Prominent Nose

A nose that is too large for the face will draw an observer’s attention away from other, more attractive aspects of the face, i.e. the eyes. Therefore, a successful rhinoplasty should lead to a nose that is in balance with the remainder of the face. A nose with a tip that protrudes too much is called ‘over-projected’. Often, a prominent nose has other problems including a bump, wide and bulbous tip and a droopy tip (‘down-rotated’). All of these issues need to be addressed during rhinoplasty for an aesthetically pleasing end-result.

Although some mathematical calculations for “optimal” nose projection exist, meeting the patient’s aesthetic goals should be the main objective of rhinoplasty surgery. One of the reasons people consider rhinoplasty in the first place is a conflict between one’s self image and actual appearance. A caring plastic surgeon will always have the overall well-being of the patient as his top priority. In rhinoplasty, the surgeon will advise the patient about goals that will lead to a natural appearance avoiding the over-done look. For instance, some people who have been bothered by their big nose for many years may just want a smaller nose but a nose that may be too small. Because such an over-compensation is natural and common, the rhinoplasty specialist will educate the patient about a normal looking nose in relationship to the person’s face and body. Although it may be easier to just “do what the patient wants”, truly understanding a person’s desires and educating him or her about “a good nose” will distinguish the caring plastic surgeon.

How is a Prominent Nose Made Smaller?

Many techniques have been described and whole textbooks have been written about the question of de-projecting a nose that is too large. In general, a thorough understanding of the complex nasal anatomy and how it relates to tip projection is obligatory. Then, the cosmetic nasal surgeon will determine, what changes of the tip region are necessary and how all of these improvements are best achieved for this particular patient. One of the concepts widely used to understand tip projection is called the “tripod principle”. This theory may help a rhinoplasty surgeon understand how particular changes of the tip cartilages translate to changes in projection (nasal prominence) and rotation (turned up or turned down; angle between upper lip and under-side of nose). Applying this concept, one can shorten the medial crus of the lower lateral tip cartilages and expect a less prominent and turned-down nose. If only the lateral crus is shortened, the nose may end up being more up-turned and if both, the medial and lateral crura are shortened, the tip may fall backwards without changing rotation. Although this model is helpful, most experienced rhinoplasty surgeons understand that other factors determine the final tip position and they therefore apply additional techniques.

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