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This patient demonstrates the importance of an extremely meticulous and detailed consultation.  She was bothered mostly by the side view and projection of her nose, but also by how it appeared very wide when viewed from the front.  From the side view, we can see the tip was over-projecting. An over-projecting tip protrudes too far from the face, and is also too long – a young woman’s nose should be turned up a bit more.  This patient’s septum was also overgrown, pulling her lip up onto her nose.  From the front view, we can see that the bone was quite wide and the tip was wide as well.  Notice the deep grooves on both sides of the tip, adding to the appearance of wideness.  After a long and detailed exam and discussion, we came to agreement about 10 issues that would be addressed simultaneously.  The tip would be set back, but rotated upward into a more youthful position.  A specific part of the septum would be trimmed to bring about a more youthful and normal length of upper lip.  The bone would be narrowed and the tip would be narrowed.  The other planned surgical issues were related to these same changes, as well as maintaining good breathing.

The patient is extremely pleased with the results of her surgery.  She feels the appearance of her nose is natural and does not have an operated-on appearance.  Very early after surgery, she felt her breathing was already improved from before the procedure, and she had not even been aware it was an issue.   Of course, this sort of breathing improvement is not common, but there are indeed some patients who are not aware of a breathing problem until it is improved after surgery. 

Surgeon: Dr. Thomas Hubbard

Case Number: 163

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