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Steven M. Denenberg, M.D.
Steven M. Denenberg, M.D.
rhinoplasty
 
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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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Next: an example of the solid advice Dr. Denenberg gives patients on RealSelf.com.
Get that advice for your own situation by emailing your photos to Dr. Denenberg.

Questioner: What can be done to improve the droop of my nose? I also seem to have what looks like a bump in my profile when I smile.
I only like my nose when I am staring straight into a camera and tipping my head upward. My goal is to not have a droop when I smile, to make my smile more symmetrical (one nostril is slightly higher), to breath better (70% of the time left nostril "whistles" when breathing), and to improve the slight bump. I want to prevent looking overdone or like Jennifer Grey post-op. My nose but better. All answers are much appreciated!
(Questioner submitted photos)

Dr. Denenberg's answer: Elevating the tip is possible in a rhinoplasty
Hi, 
Whenever someone smiles, the tip of the nose tends to move down. When we work on a nose, we don't try to set the nose to be perfect when the patient is smiling, because then it wouldn't look right the other 99 percent of the time. If someone's nose is distinctly too long with a smile, that almost always means that it's too long when the face is at rest, too. We make the nose look as good as we can when the face is at rest, and then good things happen during the smile:

Since the nose is *starting* from a shorter position after the tip is elevated surgically, it can't lengthen down to the same level with the smile, so the smile is not as bothersome to the patient. Then, since the tip is usually held in its new position with stitches, the *distance* that the tip can drop during the smile is less, and that helps, too. Then, the natural scar tissue that forms after any rhinoplasty also helps to minimize the movement with a smile.
See the video for a simulation of possible results on your nose, and the Web reference link for noses that were shortened by elevating the tip.

If there are problems breathing, those can almost always be addressed at the same time as changing the appearance of the nose. However, asymmetry of the nostrils, especially "slight" asymmetry, is almost always not possible to fix. We are not good at tiny asymmetries, but most people don't notice them anyway.

These proposed changes to your nose require advanced techniques on the tip cartilages, and most plastic surgeons cannot accomplish them. Be sure to see before and after photos of the surgeon you are considering using, and don't just see profile images where a bump was removed. The photos are the only way for you to check out your doctor: board certification diplomas tell you nothing about his skill in the operating room.

Link to this question on RealSelf.com



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