I saw a patient recently that went to another doctor who had suggested to add tissue to the top of the bridge of the nose and also the bottom to camouflage the mild elevation in the middle of the nose. She really didn’t want to do that and was only interested in refining the nasal tip. In my opinion, everything looked really good with her nose except a moderate amount of tip bulbousity. On my exam, I noticed that her elevation was more inferiorly near the tip. I attributed this elevation to extra large tip cartilages. In my opinion she only needed to refine the tip by excising the top part of the tip cartilages through rhinoplasty or nose reshaping. In the picture below, the lateral crus is where I identified where her tip cartilages were enlarged. They were so enlarged that it increased the size of the bridge in this area. By refining the lateral crus, it would decrease the bridge in this area and would effectively cause a little desirable break just above the nasal tip that is beautiful when it is achieved. I thought that her nose would be significantly masculinized if she were to get her nasal bridge in between her eyes elevated and enhanced. It would be a wrong choice for her by this other surgeon. The other surgeon wanted to narrow her nose as well. On my exam, her nasal bridge was about the width of her irises which to me was ideal. This was consistent with her ideals as well and was also consistent with my theory on facial beauty. You can read my theory here (Dr Young received the Sir Harold Delf Gillies Award for this theory by the American Academy of Facial Plastics and Reconstructive Surgery). Going to someone who has a good sense of aesthetics is probably one of the most important things about a surgeon. You can have the best techniques but if you don’t have blueprint how are expected to achieve the result without knowing the ideal or what is the best end result. The best techniques can lead to a bad result even if everything was done right. That is why aesthetics is so important!
Thanks for reading, Dr Young
Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington