septal shortening and deviation. The internal inferior turbinates are usually hypertrophied. The combination of septal deviation, large turbinates and middle vault upper cartilage collapse undoubtably makes some contribution to your breathing difficulties. In addition, the nasal bones are displaced and often deviated. The nasal tip is large and too wide and long for good nasal balance.
To correct such a nasal problem, a complete open septorhinoplasty is needed to straighten the septum, reduce the size of the inferior turbinates, reconstruction of the middle vault with cartilage spreader grafts, nasal hump reduction with straightening osteotomies, and tip cartilage reduction and narrowing a columellar strut cartilage graft. I have done some computer imaging in profile to show you a potential result on the external nose shape. Unfortunately, the quality of your frontal picture is not adequate to do any computer imaging and will have to await better photographs taken in my office.
Dr. Barry Eppley