Question: How many rhinoplasties are too many? I have undergone a total of 5 procedures and I still do not feel that the work of the first doctor has been sufficiently fixed. Is it still possible to have my nose fixed?

Answer: It is certainly possible to have your nose fixed even if you have undergone 5 previous rhinoplasties, but I will say that, after each additional rhinoplasty, the procedure does tend to get more and more difficult due to a significant amount of scar tissue that is present. Furthermore, the far majority of cartilage that would be required to reconstruct the nose is now lacking, and most patients that have undergone this many rhinoplasty procedures would be best served by a rhinoplasty surgeon that harvests rib cartilage to reconstruct the underlying framework of the nose.

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Question: Since nonsurgical rhinoplasty involves the use of fillers, I am assuming that the only changes that can be made are though in which the nose needs to be augmented as opposed to being made smaller. Is this true?

Answer: It is true simply due to the fact that the filler obviously adds volume to a nose and a filler can only therefore make the nose theoretically larger, but the interesting thing about the shape of the nose is that in certain patient’s anatomy, adding volume to a particular region especially a depression above or below a nasal hump can make the nasal hump appear smaller even though we are adding volume to the nose. So it is a bit complex, but due to the 3-dimensional nature of the nose, we can in certain circumstances improve the appearance of the nose by adding filler to it.

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Question: I am of Middle Eastern descent and my main concern is my nose on profile? How can this be fixed?

Answer: I am assuming by your question that you have a dorsal hump and possibly a dependant tip. This can be corrected by a rhinoplasty procedure where the dorsal hump is removed, the nasal tip is elevated and overall more harmony is not only created between the various aspects of the nose but more harmony is also created between the nose and the remainder of the face. Ultimately, I would recommend an evaluation by an experienced rhinoplasty surgeon so that you can have a customized treatment plan that will address all the issues that you have concerns about.

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Question: Is skin thickness a greater factor in ethnic rhinoplasties and why?

Answer: I am not sure that I would say that skin thickness is a greater factor in ethnic rhinoplasties, due to the fact that I see various skin thickness in various ethnicities, but there are certainly ethnic noses that have very thick skin and this prevents a rhinoplasty surgeon from creating a significantly sculpted nose, due to the fact that you just will not be able to see the underlying cartilage due to the very significant thickness of the overlying skin.
On the other hand, in northern Europeans, they can have extremely thin skin which then allows for the underlying cartilage to be visible, which is typically a good thing, but also it is a challenge due to the fact that if there is even the slightest irregularity or asymmetry, this also is going to be visible. Overall, I would guess that most rhinoplasty surgeons appreciate medium-thickness skin due to the fact, that we can not only get the result that we desire, but we can also camouflage some extremely minor irregularities that may be left behind.

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Question: I am Asian and want to know how you would suggest changing a bulbous nasal tip and flared nostrils.

Answer: For most Asian patients that have a bulbous tip and flared nostrils, I would recommend placement of a columellar strut graft which is a cartilage graft that is harvested from the nasal septum, which is the wall that divides the right and left sides of the nose. This graft is then placed between the nostrils and goes up towards the tip. The tip is also addressed by either what is called a dome division or a nasal tip suturing technique to narrow the overall width of the tip. In most of my Asian rhinoplasty patients they also desire augmentation of the nasal dorsum or bridge of the nose, and in most patients this involves placement of an allograft or implant to improve upon this region. Ultimately, though I would highly recommend seeking out an experienced rhinoplasty surgeon, so that your particular nasal anatomy can be evaluated and a customized treatment plan can be created.

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