Well certainly if you are viewing results from another surgeon that are not your actual photos, then it is very important to have extremely consistent photography and very consistent poses in the before-and-after photographs so that you can assess the result properly.  It is also important to be able to view the nose from multiple different angles and, classically, rhinoplasty surgeons take six to seven different views of the patient in both the before and after photos.  Due to the large number of photographs, I typically do not show all of these different views on my website but they are certainly available for patients who are interested.  Otherwise, if you are actually viewing your own results after a rhinoplasty, I like to recommend that patients do what I consider a first impression approach toward their results, which means they look at themselves in the mirror, and their first impression should not be a noticeable nasal abnormality.  In other words, I expect the nose to not detract from their overall appearance, and they should really notice their eyes after a rhinoplasty.  With that being said, they could still have some minor irregularities that are actually visible after a rhinoplasty, and these irregularities may bother the patient and certainly may also bother the surgeon and require some sort of revision surgery.  These irregularities hopefully will not be so significant as to make the nose “noticeable” as the whole goal of a rhinoplasty is to create the nose that better fits the face and is therefore not “noticeable.”

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Well depending on how far out from the rhinoplasty you are will essentially determine whether the appearance of a crooked nose is due to asymmetric swelling or due to a problem with the actual rhinoplasty itself.  If you are six months or more out and continue to have the appearance of a crooked nose then, more than likely, there is indeed something asymmetric about the underlying cartilaginous and bony framework of the nose.  If you are only a month out from surgery then, by all means, swelling can certainly give the illusion of a crooked or asymmetric nose and this should then spontaneously resolve over the next several months.  In patients who started with an extremely crooked nose, they can have an appearance of a persistently crooked nose after surgery for an extended period of time due to the fact that the soft tissue overlying the nose has essentially been formed in a crooked fashion due to the longstanding asymmetry that their nose has had.  A surgeon can correct the underlying cartilaginous and bony framework into a very nice and precise midline and symmetric structure and yet the overlying crooked soft tissue will not fit and seat properly on this underlying framework.
This is typically a relatively subtle asymmetry and certainly, compared to the preoperative crooked nose, is a dramatic and significant improvement.  I do, however, nonetheless tell my patients with extremely crooked noses to expect a very subtle asymmetry after surgery due to the aforementioned fact that the soft tissue is indeed asymmetric.  This seldom concerns my patients with formerly very crooked noses as they are typically quite satisfied with the very significant improvement that we have achieved through the rhinoplasty itself.

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An underprojecting tip is a nasal tip that does not stick out away from the face far enough.  Essentially, projection has to do with the distance that the nasal tip extends out from the face.  If the tip sticks out too far from the face, then this would be considered an overprojecting tip and, if a tip does not stick out away from the face far enough, then this would be considered an underprojected tip.  Many times a tip can appear to be underprojected due to an overly large hump and, by just removing the nasal hump, the tip can appear to have a more appropriate projection or distance out from the face.  In a similar way, a tip that appears to be overly projected can actually have an appropriate distance away from the face and it only appears overprojected due to a lack of a dorsal profile.  In that circumstance, if the dorsum is augmented or the bridge of the nose is made to stick out away from the face further, then this will give the illusion that the tip does not stick out as far.  Ultimately, I find it exceptionally helpful to perform computer-generated imaging on my patients so that we can determine whether it is an optical illusion or a reality that they have or do not have an under- or overprojected nasal tip.  This typically becomes quite apparent when we make changes on the computer, and we typically then realize that there are other changes that are necessary in order to give the patient the nasal appearance that they desire.

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No, I really have not seen any fat loss or lipoatrophy after rhinoplasty.  When a rhinoplasty is performed properly, the soft tissue is elevated off of the underlying cartilage and bone at a level directly against the cartilage or bone and thus the soft tissue of the actual nose is never injured.  Occasionally in some patients that have very thick skin, the undersurface of this soft tissue may be defatted with the scissors in order to thin the soft tissue over the cartilage and bone.  This is different than lipoatrophy.  Certainly rhinoplasty patients do have some moderate swelling of the soft tissue after the procedure and the swelling can take an extended period of time, in fact up to a year, to completely resolve.  This slow resolution of swelling may give patients the appearance of volume loss and some may mistake this for lipoatrophy, but all this is, is actual swelling of the soft tissue resolving over a six to twelve month period.  Regarding other areas of the face such as the cheeks, I have never seen anyone have any significant volume loss after a rhinoplasty and a rhinoplasty really should have no affect whatsoever on the fat volume of the remainder of the face.

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If your question means that you have irregularities along the side of your nose and you are asking whether a rhinoplasty can correct this, the answer would be yes.  I will frequently see patients that have an overly wide nasal dorsum with some irregularities along the side.  This may be due to prior trauma or may just be the way that the nose developed.  Irregardless, a well-performed rhinoplasty by an experienced rhinoplasty surgeon can certainly define the side of the nose so that there is a nice smooth line from the eyebrow curved down to the side of the nose and then this extends out to the tip in a very esthetic fashion.  I personally like to employ computer generated imaging so that I can not only appreciate the abnormality better visually, but I can also then customize a treatment plan to assure that we answer all of the patient’s concerns and create a nose that is symmetric and in more harmony with the other facial features.  The whole goal of a rhinoplasty surgery is to create a nose that better fits the face and thus is not as “noticeable” as the preoperative nose was.  In essence, most patients that seek a rhinoplasty have a nose that is “noticeable” in that it detracts from their appearance due to some abnormality, irregularity, asymmetry, or bulbosity. By creating a nose that better fits their face, that has more smooth lines of transition and has more esthetic features that are in harmony with the remainder of their face, a rhinoplasty can make a nose visually “disappear”  This nose thus becomes less “unnoticeable” and will therefore not detract from their appearance.  Though I can honestly say that not everyone can have a perfect or beautiful nose after a rhinoplasty, if we create a nose that is no longer “noticeable”, then this less than perfect nose still is a fantastic improvement from their preoperative nose.  In essence, we can only alter or modify the nose that we start with.  We can definitely not recreate an all-new nose for the patient.  Thus rhinoplasty surgeons must accept the fact that their post rhinoplasty nose may not be considered a beautiful nose and yet they have performed a highly successful rhinoplasty surgery in that they have created a nose that nobody notices.  I know this may sound strange to some of our blog readers, but I have shown countless patients their computer generated images for the proposed rhinoplasty outcome and even though their nose may not be considered perfect, it makes such a dramatic change to their overall image that they are extremely pleased by the result that I can show them and the result that I can achieve from their rhinoplasty surgery.

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