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Steven M. Denenberg, M.D.
Dr. Denenberg's articles on Medium.com.
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This young woman's nose appeared to sit too close to her face.  She had inadequate projection.  The goal of her operation was to bring the tip of her nose farther out from her face.

Her nose has some of the appearance of a cleft lip nose, but her lip is perfect: she was injured in a jungle gym accident.  The nose is reminiscent of a cleft lip nose because persons with that congenital deformity often have an associated deformity of the nasal tip cartilages that causes the tip of the nose to sit too close to the face.

The rhinoplasty surgery tutorial contains a chapter that discusses the importance of tip projection and how it is maintained or created surgically (the surgery tutorials contain explicit photographs taken during surgery).


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"I traveled from my country (Portugal) to U.S. ... "
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Next: an example of the solid advice Dr. Denenberg gives patients on RealSelf.com.
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Questioner: I'm trying to understand my surgeon's operative report in order to understand what was and wasn't done. Please help?
As the photos demonstrate, my primary rhinoplasty was not successful in any way, shape, or form. Since acquiring my surgeon's operative report, I've been trying to make sense of the medical terminology in order to understand what was done to my nose during my operation... Thus educating myself. I want to fully understand as I navigate my revision consults. I keep telling people that the "tip wasn't touched at all," but aside from that, could someone please help me interpret the report? (Photos).
(Questioner submitted photos)

Dr. Denenberg's answer: It doesn't look as though much was done to your tip.
The report says "a portion of the lower lateral cartilages" was removed. That *can* result in a tip that is less wide, or less projecting, but it's the rare, rare tip that will respond completely to a simple removal of some of the tip cartilages as described. Perhaps your tip requires much more advanced work to change it's size and shape.

If you are seeking a revision, be very careful. Revision rhinoplasty is far, far more difficult than a first-time rhinoplasty, and even in a first-time rhinoplasty, most plastic surgeons are not expert enough to handle more difficult tip structures. You must see before and after photos of a doctor's work before deciding whether to use him for your revision. See the attached video and the Web reference link for examples of the changes that are possible in expert hands.

Link to this question on RealSelf.com