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Rhinoplasty and Facial Balancing

By: Tim Neavin, M.D. on December 5, 2011

Beverly Hills rhinoplasty, facial fat grafting, chin augmentation, buccal lipectomy, neck liposuction.
Rhinoplasty is one of my favorite operations. It truly is a surgical art, because when I see rhinoplasty patients I see an opportunity to improve the entire face (not just the nose)  with very little additional work or complexity after improving the nose aesthetics.
A beautiful nose will beautify a face. And, a beautiful face will beautify a less than aesthetically ideal nose. Thus, when evaluating a nose, I always judge the aesthetics of the nose as a single component against the entire architecture of the face. That is, the nose should be balanced to the face and the face must be balanced with the nose if the goal of the rhinoplasty is to truly beautify the face.
Some rules about facial balancing with rhinoplasty: A small chin will make a nose look bigger. A prominent chin will make a nose look smaller. The nose is also judged against the mid face. Larger cheeks can make a nose look smaller, and deficient mid face can make a nose look more prominent.
In the photos included in this blog, this woman desired a more feminine nose. As the nose is the centerpiece of the face, a true beautification of her nose with rhinoplasty  included not only nose surgery, but fat grafting to cheeks, buccal lipectomy (removing fat from chipmunk cheeks), advancing the chin with a small chin implant, and neck liposuction to improve her profile.
The red and yellow arrows mark the shift of cheek prominence to a higher level on the face. This was done with facial fat grafting. The buccal lipectomy “sucked” in the chipmunk cheeks, and along with cheekbone fat grafting, generated a very modelesque shadow below her cheek bone.
To feminize her nose, it was tilted and the hump was taken down. To improve her nostril show, grafts were placed inside the nose.
Her chin was augmented with a small silicone chin implant through a small incision inside the mouth to balance her nose. The neck was then liposuctioned to improve her profile.
The complete surgery was all done with no visible incisions (nose was done in a closed fashion, fat grafting was injected through the corner of the mouth, chipmunk cheeks were removed from inside the mouth, and neck was liposuctioned from behind ear and just under chin.

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