Your question: What can be done with my nose?
Now that I'm 30, I'm ok with the size of my nose. I dislike the shape of the tip, and the asymmetry of the tip. My nose looks different depending on which side of me you are sitting next to, so I am self conscious of people sitting to my right because of the bulbousness of the tip on that side. I dislike how curved my nose is, but I don't know how how straightened out my nose can be because I've already have one rhinoplasty and one septoplasty.
Dr. Denenberg's answer: Your tip can very likely be improved.
See the Web reference link, just below my response. I made a couple computer morphs of your nose, and animations of the morphs, to show the changes that could be possible for your nose in truly expert hands.
In the three-quarter view, I decreased the obviousness of that left tip cartilage, and I simulated narrowing the tip and also elevating the tip on that view. As is typical with many noses, when the cartilages are wide, it makes the nose look much longer on the three-quarter view than it does on the profile views.
That three-quarter view also makes it look like there's a bump higher on the bridge. That's probably because the right nasal bone is more prominent, wider, than the left bone.
In the frontal view, the strong tip cartilages, besides making the tip look wide, make it droop, too, and I simulated elevating that part. I narrowed the tip some, I again decreased the prominences of the tip cartilages. On this view, especially on the animation, you can also see that I narrowed the right nasal bone, and I built out the left side, where it seem sunken in.
I tried to NOT do a perfect job, because it's not possible to completely correct these features. I tried to keep the tip a little wide from the front, to keep that left side sunken in a little, to leave the crease by the left nostril alone. But the animation shows changes that should be possible.
This is a complicated revision, but the good news is that the photos indicate strongly that your tip cartilages have not been modified in a fashion that can allow the tip to come up and narrow and make the cartilages less obvious. Since that wasn't done in the first operation, it's available to be done in the revision, making me optimistic that there is improvement possible for you.
You should understand that the changes I demonstrated in the morphs 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.
Your nose is also a good example of why computer imaging is mandatory in rhinoplasty. You need to know exactly what the surgeon is planning to accomplish -- what features he'll change, and by how much he'll change them -- so you know whether it's enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. Then, he must show you before and after photos to prove that he can actually accomplish what he draws on the computer.
1) Proposed before and after:
Here's an animation of those changes. Give it a couple seconds to load:
And the animation:
Does this fit with what you have in mind for yourself?
Click here to
ask Dr. Denenberg a follow-up question, or to comment on his changes,
or to thank him for the morphs.
3) Click here to see more revision rhinoplasty before and afters.
Click here to see most of the morphs that Dr. Denenberg prepared for other RealSelf participants!
More info on Dr. Denenberg:
Click here for Dr. Denenberg's profile, and more before and after photos, on RealSelf.com
"I always thought that having a beautiful nose would make me feel better, but I could never imagine that it would change my life.
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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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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. 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. Dr. Denenberg is one of the rare doctors to receive that award every year since the program began in 2001.
Here's a link to Dr. Denenberg's recognition page at Castle Connolly.
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