A Case Study
by Tim Neavin, M.D.
Virtually all women want a feminine nose. While opinions of the aesthetic nose ideal differ, most would agree that a feminine nose can be characterized by a few things. They are rather small, have a slight break off point as the nose slopes to the tip, and slight upward tilt (generally 100 to 105 degrees.)
However, one way to feminize the nose in addition to rhinoplasty, is to also feminize the midface. That is, in women, I like to address the nose and cheek (or midface) as a “region” rather than as unrelated, or separate units.
Every man and woman who approaches me for rhinoplasty will have their midface and chin evaluated. Its relationship to the the nose is critical.
Often a small chin implant alone will “reduce” a large nose by balancing the nose chin relationship. In fact, I can recall a few patients who came to my office unhappy with their nose, and a rhinoplasty was obviated with simply balancing the midface, lips, and chin using fat grafting and a silicone chin implant.
While I recommended a small chin implant in this woman, she declined. 24 cc of fat was injected into the cheek and under the eye to restore a youthful, well rested appearance, while also framing the more feminized nose. In this case, there are no visible facial incisions. The nose was reduced internally (closed approach), and fat was injected with fat grafting through the corner of the mouth. Most of my rhinoplasty surgeries will include some volume addition to the midface with fat grafting. About 30 to forty percent will also benefit from a small or medium chin implant.
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