Dr. Steven Denenberg's facial plastic surgery before and afters: Rhinoplasty, combination noses #7

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In these photos we see another clue, that his nose is over-projecting. In the after photo, draw these two imaginary lines: a mostly-horizontal line drawn along the base of his nose, and a line drawn along the skin from the base of his nose down to his upper lip. Those two lines meet at a sharp angle. In the before picture, however, they don't. The line that traces the skin of his upper lip curves forward to meet the bottom of his nose in the before photo.

If you grab the tip of your nose and pull it forward, making your nose more projecting, your upper lip skin will do the same thing. When the upper lip skin pulls forward like that, we call it "tethering of the upper lip," and it's usually an indication that the nose is a projecting nose.

The rhinoplasty section of the Surgery tutorials contains a chapter that discusses the phenomenon of upper lip tethering (the surgery tutorials contain explicit photographs taken during surgery).

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"...extreme skill and experience was evident. "

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All views of this rhinoplasty patient:

rhinoplasty 1: Right oblique	rhinoplasty 2: Left profile	rhinoplasty 3: Left oblique	rhinoplasty 4: Right oblique

rhinoplasty 5: Left oblique	rhinoplasty current: Right profile	rhinoplasty 7: Base

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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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