Category Archives: Rhinoplasty

Rhinoplasty: Alar Base Reduction Technique

Intraoperative views of alar wedge and sill excisions. A, Both alar flaring and sill excess are present. B, Open rhinoplasty is performed with increased tip projection and a modest change in the nostril shape. C, Incisions are placed to remove flare and to enter the nasal sill medially to the alar insertions, preserving the lateral ala. On the patient’s left (C), flare and sill excisions have been carried out, and markings show the planned excision on the patient’s right. The oblique marking line (C) is useful for realigning the alar segment after the sill excess has been removed. D, Flare and sill reduction are completed bilaterally.

Comments: Although the client seems to be liking nose with small Alar Base(pic D), but in my view, his nose was better off with only tip reinforcement leaving alone the wide alar base intact, i-e, nose as shown in pic B. In the pic B Nostril size is in proportion with the mass in reinforced tip. Compare pic B to the view in pic D where tip vs nostrils size proportion once again is out as it was origionally in pic A.

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Common Reasons For Nose Reshaping

There may be as many reasons to have a nose job as there are noses. But it is important to know what can and cannot be changed and what rhinoplasty can and cannot do for you.

When you first go on see a plastic surgeon for a consultation, you will tell him or her how you want your nose to look. You will describe what you think is the perfect nose for you. Your surgeon will then tell you what he or she thinks is the best nose for you and will tell you what nose reshaping is surgically possible. What you want may not be what is aesthetically best for your nose, or may not be surgically possible without impairing the function of your nose.

Understand that it is easier to take away than to add to a nose. Once the nose has been reduced, it may be very difficult to go back up a size if you went too far during your initial nose reshaping surgery. You have to have good communication with your surgeon.

You might want to start collecting pictures of what type of nose you want. You can bring them to your consultation to show the surgeon. But be realistic! Those noses may not be good for you for any number of reasons.

Of course, you may need surgery on your nose if you have breathing problems caused by a deviated septum or other blockages or recurrent infections. Here is a list of the most common cosmetic reasons for wanting rhinoplasty, both the realistic ones and irrational ones.

Cosmetic problems that can realistically be helped by rhinoplasty:
Too big a nose
Too flat a nose
A hump or bump in the middle of the nose
Too wide or fat a nose
Too thin a nose
Too long a nose
Too short a nose
Too pinched-looking a nose
Scooped nose
A hanging columnella (the piece of skin and cartilage between the nostrils)
A crooked nose
Asymmetry, in general
A bifid tip (a ditch or cleft on the tip between the two tip cartilages)
Dents
A build up of scar tissue from breaks
A hooked nose
A “piggish” nose
Too pointy
Too bulbous
Not angled enough
Angled too much
Ethnic nose

Irrational or unrealistic reasons for a rhinoplasty wanting nose reshaping surgery:
To attract a mate or rekindle the affection of the mate you have
To gain popularity
Self-image problems
Low self-esteem due to emotional issues not connected to your appearance
Because someone else thinks you need a nose job

You might want to have nose reshaping a nose job because you think it will help your career. Certainly, if you are in the entertainment industry, this could make sense. If you are an accountant, it might not make as much sense, but everyone wants to look better, so why not? Just understand that having a rhinoplasty won’t make up for poor accounting skills.

Just be sure that you are having surgery for yourself and for no one else. Make sure that you understand that changing your nose will not change any other factor in your life.Don’t try to trick yourself into thinking you want it for the right reasons if you really want it for the wrong ones. It will save you a lot of grief (and money) down the road.

The Ideal Nose

Question: What is the ideal nose?
Answer:
 The “ideal” nose is a nose that is in harmony with the other favorable features of your face. The “ideal” shape for a male or female nose is an aesthetic concept that has its roots in our perception of beauty. This cannot be completely boiled down to lines and numbers — there is always an indescribable “artistic” element. However, by studying beauty, and faces that are universally felt to be beautiful, artists and plastic surgeons can arrive at some guidelines or proportions that represent the “aesthetic ideal.” Leonardo da Vinci was among the first to make such studies of beauty and aesthetic proportions. He and other artists have been joined in this pursuit by facial plastic surgeons, whose job entails understanding beauty and then making changes that enhance the beauty of their patients.
What follows are the lines and measurements that facial plastic surgeons have in their heads as a guideline to the aesthetic ideal. They are reprinted with permission from Rhinoplasty Dissection Manual, by Dr. Toriumi and Dr. Becker.
You may be satisfied to realize that these lines, numbers and measurements exist; of course, on the other hand, you should feel free to study them and become more of an “expert!”
The first two figures below point out major surface reference points. These are essential to allow you to understand the material presented later on this page.

SURFACE ANGLES, PLANES & MEASUREMENTS

The “ideal” face should divide into equal horizontal thirds as shown below:
Facial thirds:
(Figure 1)
Upper third: trichion to glabella
Middle third: glabella to subnasale
Lower third: subnasale to menton.
The “ideal” face should divide into equal vertical fifths as shown below:
Horizontal fifths:
(Figure 2)
Five equally divided vertical
segments of the face.
       
For the angles that follow, the face must be in a standard position for reproducibility of measurements. If the patient’s head is tilted up or down, some of these angles may change. The Frankfurt plane defines the standard facial position used by most facial plastic surgeons.
Frankfort plane:
(Figure 3)
Plane defined by a line from the most superior point of auditory canal to most inferior point of infraorbital rim.
The angle formed where the forehead meets the nose is the nasofrontal angle. An overly sharp nasofrontal angle divides the forehead from the nose and makes the nose appear relatively short; an overly shallow angle results in continuity between the nose and forehead which can give a longer appearance to the nose.
Nasofrontal angle:
(Figure 4)
Angle defined by glabella-to-nasion line intersecting with nasion- to-tip line. Normal 115-130 degrees (within this range, more obtuse angle more favorable in females, more acute in males).
Nasal projection refers to forward protrusion of the nasal tip from the face (like Pinocchio or Cyrano de Bergerac). Two reliable measurements of nasal projection are listed here:
Nasal projection: (Figure 5)
Forward protrusion of nasal tip from face. Goode’s method – A line drawn through the alar crease, perpendicular to the Frankfurt plane. The length of a horizontal line drawn from the nasal tip to the alar line (alar point-to-nasal tip line) divided by the length of the nasion-to-nasal tip line. Normal 0.55-0.60.
Crumley’s method – The nose job with normal projection forms a “3-4-5 triangle.” ie., alar point-to-nasal tip line (3), alar point-to-nasion line (4), nasion-to-nasal tip line (5).
One way of assessing the projection of the nose from the face is the nasofacial angle. If the nasofacial angle is large, this is a clue that the nose is probably too far from the face And if the nasofacial angle is too short, the opposite may be true. One can get an impression about projection just by looking at the nose jobs in profile, but these measurements add “science” to the art of facial analysis.
Nasofacial angle:
(Figure 6)
Angle defined by glabella-to-pogonion line intersecting with nasion-to-tip line. Normal 30-40 degrees. [PEARL: “Normal” projection with a 3-4-5 triangle described by Crumley (see above) gives a nasofacial angle of 36 degrees.]
Sometimes, a small chin can make the nose appear larger. Attention to the nasomental angle (in conjunction with other measurements) helps the surgeon analyze the role that adjustments to the chin may play in achieving facial harmony.
Nasomental angle:
(Figure 7)
Angle defined by nasion-to-tip line intersecting with
tip-to- pogonion line. Normal: 120-132 degrees.
The surgeon assesses whether the lips are in proper relationship to other parts of the face.
Relationship of lips
to nasomental line:

(Figure 8)
Upper lip 4mm behind, lower
lip 2 mm behind line from nasal
tip-to-menton.
A sharp mentocervical angle is a desirable feature.
Mentocervical angle:
(Figure 9)
Angle defined by glabella-to-pogonion
line intersecting with menton-to-cervical
point line.
If a patient’s nose is droopy, he or she may have an acute nasolabial angle. If the nose jobs is too short or “uplifted,” then this angle may be obtuse.
Nasolabial angle:
(Figure 10)
Angle defined by columellar point-to-subnasale line intercepting with subnasale-to-labrale superius line; normal 90-120 degrees (within this range, more obtuse angle more favorable in females, more acute in males).
From the side, too much or too little “columellar show” is undesirable. Because there are three possible configurations for the columella (normal, hanging, or retracted) and also three for the nostril rim or ala (normal, hanging, or retracted) there are NINE possible configurations for the alar-columellar relationship. These are shown here. The surgeon must diagnose which of these nine configurations exists in you.Columellar show:
(Figure 11)
Alar-columellar relationship as noted on profile view, 2-4 mm of columellar show is “normal.”

Question: Teach me some the characteristics of the “ideal” male nose and female nose.
Answer:
 The figures above show diagrammatically the ideal dimensions of the nose. This aesthetic “ideal” is simply a goal or a frame of reference that must be modified to reflect the realities of a particular patient’s facial features.
Question: How does the surgeon analyze my nose when he examines it in the office, and in photographs?
Answer:
 The surgeon makes mental note of a “first impression.” For example, the surgeon may find your nose is too big, or perhaps it is a twisted nose, or a nose with a large hump, or an overoperated nose that needs revision. This first impression is important, because the odds are that this is what is bothersome to the patient as well. Often the surgeon will also ask the patient early on what it is that bothers the patient about his or her nose.
The surgeon considers the nose from the front. He determines whether the nose is twisted or straight, whether the nose is narrow, normal, or of excessive width, whether the nasal tip is bulbous, asymmetric, or otherwise abnormal. He also makes note of the skin quality: thin, medium or thick.
The surgeon considers the nose from the side and determines whether the nose is too long or too short. He determines if the profile has a hump, or if it is a “ski-slope,” or if it is a pleasant profile that fits the patient’s face. The surgeon determines if the tip of the nose sticks out too far from the nose (“overprojected”), if the nose is too small (“underprojected”) or if it is just right. The surgeon also examines the nose to see if there is too much nostril show.
The surgeon considers the nose from all angles, including from the bottom. Important information about the nasal anatomy is learned from this examination and is critical to planning a successful surgery.
Examination of the nose also includes palpation. Feeling the nose tells the surgeon essential information about what must be done.
Question: Can you give me a specific example of an analysis of a patient’s nose, and how you changed it to make it fit his face?
Answer:
 Of course. This patient is interested in improving the appearance of his nose. He feels it is too big for his face, and we agree. Also, he has trouble breathing through his nose. From the side view, it is clear that the patient’s nose is “overprojected” (sticks out too far from his face) and that he has a large nasal hump. His nose is neither too short nor too long – the length is just right. His nostrils also have a normal shape from this angle.

The patient’s chin is a little underdeveloped. Probably, one of the reasons he likes his goatee is that it makes his chin area a little more prominent and provides facial balance. He is not interested in a chin implant.
Careful examination of the front view shows that the patient has a very subtle twist to his nose. We will make every effort to improve this for him, but some degree of twist may persist. The patient had never noticed this before, but he sees it now. Also, the front view shows that the nasal tip is a little full. We will provide some conservative refinement of the nasal tip. The patient’s nose is of normal width. He has medium thickness skin.
The base or bottom view shows again that the nose sticks out too far from his face. The nose is not too wide for his face. The tip is a little full or bulbous and we will refine this for him. Palpating, or feeling, the outside of his nose shows that the patient has relatively short nasal bones and relatively long upper lateral cartilages, which comprise the middle portion of the nose. This is important because we will want to provide some extra support to the cartilaginous “middle portion” of the nose.
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Shakira Nose Job Before and After

Shakira Denies Nose Job + Then & Now

Colombian pop star Shakira has laughed off reports that she recently went under the knife for a nose job. The singer sparked surgery rumours after admitting that she visited a surgeon because she was unhappy with the size of her nose.

‘So many things going on in the world and yet some invent stories about me getting a nose job! Why would a she wolf (apparently the title of her new album) want a smaller nose?’ she posted on her Twitter.com homepage.

Source: Yahoo News

This is not the first time Shakira has talked about plastic surgery – here’s what she said a while back:

“A few years ago, I considered (plastic) surgery, breast augmentation, and all kinds of things. Maybe my eyebrows should be higher. Maybe my lips should be bigger. It was really making me bitter. I’d think I’m not going to look good for my fans! But eventually I said, “forget it” and I started accepting myself the way I am and realized that I’m just not perfect.”

OK, I’ll tell you what I think. I don’t know about the nose job, but she changed her hairstyle, make-up, eye-brows and lost some weight and these all changed her face.

However, I think that her nose is quite photoshopped in magazine spreads and on album covers (it’s shorter and narrower) and this might be the reason why the rumors started in the first place. Here’s an example:

… and another photoshopped one: