Erin is a 23 year-old woman who was dissatisfied with the appearance of her nose. In 2001, she underwent a rhinoplasty which was performed by another surgeon. As the swelling resolved, she began to notice asymmetries and irregularities in the contour of her nose.

When I met Erin, I asked her what bothered her about her nose. I then manipulated her photos on the computer so we could have a specific discussion about what changes needed to be made. In my analysis, the bridge of her nose started too low on her face, which made her tip appear to project too far forward. The base of her nose was also too high. This made her upper lip look long and as if it were under tension. The contour of the bridge of her nose was irregular which was evident not only on her profile but on her frontal view in the form of an inverted “V”-shaped shadow. Also, her nostrils were uneven and her tip too narrow.

During surgery, I removed a piece of cartilage from one of Erin’s ribs. This provided enough material to lengthen her nose, set it back closer to her face, and smooth out the irregularities and asymmetries. Now, her nose is in better proportion with her other features and she has a natural-looking result.

Before. Erin’s profile was irregular and the tip protruded too far from her face. Her nose was also too short, making her upper lip look long.

After. A smooth graft on her bridge straightens out her profile and a second graft supports her slightly longer nose and deprojected tip.

After.

Before. Erin’s tip was deviated to the right, pinched, and her nostrils were asymmetric. Her cartilages had separated from her septum as a result of her first surgery.

After. I reattached her cartilages to the septum and straightened out her tip. Her nostrils are much more symmetric.