• Rhinoplasty
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Steven M. Denenberg, M.D.
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In the before picture, you can see some white marks in the middle of her dorsum that are reflections from the flash, right where the hump was.  The marks are crooked, indicating that her nose was a little crooked in that area before surgery.  I mentioned in the section on nasal reconstruction that correcting a crooked nose is one of the hardest changes to make in rhinoplasty.  However, if the crooked area is small, and if it's on the hump, sometimes simply removing the hump removes the crookedness entirely.

We also know that her nose was shortened somewhat during her rhinoplasty, because we get a better view of her nostrils in the after picture.


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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 I improve my smile through closed rhinoplasty but without reduction?
Hi. I'm relatively happy with the shape of my nose (and the tip) when not smiling. When I smile, my nose droops (curves down) and my nostrils "stretch" and get a bit longer/bigger. I know that the removal of the depressor septi + placing a graft, while rotating my tip up will improve my smile. I'll also be removing the nasal hump (all through closed rhino). Will this fix the curving down or do I have to get a reduction? Will my nose (front) look wider if I don't do reduction? Thanks!!
(Questioner submitted photos)

Dr. Denenberg's answer: Your surgical plan worries me
Hi,
I'll give you my take on your comments and photos.

In my experience, doing something to the depressor septi muscle does nothing, or almost nothing, to the nose, either at rest or during a smile. It's one of those things that seems to make sense mechanically when you look at the anatomy books, but it doesn't work in practice. When someone gets a good improvement in that area, it's because of *other* things that were done during surgery, not because of work on that minuscule muscle.

Next: placing a graft will not rotate your tip up, any more than taping a Q-tip stick to the underside of your nose will cause it to rotate up. Rotating the tip of the nose up requires advanced work on the tip cartilages, something most plastic surgeons are not successful at, so you need to see lots of before and after photos from the surgeon you are considering using, to see that he has successfully shortened noses like yours. Especially: when a hump is taken down, it makes the nose appear *longer*, even if the position of the tip hasn't changed, so shortening the nose is very important in your case.

When you smile, the tip of the nose will always try to drop. After surgery, if the nose was shortened, the tip will be starting from a higher position, so when it drops with a smile, it doesn't get as low as it did before surgery, so that would make you more comfortable with your smiling nose, but the nose will still lengthen with the smile. In general, we try to set the nose so it looks great not during the smile, but for the other 99 percent of the time. 

Link to this question on RealSelf.com