Dr. Steven Denenberg's facial plastic surgery before and afters: Rhinoplasty, long noses #10

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Along the dorsum, you can see parallel vertical white lines that are the reflections of the flashes. The linear reflections are prominent, and a bit crooked; they softened and straightened after the hump was removed.

Look at the tip of her nose. In the after picture, there are two white dots, also reflections from the flashes. The white dots are small and symmetric, closer together than in the before picture, more distinct than in the before picture, and positioned higher above the nostrils than in the before picture. Those findings are our indications that the tip of the nose was narrowed and elevated during the operation. Also, we get to see just a little bit more of her nostrils after surgery, another indication that the tip of the nose was elevated.

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All views of this rhinoplasty patient:

rhinoplasty 1: Left oblique	rhinoplasty 2: Left profile	rhinoplasty current: Frontal	rhinoplasty 4: Right oblique

rhinoplasty 5: Right profile	rhinoplasty 6: Right oblique	rhinoplasty 7: Left oblique

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Questioner: Is This a Normal Result After Septorhinoplasty?
I got septorhinoplasty almost 5 months ago and i am depressed how my nose looks from the front and am so self concious now when i smile. I had deviated septum fixed, dorsal hump removed and deprojection of my nose done and NO TIP Work done. My nose looks great from the side profile but looks huge and like a shapeless potato from the front when i smile. Is it normal for it to look that way? Can steriod shots help? Please help!! thank you
(Questioner submitted photos)

Dr. Denenberg's answer: It's possible to improve the frontal view, depending on what was done to your tip cartilages
Hi. Forgive me if I try to address your frontal view by starting with your profile. When a hump is removed, it can make a nose look longer, so we often shorten the nose. Making the nose shorter can help the frontal view by presenting less of a vertical height of the nose. See my "Web reference" link for a morph I made of your profile view.

Since you had no tip work done, the tip of your nose probably didn't deproject, because deprojecting the tip of the nose, and shortening it, require complicated work on the tip. In my morph, I raised your tip and deprojected it.

Further, when a hump is removed, it's important to look at the very top of the nose, just below the eyebrows. If that part of the nose isn't reduced as well, the profile can take on a little bit of a Roman statue look, where the forehead seems to slide right onto the nose. You'll see in the morph animation that I brought that part of your nose closer to your face. If you find yourself thinking about a revision to get the frontal view looking better, you might think about these changes to the profile, too.

I personally don't think steroids would work very much this late after surgery. I would hope that at least part of the problem is due to the fact that no tip work was done, because that would make it more predictable to make some improvements: we are better at modifying cartilage than controlling the thickness of skin or scar tissue under the skin.

Link to this question on RealSelf.com


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