NOSE Note: All procedures shown were performed by Dr. Churukian, and no photos were altered to enhance the results. NOSE (RHINOPLASTY) What might we consider the simplest request for nasal surgery? Very often this is just to smooth out a bump (or hump). Note that we generally avoid the “scoop” look these days and aim for a mostly straight profile. This helps to maintain a natural looking nose. Not all nasal humps are in the upper bony part of the nose. Here the nose is straight until it gets to the lower cartilage portion. Trying to straighten the profile by lowering the upper bony portion would make the nose look unnaturally small. Instead the tip was raised and better supported to match the rest of the nose. This is a more involved procedure than the first example but allows the nose to retain a size and shape that better fits the face. Changing the size and shape of the nose can visibly alter the overall character of the face. So we tend to be more conservative as our patients get older. We want to be certain which changes are desired. Here instead of a straight profile we actually retained some of the original bony hump and nasal character. We also trimmed her upper lids and a microlipo of her neck and jawline to go with her new nose. Aesthetic nasal surgery can involve changing the shape of the nose, the size or both. Here, my youngest daughter decided in her mid-twenties that although she didn’t mind the hump so much, she felt that her face was either too small or her nose too large. We settled on making the nose smaller while keeping a similar shape, just toning down the hump a bit. Before After 2 Years Just as we may wish to change the profile of the nose, we often change the width as well. The nose happens to be the most frequently broken bone in the body. Here we see the result of something like a baseball hitting the nose straight on and forcing the bones apart. Ouch! We call this an “open roof.” To close the roof, the bones are rebroken and angled back together in the middle. Before After 1 Year More common than the “open roof” of the nasal bones is a greater than desired width at the base of the nasal bones where they join with the cheeks. Here we must again break the nose then push the bones closer together. The nostrils can be narrowed at the same time. Before After 6 Months Do the nose and ears really grow as we age? That may or may not be, but gravity and upper lip motion do tend to drop and sometimes widen the tip of the nose. Here as part of a general freshening up we see a conservative lifting and narrowing of the nasal tip to create better definition. Before After 8 Months Speaking of gaining greater definition, a more distinct nasal tip helps to better define the entire nasal profile. Before After 8 Months Also in this example the nose was narrowed slightly to maintain the proportions of a smaller or more defined nose. Before After 6 Months This is another example from an oblique view that reducing the profile generally means also narrowing the tip. Again, this is to maintain natural nasal proportions. Before After 8 Months Narrowing the nose has the added benefit of making the eyes appear larger and the face slimmer. Here we also took a drop of fat out from under the cheekbones (microlipo), again for definition. Before After 11 Months The end result of surgery depends upon a number of variables, some of which are difficult to predict. The thickness of the skin limits how narrow the nose can become, especially at the tip. Here we see a modest change in the tip due to the thickness of the skin. Before After 3.5 Years Thin skin lends itself to greater narrowing and definition but with caution, as even small changes become visible over time. The nose typically requires one or two years or even longer to heal and take a final shape and size. Before After 3.5 Years A straight profile with the tip slightly elevated matches the narrowing and greater definition of the nose from the front. Was I a bit crazy to work on my wife? Probably so, but she wanted me as her surgeon and I figured she didn’t need much. Actually her nose had never really bothered her. She just got tired of being asked if I had “done” her nose. So in 1983 her nose went from her Dad’s Portuguese side to her Mom’s English side. No one asked after that. It was a little straighter from the front and side but very few friends or family actually noticed the change. That seemed strange but that is fairly typical if the nose still fits the face. Home | Face & Neck | Nose | Ears | Eyelids | Fat Grafting | Microlipo-Neck | Microlipo-Body | Skin Resurfacing | Testimonials | Give Back | About Dr Churukian | About the Clinic | Patient Info | Contact