From Steven M. Denenberg, M.D.
Here is the modification I made of your profile. I brought the tip of your nose back closer to your face, raised the tip, and especially reduced the strength of your nose, at the top, just below your eyebrows:
Click on the photos above to see rhinoplasty patients of mine, many of whom had their noses shortened and deprojected.
Here is an animation of the morph:
Raising the tip of the nose and bringing it back closer to the face involve complicated work on the tip of the nose. You mentioned that tip work was not in the plan for your rhinoplasty, but in any event most plastic surgeons are not able to make these changes. If you have a revision, you need to see before and after photos of the doctor's other patients who had deprojection and elevation of the tip, so you can be sure he has the skill to accomplish those changes.
Let me know what you think of these modifications.
If you have any questions about this, or if you want me to evaluate any other photos of yours, feel free to email me:
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Plain talk about picking a plastic surgeon for your first-time or revision rhinoplasty.
I do lots and lots of revision rhinoplasties, and I'll try to give you some advice here, to maximize the chances that you'll be happy after surgery, and to minimize the chances you'll need a revision.
Important!! Your consultation:
Photos. If a surgeon doesn't or won't show you before and after photographs, scratch him off of your list. Period. No exceptions. Deal-breaker.
You pick a surgeon primarily from his before and after photos. Diplomas and board certifications tell you nothing about a surgeon's rhinoplasty skill. You must see before and after photos of other patients who had some features similar to your nose. And don't rely only on profile views. Carving a hump off of a profile is not the same complexity as narrowing and repositioning a wide and drooping tip. Or doing any revision.
If you see his photos, but you don't love them, scratch him off your list. That's why you asked to see the photos in the first place: so you could reject him if you didn't like the photos!
Communication. If he treats you disrespectfully, scratch him off your list. If he won't patiently listen to what you want for your nose, same thing. How will he know how to make you happy if he won't hear what you want for your nose?
If he doesn't even examine your nose, deal-breaker. If it's the nurse and not the surgeon who conducts the consultation, run away fastest. All due respect to the nurse, she doesn't know what's possible and what isn't. If the plan is to only see the surgeon on the morning of surgery, deal-breaker. For sure.
Computer morphing. If the surgeon doesn't do computer morphing of your nose, scratch him off your list. The morphing is crucial, so the surgeon can prove to you that he understands exactly what your goals are. Also, if the surgeon recommends some changes that you hadn't thought of, you need to see the morphs, so you can see whether you like those changes.
Your intuition. If your gut tells you "no," don't use the surgeon. Don't ever use a surgeon only because you know him, or your kids know him, or he lives on your street, or your primary care doctor referred you to him, or he did your breasts, or your tonsils, or your wisdom teeth. I hear these stories all the time from my revision rhinoplasty patients. You must do your own evaluation of any surgeon you visit. And by "evaluation," again, we're talking mostly about seeing his photos and seeing how well he communicates with you. Don't bother checking his licensure and board certification and hospital affiliations and all that; it'll just distract you from what's important.
Conclusion. The fact is, the great majority of plastic surgeons who perform rhinoplasty shouldn't be doing the operation. It's an incredibly difficult procedure, technically demanding, requiring experience, skill, judgment, an artistic eye, an exceptional level of communication and thoughtfulness, and a rare level of empathy and caring for the patient. No hospital board protects you by judging the quality of a surgeon's rhinoplasties and prohibiting him from operating if he's terrible. It's the wild, wild west out there, folks.
More plain talk: should you let your primary surgeon perform your revision?
Rhinoplasty is by far the most difficult of the facial plastic surgery operations. And revision rhinoplasty is ten times more difficult than a first-time operation.
First, you need to consider whether things didn't turn out great on your first operation because of some unusual circumstance with the surgery or the healing, or whether things went wrong because your doctor was not expert in rhinoplasty in the first place.
Evaluate your surgeon again. Read the section above, on how to evaluate a surgeon for a rhinoplasty. If you saw lots of before and after photos of your surgeon's other patients who got excellent results, in noses at least somewhat similar to yours, then your surgeon probably knows what he is doing, and you can consider letting him perform your revision. Even the very best surgeon has the occasional disappointing result.
However, if, on looking back, you decide that you did not do excellent research on your original surgeon -- perhaps you relied on a referral, or on his board certification, without being able to see his photos -- then you probably should not have him perform the revision. If he couldn't get you close to your goal the first time because of a lack of skill, he will have no chance at all on the second try, and then you'll be in the tough position of looking for a third operation.
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Dr. Denenberg has been selected as one of America's Top Doctors by Castle Connolly Medical Ltd.
The America's Top Doctor award is not a popularity contest. Unlike all the local copycats and spin-offs, Castle Connolly allows only physicians to nominate, and vote for, Top Doctors. The "America's Top Doctor" is a doctor who is voted into that position by a national review of recognized experts in the doctor's field. Dr. Denenberg is one of the rare doctors to receive that award every year since the program began in 2001.
Here's a link to Dr. Denenberg's recognition page at Castle Connolly.
If Dr. Denenberg asked you to post or send better photos ...