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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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All views of this rhinoplasty patient:
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current: Left oblique
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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: Can this nose be fixed?
I need a seriously talented surgeon to do my third and hopefully final rhinoplasty. I need a grand slam and I will travel anywhere if I can find a surgeon who can perform these multiple techniques. I need someone who can: 1. Decrease nostril width 2. Decrease projection 3. Tip reconstruction using donor cartilage 4. Lengthening of the nose I don't see raising the bridge as the solution to avoiding having to decrease projection. Referrals welcomed also.
(Questioner submitted photos)

Dr. Denenberg's answer: You may not need all of the techniques/changes that you listed
First of all, I agree that, from these photos at least, it's not at all clear that you need to have your bridge raised. The "profile" shot isn't really a profile, because the camera is too high and is looking down at your face, but it appears that the tip of your nose has very strong projection, and bringing the tip substantially back closer to your face will make the relationship between the tip and the bridge much better, without raising the bridge.

Then, a significant de-projection of the tip often can make the nose *appear* longer, so you might not need as much lengthening as you thing you might. 

It's also not clear that you'd need donor cartilage to help the tip. Often, even after previous surgery, modifying the cartilage that is still there is all that is needed.

See the attached video and Web reference links for some ideas.

If we had a pure profile, maybe a morph could be make to illustrate how deprojecting the tip also helps both the bridge and the length.

Link to this question on RealSelf.com