Dr. Steven Denenberg's facial plastic surgery before and afters: Rhinoplasty, combination noses #1

Views of this rhinoplasty patient:

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Let's try to evaluate the surgical changes from this frontal view. You can see some of the changes from removing the hump: the before picture has two parallel vertical white stripes along the dorsum of his nose. Those stripes are the return from the flashes in my photo room. The stripes give you a feel for the position of the dorsum and the presence of the hump, and they are missing in the after picture.

Nasal length: in the after picture, we can see just a glimpse of his nostrils. That glimpse is our indication that his nose was shortened, because in the before picture, his somewhat droopy tip hung over and obscured our view of the nostrils.

Actually, he has his head tilted down slightly in the before picture, but the analysis is still valid. (You can tell that his head is tilted down a bit by looking at his right eye and his right ear. In the after picture, his right eye is at the level of the top of his ear. In the before picture, his right eye sits below the level of the top of the ear.)

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All views of this rhinoplasty patient:

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

rhinoplasty 4: Right oblique	rhinoplasty 5: Left profile	rhinoplasty 6: Right oblique

rhinoplasty 7: Left oblique

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Next: an example of the solid advice Dr. Denenberg gives patients on RealSelf.com.
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Questioner: Will a Septo-rhinoplasty Improve my Smile As Well?
I have always had a complex about my nose and wanted to get a rhinoplasty, I think I am financially and emotionally ready to start the process. Besides the obvious reasons of my dorsal hump and bulbous tip I also have a deviated septum which gives me breathing and congestion problems. I would like to know if this procedure would also affect my smile? As you can see my teeth barely show. If not, is there a procedure that the doctor can do in addition? Thank you!
(Questioner submitted photos)

Dr. Denenberg's answer: Not so sure working on your smile is a good idea
Hi. You do look like a good candidate for a rhinoplasty. You've got that hump, and the tip is wide, as you said. Also, from the profile view, a lot of the inside of your nose shows, and we would want to reduce the amount visible from the side. See my "Web reference" link for a morph showing potential changes to your nose, and an animation of the morph. I didn't make a frontal morph because your photos are sooo very tiny, but they do show the width of the tip of your nose. Be aware that work on the tip of the nose is difficult, and not every plastic surgeon has the skill to accomplish it with expertise. Be sure to see before and after photos of the doctor you choose. Seeing how he made changes for someone else is your only way to determine whether he has the skill to accomplish the changes you want for yourself.

Concerning your smile, I don't think working on your nose would change your smile in a meaningful way. Again, the photos are too small to have a good evaluation of your upper lip skin and how it attaches to your nose, and how things change with a smile, but in general, the smile is controlled by strong muscles, and the static position of the nose doesn't have much of an effect on it.

There *are* operations that claim to allow more of the upper teeth to show in a smile -- the "lip lift" operation comes to mind, but it seems to me that an operation like that would just be "something to try" rather than a solid, predictable solution, and you might be much better off leaving it alone. You don't want to be left with visible scars on you lip and no improvement in the feature you were concerned about.

Link to this question on RealSelf.com


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