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-   -   Planning ahead for revision (http://www.plasticsurgeryspot.com/nose-surgery-primary-revision-rhinoplasty/1227-planning-ahead-revision.html)

Norm 03-16-2010 08:53 PM

Planning ahead for revision
 
Some of what appears below is a repeat of my posts on another thread. Please pardon the novel-length.

I'm due for a revision rhinoplasty sometime in the future. I've only recently started contemplating it in earnest. This forum is one of the first stops in my research. Currently I'm in NYC and likely to get it done here rather than LA. But we'll see what happens between now and then.

Here's a bit of background. Six years ago I got a rhino for about ten grand, after minimal research. I had narrowed it down to the two "top" LA surgeons (I mean, how can you possibly go wrong?); saw one and found his listening skills atrocious; went with the other one.

What both offered to do, and what I ultimately had done, was a simple shaving of the dorsal hump and trimming of a dangling columella. I would have liked more. Both my general unfamiliarity with rhinoplasty, and my fear of having "too much" done, contributed to my willingness to accept the limitations they imposed.

For future revision surgery (not to undo what's been done, but to continue where the last surgeon left off), I'm trying to determine what specifically I should be requesting; then I may have a better of idea of who I should see. Three things come to mind. You can judge for yourself based on the photos below.

First, I want to fix the crookedness. The right side of my nose is concave, the left is convex. This may be bone structure, it may be cartilage shape, it may be a combination. It's the most difficult aspect of the surgery, but the most key I believe. (I actually consulted with a few surgeons prior to narrowing it down to the two mentioned above; I was always amazed/frustrated at how resolutely they would deny that there was any crookedness.)

Second, I'm thinking a reduction of nostril size. (Of course, I'm not sure this is even possible without bringing the tip closer to the face.) Third, and most vague, a general reduction in size overall. (This is where I'm most concerned about having "too much" done.)

Long before any of this happens, I'm already scheduled with a maxillofacial surgeon (whom I have a generally good feeling about) to shift my class 2 lower jaw forward, along with (to a lesser extent) the chin bone. (He'll also do some liposuction on the neck fat that has mysteriously accumulated in the past couple years and that I'm sure has nothing to do with my eating too much pizza.) The result, if all this goes well, is that I'll have a better idea of what facial foundation my nose ultimately rests upon.

That's the background in brief. Here are the pics. The first two are three years before the surgery; the last three are six years post (i.e., today). Edit: replaced with more useful photos. Interested in opinions, concurring or differing.

pastypigeon 03-16-2010 10:23 PM

It's hard to see how your nose fits with your overall face from the frontal pictures. If I were you, I would remove the bump at the very top and maybe lift the tip a few mm. Reducing the size usually always help, but by how much depends on the proportions of the rest of your face. Reducing too much could be too feminizing, if that's not what you're looking for (some people prefer the "pretty" look to the super-masculine look, however).

Norm 03-16-2010 11:08 PM

Thanks pasty. I definitely prefer masculine to pretty, hence my caution about any dramatic reduction. That said, I don't have especially rugged facial features, so I have to find some sort of balance. It's difficult to gauge what kind of look I can "carry off."

Understood, regarding the limited usefulness of these pictures. Edit: Here's a full frontal to give a better idea.

http://i564.photobucket.com/albums/s...en/Image2a.jpg

pastypigeon 03-17-2010 12:55 AM

on the bright side, you can always delete the photos by editing your posts once you have the answers you're looking for. or, just black out your eyes.

would appreciate your feedback on my post, if you have the time :)

robyne00 03-17-2010 06:28 PM

The full frontal photo is very helpful. To enhance forum members ability to assess your issue further, why not post a true profile shot? Especially now that you're not camera shy! :) Your concerns are understandable!!!

I concur that the crooked bone structure should be remedied. A reduction in nostril size is possible, but that is very secondary to the issue of your nose being crooked, however, I can understand your concern.

I do not see a bump that needs to be removed. If I were you, I would look into some tip work. Awkward and obtuse angular projection is moderately evident.

The work you are doing with the maxillofacial surgeon is warranted as well.

You have done some good prelimary research, in hindsight of your primary surgery. What other research have you done?

Norm 03-17-2010 08:51 PM

That's brilliant feedback, robyne -- precisely what I'm looking for. Thank you. And I've replaced the photos.

That's my assessment as well, that the crookedness is the primary concern. And the tip work makes sense, especially viewed from the left side. Beyond that, I think the maxillofacial results will give a better sense of how the nose fits with the rest of the face in profile.

Frankly I have not done a lot of other research at this stage. You mentioned in an earlier post that visiting doctors and their past patients is key. This makes sense, although it may not be something I undertake until after the jaw and chin are taken addressed. The main precursor to that kind of research is identifying what I would like surgery to accomplish. This thread has been useful for pointing me in that direction.

robyne00 03-17-2010 09:28 PM

So glad to help you, Norm!!!

Also, now that you have posted true profile pics, I can tell you there isn't a bump at the top of your nose, but a discontinuity that should be addressed. IMO it should be second to the crooked bone structure, but primary to the nostril size.

I hope this post continues to steer you in the right direction. It seems like you are definitely taking the proper path ... this time. If only last time, right?!? :) Best of luck to you, my friend!!! Keep asking questions, researching, and good, good luck!!! :D

pastypigeon 03-17-2010 11:09 PM

Your face seems fine to me. Maybe it's just the angle, but your jaw and chin seem strong. I like the angle your lower lip makes with your chin; it's unusual but in a good way. The main thing I would be concerned with is the discontinuity between the top of your nose and your forehead and the asymmetry in the nose. It would be nice to see the middle third of the nose narrowed as well. The nostrils don't seem to be too large in my opinion, but I think they would look fine narrower as well.

Norm 03-18-2010 09:50 AM

Thanks pasty, that's helpful. Narrowing the middle third actually wouldn't have occurred to me. As long as we're on this masculine vs. feminine kick, it seems to me that an adjustment there could be too feminizing. But then, it's hard to tell, since the crookedness tends to eclipse any other adjustments.

pastypigeon 03-18-2010 12:53 PM

I don't think it would, I think it would just make your face look more refined. In my opinion, noses look too feminized when the nostrils are too small or if the nose turns up on the profile. Thinness in the dorsum would bring out your other features, IMHO :)


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