Your question: Hello, I am a 30 YO female and I am very happy with the shape of my nose, it's just a bit wide. Any suggestion?
Hello, I am a 30 YO female and I am very happy with the shape of my nose, it's just a bit wide. It's also quite flat on top if that makes sense. I'm wondering what type of procedure would be required, as well, I would like to get an idea of the overall difficulty in achieving the results I want. I have no bump in my bridge, it is like a ski jump and my septum is not deviated. I would prefer local anesthetic if possible.

Dr. Denenberg's answer: It's reasonable to change your nose.
I see what you point out. Although you don't have a classic bump on the bridge, the bridge is wide. The upper half of the bridge is made out of bone, the rounded tip is made out of cartilage, and between the tip and the bone is the central area of the bridge, which central area is also made out of cartilage.
It looks as though your bones are farther apart from each other than you like. That causes the upper part of the bridge to be wide and to have a flat spot. Below the bones, the cartilage part of the bridge is also flat-ish and wide. Your tip has just a little excess width.
See the Web reference link, just below my response. I made an animation out of your morph. Then, I made my own morph and its animation. In my morph, I did what you did to the tip and to the cartilage part of the bridge, but I also simulated bringing the nasal bones a little closer together.
I never use general anesthesia for rhinoplasty, but I do like it if I can give the patient some IV sedation at the same time as the local anesthetic, too
These are changes that should be possible with a rhinoplasty. You should understand, however, that the changes require advanced techniques, techniques that most plastic surgeons cannot handle. Be sure to read the section in the Web reference link on how to stay out of trouble while searching for a rhinoplasty surgeon.

 

1) This is an animation of the changes your proposed. Give it a couple seconds to load:

 

Here are my changes. I just narrowed the upper part of your nose a little bit, too:

 

Does this fit with what you have in mind for yourself?

 

2) Click here to comment on those changes, or to ask Dr. Denenberg a follow-up question.

 

3) Click here to see more rhinoplasty before and afters of patients with combinations of features to correct.

 

 

Click here to see most of the morphs that Dr. Denenberg prepared for other RealSelf participants!

 

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

Important!!  How to tell whether your consultation was acceptable:

Photos.  If a surgeon doesn't show you before and after photographs, scratch him off of your list. Period. No exceptions. Deal-breaker.

You pick a surgeon primarily from his before and after photos. Diplomas, board certifications, hospital affiliations, academic appointment, and even reputation tell you nothing: a surgeon is never tested for his skill, his artistic eye, the quality of his outcomes, or even whether he cares that his patients are happy.

You must see photos of other patients who had some features similar to your nose. For example, if your nose has a wide and drooping tip, don't accept profile-only photos of patients who had a hump carved down. You can't see the width of the tip on a profile photo.

Revision nose operations are much more difficult than first-time operations, so if you are consulting a surgeon about a revision operation, you must see photos of his revision patients.

If you see the surgeon's photos, but you don't love them, scratch him off your list. You want to use a surgeon whose work you like. Don't assume that he'll do great on you when he didn't do great on the other people.

Communication. If the doctor treats you disrespectfully, scratch him off your list. If he won't patiently listen to what you want for your nose, same thing. How will he know how to make you happy if he won't hear what you want for your nose?

If he conducts the consultation from behind his desk and doesn't examine your nose, deal-breaker. If it's the nurse and not the surgeon who conducts the consultation, run away fastest. All due respect to the nurse, she doesn't know what's possible and what isn't. If the plan is to see the surgeon for the first time on the morning of surgery, deal-breaker. For sure.

Computer morphing. If the surgeon doesn't do 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 morphs, so you can see whether you like those changes.

Your intuition. 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, or you saw his advertisement, or his awards.

I hear these stories all the time from my revision rhinoplasty patients. 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 the surgeon's licensure and board certification and hospital affiliations and all that; it'll just distract you from what's important.

Conclusion. 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 artistic eye, 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, folks.

 

More plain talk: should you let your primary surgeon perform your revision?

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.

First, you need to consider whether things didn't turn out great on your first operation 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. Read the section above, on how to evaluate a surgeon for a rhinoplasty. If you saw lots of before and after photos of your surgeon's 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.

 

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