Before and after, showing take-down of the hump, but also elevation of the tip, and bringing the tip back closer to the face:

An animation of those changes:

 

 

If you like the answer I gave here, click the "like" button next to my answer on the RealSelf page:

 

More info on Dr. Denenberg:

Click here for Dr. Denenberg's profile, and more before and after photos, on RealSelf.com

Click here for reviews of Dr. Denenberg on RealSelf.com

Dr. Denenberg has been selected as one of America's Top Doctors by Castle Connolly Medical Ltd.

He is one of the rare doctors to receive that award every year since the program was begun in 2001. He is also the only plastic surgeon in Nebraska to ever receive that award. More on the Top Doctor award at the bottom of this page.

Patients from over 55 countries, ...

... and almost every U.S. state, have come to Omaha to see Dr. Denenberg. We put a red or white flag on each location:

 

Plain talk about picking a plastic surgeon for your first-time rhinoplasty.

I do lots and lots of revision rhinoplasties, and I'll try to give you some advice here, to maximize the chances that you'll be happy after surgery, and to minimize the chances you'll need a revision.

How to pick a surgeon? Primarily, from his before and after photos. Diplomas and board certifications tell you nothing about a surgeon's skill in this area. You must see before and after photos of other patients who had some features similar to your nose. And don't rely on only profile views. Carving a hump off of a profile is not the same as narrowing and repositioning a wide and drooping tip.

If a surgeon doesn't or won't show you befores and afters, scratch him off of your list. Period. No exceptions. If you don't like his before and afters, scratch him off your list. That's why you asked to see the photos in the first place: so you could reject him if you didn't like the photos!

If he treats you disrespectfully, scratch him off your list. If he won't patiently listen to what you want for your nose, same thing. If he doesn't even examine your nose, same thing. If it's the nurse and not the surgeon who conducts the consultation, run away.

If the surgeon doesn't do some kind of computer morphing of your nose, scratch him off your list. The morphing is crucial, so the surgeon can prove to you that he understands exactly what your goals are. Also, if the surgeon recommends some changes that you hadn't thought of, you need to see the morph, so you can see whether you like those changes. The rare nose won't be able to be morphed in a helpful fashion, but that's quite uncommon.

If your gut tells you "no," don't use the surgeon. Don't ever use a surgeon only because you know him, or your kids know him, or he lives on your street, or your primary care doctor referred you to him, or he did your breasts, or your tonsils, or your wisdom teeth. I hear these stories all the time. You must do your own evaluation of any surgeon you visit. And by "evaluation," again, we're talking mostly about seeing his photos and seeing how well he communicates with you. Don't bother checking his licensure and hospital affiliations and all that; it'll just distract you from what's important.

The fact is, the great majority of plastic surgeons who perform rhinoplasty shouldn't be doing the operation. It's an incredibly difficult procedure, technically demanding, requiring experience, skill, judgment, an exceptional level of communication and thoughtfulness, and a rare level of empathy and caring for the patient. No hospital board protects you by judging the quality of a surgeon's rhinoplasties and prohibiting him from operating if he's terrible. It's the wild, wild west out there.

 

Plain talk about picking a plastic surgeon for your revision rhinoplasty.

Rhinoplasty is by far the most difficult of the facial plastic surgery operations. And revision rhinoplasty is ten times more difficult than a first-time operation.

In deciding on a revision surgeon, you need to consider whether things didn't turn out great because of some unusual circumstance with the surgery or the healing, or whether things went wrong because your doctor was not expert in rhinoplasty in the first place.

Evaluate your surgeon again. If you saw lots of before and after photos of his other patients who got excellent results, in noses at least somewhat similar to yours, then your surgeon probably knows what he is doing, and you can consider letting him perform your revision. Even the very best surgeon has the occasional disappointing result.

However, if, on looking back, you decide that you did not do excellent research on your original surgeon -- perhaps you relied on a referral, or on his board certification, without being able to see his photos -- then you probably should not have him perform the revision. If he couldn't get you close to your goal the first time because of a lack of skill, he will have no chance at all on the second try, and then you'll be in the tough position of looking for a third operation.

 

Are you "Following" Dr. Denenberg on RealSelf.com?

If not, go here, and click on the little "Follow" button underneath his photo.

If you are following him already, drop him an email and comment about something!

 

The Castle Connolly America's Top Doctor award:

The America's Top Doctor award is not a popularity contest. Unlike all the local copycats and spin-offs, Castle Connolly allows only physicians to nominate, and vote for, Top Doctors. There are two awards: the "Castle Connolly Top Doctor" is a physician who is regarded as especially competent by his local colleagues. The "America's Top Doctor" is a doctor who is voted into that position by a national review of recognized experts in the doctor's field.

Here's a link to Dr. Denenberg's recognition page at Castle Connolly.