Rhinoplasty for small nose can mean a lot of things. Does the patient want to augment the bridge of his/her nose? Or does he/she want to correct the upturned tip, a feature that can make the nose appear too short or small in relation to the face?
The before photo shows the patient having very visible nostrils due to her over-rotated tip. By counter-rotating the tip with the use of cartilage graft, the nose now appears more proportionate to her face as shown in the after pic.
To achieve results that will satisfy the patient long term, leading Los Angeles plastic surgeon Dr. Tarick Smiley highlights the importance of candid discussion with a rhinoplastic surgeon.
Dr. Smiley says the right candidate for rhinoplasty, or nose job in layman’s term, is someone who can explain his/her goals in detail, adding that vague or generalized description is a big no-no for this surgery in which the success or failure is determined by a few millimeters.
To further shed light on the issues involving rhinoplasty for small nose, the renowned plastic surgeon explains the two most common goals of patients.
- Augment the dorsum or bridge
Some ethnic patients ask for rhinoplasty augmentation to make their nose appear more proportionate to their face. The goal is to create results that are ethnically consistent with the face and so over-augmentation must be avoided.
To augment the dorsum, most surgeons prefer autologous cartilage graft, meaning the patient’s own tissue is used instead of synthetic materials such as silicone or silastic. Possible “sources” include the nose itself, ear, hips, and ribs.
Patients having their primary rhinoplasty (no previous nose surgery) and are only seeking for a conservative amount of augmentation are generally good candidates for autologous cartilage graft, therefore avoiding the potential risks that come with artificial implants.
- Correct the over-rotated [upturned] nose
Sometimes referred to as Miss Piggy (in reference to the Muppet character), an overly rotated or upturned nose can make it appear too short for the face. Some people have this as an inherited feature, while in some cases it occurs from trauma or a botched nose surgery.
To correct the short and over-rotated appearance, the most important thing is to create a strong support to the tip, allowing it to maintain its counter-rotated position.
Because the tip requires significant reinforcement, most surgeons use septal cartilage, which is collected from the nose itself. Rib cartilage is also a good option to create a strong support and to lengthen “visible” wall of tissue between the nostrils. Ear cartilage, meanwhile, is rarely used in this surgical maneuver due to its insufficient strength.
Augmentation rhinoplasty procedure is a general term to describe a nose-reshaping surgery in which the goal is to increase the height of the nasal bridge. Oftentimes, the surgery also involves the tip and/or nostrils to create a smoother and more natural result.
A good number of augmentation rhinoplasty is performed in ethnic patients (e.g., Asian and Hispanic descent). The vast majority of them want to enhance the appearance of their nose without making it look out of sync or “ethnically inconsistent” with the rest of their facial features. Hence, patient satisfaction is closely tied to “how natural the nose appears.”
Leading Los Angeles plastic surgeon Dr. Tarick Smiley explains what augmentation rhinoplasty can accomplish.
- Increase the height of the nasal bridge
Aside from ethnic patients, augmentation rhinoplasty is also commonly sought by people with nasal collapse and other deformities (due to congenital, disease, or injury). Nonetheless, their appearance can be improved when their nasal bridge receives additional height.
Despite the reasonable safety and proliferation of alloplastic and other synthetic materials, Dr. Smiley believes that using natural material (i.e., derived from the patient’s body such as the nose itself, ear, and rib) remains the most ideal method as it has the least chance of extrusion, rejection, infection, and unnatural results.
- Improved definition of the bridge when viewed from the front
Patients seeking augmentation rhinoplasty typically have flat and undefined (or even excessively wide) bridge on front view. While the surgery can improve this “feature,” it should be done within the confines of the underlying anatomy and facial harmony to achieve natural-looking results that can last a lifetime.
In general, augmentation rhinoplasty should not raise the bridge all the way to the radix (i.e., it defines the nasal root or the nose’s origin from the forehead area) in female patients because of the too masculine effect, and in ethnic patients due to the unnatural appearance.
Meanwhile, men and patients with a prominent or strong jawline can generally tolerate a stronger nose.
- Tip and nostril refinement
By taking into account the appearance of the tip and nostril, doctors are able to create a smoother, more natural result. Oftentimes, increasing tip projection is enough to improve the nostril and alar base (or width of the nostrils) without using incisions to narrow them.
Again, when doing tip refinement and nostril reduction, it should be done in a way that respects the underlying anatomy (to prevent nasal collapse and breathing problems) and the patient’s ethnic features, gender, and personal goals.
Reducing the amount of rhinoplasty bleeding is one way to promote shorter social recovery. Hence, plastic surgeons who use precise and gentle dissection during surgery have patients “socially” and “professionally” ready at 1-2 weeks.
Aside from meticulous dissection during rhinoplasty, or in layman’s term “nose job,” leading Beverly Hills plastic surgeon Dr. Tarick Smiley says that bleeding can also be minimized with careful patient selection. The idea is to reserve this cosmetic surgery to people with no chronic medical condition such as bleeding disorder, heart problem, etc.
Because the patient’s health status is closely tied to the success of rhinoplasty, Dr. Smiley highlights the importance of lab screening whose “details” will depend on the information gathered during the initial consultation. For this reason, he says that patients must fully disclose their medical history and drug use to prevent complications.
Once they pass lab screening, Dr. Smiley says “preparation” is the next step to further reduce bleeding and risk of complications. There are generally agreed upon guidelines such as complete cessation of smoking (minimum of three weeks); discontinuation of drugs and supplements with blood thinning properties (at least two weeks); and controlling medical condition, if there is any, through lifestyle changes and/or medications.
After surgery, a very small amount of bleeding can be expected (and is normal) in the first few days. Severe bleeding in which blood is pouring out or down one’s throat, meanwhile, is extremely rare and requires immediate treatments, says Dr. Smiley.
To prevent bleeding and healing problems, Dr. Smiley says he requires all his patients to avoid nose-blowing, rigorous activities, blood-thinners such as aspirin and ibuprofen, and alcohol for a certain period of time (usually 2-3 weeks, although the specific instructions may differ from patient to patient).
To further promote healing, keeping the amount of bruising and swelling to a minimum can also be a huge help, says. Dr. Smiley who advocates head elevation and cold compress (around the cheeks and eyes for the bruises).
Male rhinoplasty for large nose is a highly customized procedure in which the patient must be able to describe his goals in the most exact detail. Furthermore, the surgeon must conduct a comprehensive physical exam to evaluate skin thickness, underlying structures of the nose (cartilaginous and bony framework), and even the entire face to achieve proportionate, natural-looking results.
Rhinoplasty, or in layman’s term nose-reshaping surgery or nose job, is one of the most technically challenging plastic surgery procedures that its success is determined by minute changes measured in millimeter. Hence, it requires deep understanding of the anatomy and respect of the patient’s ethnicity, gender, and facial and nasal anatomies.
Leading Inland Empire plastic surgery expert Dr. Tarick Smiley has recently posted a series of videos on Snapchat to demonstrate a male patient who required rhinoplasty for large nose.
Aside from having a hugely disproportionate nose (relative to his “small” face), Dr. Smiley said the patient also complained of the following cosmetic issues:
- dorsal hump or excessive fullness along the bridge of the nose
- hooked or drooping tip
- bulkiness of the tip
For this patient, Dr. Smiley performed the closed rhinoplasty, meaning all the incisions were made inside the nostrils, specifically within their inner lining. Aside from eliminating the risk of visible scar, the technique is also known to result in shorter “social” recovery because of the minimal postop bruising and swelling.
The incisions allowed Dr. Smiley to access the cartilaginous framework of the nose and to remove the piece of cartilage causing the dorsal bump along the bridge. But instead of discarding this tissue, he resized and reshaped it so it could be used to support the tip and refine its appearance at the same time.
With additional tip support, Dr. Smiley was also able to address the excessive bulkiness of the tip.
Afterwards, the celebrity plastic surgeon rasped or shaved down the bone (the upper one-third of the nose is made up of bony framework, while the lower two-thirds is made up of cartilage that is relatively flexible) to further reduce the fullness along the bridge. This was done with the use of a device closely resembling a nail file.
Because the patient has thick nasal skin, the amount of reduction must be on the conservative side. The idea is to allow the overlying skin to redrape beautifully around the new contour, as opposed to looking bulbous or amorphous, which could happen after an over-aggressive tissue resection.
Rhinoplasty hump reduction, aka, nose-reshaping surgery to eliminate or reduce the fullness along the bridge, entails a set of meticulous surgical techniques to achieve proportionate and natural results, which are primarily achieved when the patient’s gender, ethnicity, and facial features are all taken into account.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently posted a series of Snapchat videos involving a female patient who asked for rhinoplasty hump reduction. But to achieve a smoother, more proportionate nasal profile, he also performed a simultaneous tip refinement.
The patient, who had been involved in an accident that left her nose broken, had visible hump along her nasal bridge that looked incongruous with her feminine features.
Dr. Smiley was able to improve her nose—i.e., remove the hump and refine and slightly elevate the tip, ultimately resulting in a more feminine appearance—with the use of closed rhinoplasty technique, which basically means that all incisions are made inside the nostril; hence, the risk of visible scar is almost eliminated.
During a closed rhinoplasty technique, incisions are made within the lining of the nostril, which in turn exposes the cartilage that comprises the lower two-thirds of the nose. The upper one-third, meanwhile, is made up of bone.
In the video, Dr. Smiley is seen removing a small piece of cartilage to refine and narrow the tip. Afterward, he trimmed the offending nasal bone that was causing the excessive fullness or hump along the bridge.
Instead of the discarding the cartilage collected during surgery, the celebrity plastic surgeon reshaped it so it could be used to reinforce the tip, a technique that allows the results to persist long term and to prevent collapsed or pinched appearance.
To further create a gender-appropriate nose during rhinoplasty hump reduction with a simultaneous tip refinement, Dr. Smiley slightly raised the tip. According to studies, the ideal angle between the upper lip and nose is 105-110 degrees for women, while in men it should be 90-105 degrees.
The amount of reduction that can provide the most natural results, Dr. Smiley said, is largely determined by how much skin shrinkage is expected to occur. In general, markedly thick nasal skin does not redrape as good as thin skin.
However, thin skin is less forgiving as it shows even the tiniest contour irregularities.
Hence, patients whose skin is considered “medium thickness” enjoy certain advantage: Their skin shows the “details” and improvements without the increased risk of contour irregularities.
Preventing or at least minimizing the risk of rhinoplasty infection should be one of the most important goals of any prudent surgeon performing nose-reshaping surgery, according to California Surgical Institute website.
The list below shows the basic guidelines on how to minimize risk of rhinoplasty infection.
Anyone with uncontrolled medical condition linked to higher risk of infection and poor healing is discouraged to undergo any elective plastic surgery.
Prior to rhinoplasty, judicious surgeons require all their patients to pass lab screening to ensure that they can handle the surgery and the ensuing recovery.
- Achieve one’s optimal health
Achieving one’s optimal health generally includes eating healthy, avoiding smoking and too much alcohol and caffeine, and discontinuing aspirin and aspirin-like products for at least 2-3 weeks.
- Accredited surgical facility or hospital
This is the safest surgical venue. Being accredited means the surgical facility adheres to the highest patient safety standard.
Moreover, an accredited surgical facility has the necessary equipment, building design that promotes sterilized environment, and highly trained staff to reduce risk of infection and contamination.
Many surgeons today recommend prophylactic (preventive) antibiotics to help ward off infection, which must be taken on time and their full course completed.
The patient must be informed of the telltale signs of infection such as elevated temperature, unusual skin changes, and poor healing.
If the patient notices anything unusual, he must notify his surgeon right away than wait for his next scheduled appointment. Some individuals might be apprehensive contacting their surgeon thinking that they might bother them over some trivial thing.
Furthermore, the patient must understand that his full commitment is necessary to minimize risk of complications. For instance, smoking even just a single stick a few weeks leading up to the surgery or during the initial healing stage is enough to drastically increase one’s risk of poor healing, infection, and less than optimal results.
It is important to leave the nose alone to heal. No picking at the incisions, blowing hard, wearing eyeglasses, or anything that might compromise healing.