Patient who wanted to look normal. He said he had always he disliked his face. I spent 4 hours with patient imaging and going over potential looks. He stressed that he wanted his nose to remain overtly masculine and retain natural features to make it almost impossible to identify he had a rhinoplasty.
I felt several of his issues can be attributed to underprojection of his cheekbones and jawline, in addition to issues with his nose. The overall flat appearance of his cheekbones leads to over prominence on his eyes and leads to the middle portion of his face looking too long. The goal was to restore a better balance to the height and width of his face.
It has been noted that in patients with maxillary hypoplasia (underdevelopment of the cheekbones), may have an associated alar retraction. (Personal communication Norman Pastorek-- There is not an associated syndrome with these findings described as of yet.) You will also notice there are somethings that just don't look right with his nose on frontal view. You see too much nostril and are looking at too much attention is paid to his infratip lobule. His lateral view notes a blunted nasal tip with excess infratip lobule. He has almost 5 mm of alar retraction which, any rhinoplasty surgeon will tell you, is a large amount of alar retraction to correct.
My aesthetic for his nose and face was to create a masculine nose while giving his face more favorable skeletal support.
On his frontal view you can see that his face appears more normal. He has noted a big surge in confidence after the surgery and I think part of this is that his face appears masculine and chiseled. There are different highlights that men and women like to emphasize. In his face, The combination of strong jawline, strong cheekbones, and a natural appearing nose allow for a masculine appearance.
Looking at his nose, you will note that his nostrils and infratip lobule are demphasized. His profile view demonstrates improvement in his infratip lobule and nostril show, while maintaining a natural appearing nose. His nose is not perfect by any means, but many of my male patients like having a slightly rough aspect to it. A male nose may actually look better if the dorsum is slightly wider and has a few asymmetries in it, lending a masculine natural appearance to the nose. An overly straight dorsum, overly pinched tip, and other subtle ques in a male can be a give away to a rhinoplasty.
- Anil Shah, MD, FACS
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- United States, IL, Chicago, 200 West Superior St., Suite 200, 60654
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