Rhinoplasty on big nose involves three specific areas: the width of the nose, the tip, and the hump along the profile. By addressing all of them simultaneously, the overall size is reduced and smooth and natural results are achieved.
Reducing the overall size of the nose, according to leading Los Angeles plastic surgeon Dr. Tarick Smiley, is generally more challenging than hump removal because the nose should be made smaller in a way that its new appearance suits the face.
Further complicating rhinoplasty on big nose is the fact that the surgery only alters the bony and cartilaginous framework and so the skin must shrink down to the smaller underlying structure. However, thick skin can only shrink-wrap to a limited degree without resulting in bulbous appearance specially at the tip.
Recently, Dr. Smiley demonstrated a surgery on his Snapchat that involved a female patient with a bulbous and wide tip and a nasal profile that was too big and “too far” from her face.
The patient’s surgery involved a closed rhinoplasty technique, meaning all the incisions were made inside the nostrils for optimal scar concealment. The technique allowed Dr. Smiley to remove the “excess” cartilage and ultimately reduce the size of the nose.
(Note: The lower two-thirds of the nose is made up of cartilage, while the upper one-third is composed of bone.)
For smoother results, Dr. Smiley rasped the bony part of the nose with a use of an instrument that closely resembles a nail file. The device has been designed not to injure the soft tissue of the nose.
Meanwhile, Dr. Smiley reshaped and trimmed the patient’s excess cartilage so it could be later used to support the tip in order to make it narrower and more refined. The tip was also conservatively raised (upturned) to achieve a more feminine effect.
Because all the incisions were made inside the nostrils, there was less surgical trauma compared to the open rhinoplasty technique in which the wall of tissue between the two nostrils is cut as well. Hence, it is expected that social recovery is shorter—i.e., about a week postop the patient may go out in public without drawing unwanted attention.
Nonetheless, all the residual swelling can take up to one year to subside.