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This Virginia Beach woman in her early thirties came to me for a consultation with concerns about her nose that have bothered her since she was a child.  She is concerned more by the front view but she also does not like the shape of her tip from the side.  We had a very detailed and thorough discussion about the features that she felt were unattractive and the cause of these.   We noted that she had a hanging columnella (the skin bridge between her nostrils hung down).  Clearly, she has a very bulbous tip and her tip is slightly under-rotated, meaning her nose is a little long.  Anatomically, her tip is quite broad in the side view since it projects too much above and below where the ideal tip would be.  With the help of video imaging, we came up with a surgical plan that included eight changes. This involved positioning and shaping the tip with advanced techniques as I outlined in the chapters I wrote in the textbook, Dallas Rhinoplasty.  Older techniques cannot reliably rotate and project as well because those techniques simply remove and set back.  But if one cannot project the tip and rotate it reliably, then the tip comes back and appears wide.  When the tip comes back, the bridge has to be lowered.  When the bridge has to be lowered more, this gives it a wider look in front view as an optical illusion.   Clearly in side view, this woman did not want her bridge lowered for obvious aesthetic reasons.  Without these advanced maneuvers on the septum and tip, the tip could not be positioned and shaped this way.  Spreader grafts and alar contour grafts further refined the shaping.  This is not a simple, quick procedure.  This rhinoplasty required over three hours of surgery but well worth it for results that will last a lifetime. 

Surgeon: Dr. Thomas Hubbard
Patient Age: 30

Case Number: 425

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