Facial Balance in the New York Area
What exactly is a large nose? The New York area’s Williams Center for Plastic Surgery rhinoplasty team explains that there are a lot of noses that can be described as large, and most of these are simply out of balance and out of proportion to the patient’s face. For example: someone with a weaker bone structure or small face may not carry a nose that is ideal for someone with a stronger bone structure. The bottom line is that a well-balanced nose that is exactly the same size but on a smaller face, often appears conspicuous or larger. When someone is referring to a large nose, they are typically referring to a nose where the tip stands out from the face (this is called over projection) or they have this anatomical variant in conjunction with a strong bridge (medically referred to as a convex dorsum) and sometimes referred to as a bump. Lastly, when a nose is wide, either in the mid-section or at the bottom of the nose, it can also be considered a large nose.
Causes of a large nose are multi-factorial and consist of large nasal bones or an overly developed or cartilaginous lower nose for both. Sometimes a patient can have flaring nostrils and a wide base to the nose which create the illusion that the entire nose is larger. All of these things need to be taken into consideration when someone is considering rhinoplasty to reduce a large nose, so that the patient is left with a nose that is not only smaller,but balanced and fits their face and ethnicity. For example: A 5’2″ woman of northern European descent will more likely have a different goal than a 6’3″ African American male. Naturally, a very experienced rhinoplasty specialist can discuss the differences, including preserving ethnic characteristics so as to achieve a balanced and natural nose.
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The decision to proceed with rhinoplasty is usually followed by a consultation with an experienced specialist who will not only listen to the patient seeking large nose reduction, but will place them on the computerized imager so they are able to discuss all areas that are considered large or big and what the recommended approach will be to bring everything back into balance. Computerized imaging has revolutionized the consultation process and is also a wonderful tool for the specialist to manage expectations and for the patient to communicate more effectively with the surgeon.
Fixing a large nose is somewhat different than fixing a smaller nose, because typically some cartilage or tissue needs to be taken away. Taking tissue away is often rebalanced by putting some back, but it is usually by way of cartilage removal and/or bone removal.
One question that patients often ask is: How does the skin of a large nose go back to accommodate a smaller sub-structure? There have actually been patients in the past who thought that the surgeon had to cut skin out from a large nose, but amazingly, the skin re-drapes to accommodate the new underlining structure. However, there are some limitations on this, which is beyond the scope of this informational section and have to do with thicker skin and larger amounts of reduction.
Large Nose FAQs
Where Are the Incisions in Surgery for a Large Nose?
The incisions in surgery fixing a large nose depend on the approach the surgeon takes: open or closed/endonasal or scarless (no visible external incisions).
Some surgeons believe the open approach offers them a full view of the nose, and they value the precision afforded by this surgical technique. However, Dr. Williams finds that the endonasal or closed approach actually results in more predictable outcomes in large nose surgery and causes less trauma to the nose, meaning less healing time for the patient.
The closed approach is more complicated and requires an especially skilled and experienced surgeon. Most of Dr. Williams’ rhinoplasties in the first decade of his practice were open approach procedures and were instrumental to him gaining the understanding necessary to perform endonasal surgery—which he now does almost exclusively.
Details about surgery for a large nose, including where the incisions are placed, are the subject of the doctor’s Famous Fireside Chats series titled, The Great Debate: Open vs. Closed Rhinoplasty.
Do You Pack the Nose After Large Nose Surgery?
Since Dr. Williams primarily employs the closed (endonasal) or scarless approach for large nose surgery, there is no need for heavy packing.
In his extensive experience, heavy packing is not necessary to hold the nose in position if the surgery has been performed well. Dr. Williams prefers just a light dressing (similar to the gauze used to stop a bloody nose), which patients find to be far more comfortable than heavy packing. This light dressing stays in until the following day, and the outer splint comes off about one week later. Dr. Williams reminds patients to refrain for two weeks from any activities where the nose is at risk of being bumped.
To see just how the nose is dressed and splinted in large nose surgery, tune in to Dr. Williams’ Famous Fireside Chats video on rhinoplasty.
Will Large Nose Surgery Fix Breathing Problems?
When discussing a procedure to address a large nose, an experienced surgeon will inquire whether the patient has difficulty breathing, which can be attributed to a deviated nasal septum, narrowing nasal valves, or a twisted or crooked nose.
If this is the case, the problem may be corrected during a cosmetic surgery to correct a large nose.
Dr. Williams discusses this and other common concerns in his Famous Fireside Chats on correcting and fixing breathing during surgery to address a large nose.
The Cost of Large Nose Surgery
Fees for rhinoplasty correcting a large nose, which range from $7,000 to $14,000, depend on several factors and are subject to operating room and anesthesia fees.
If the surgery is a patient’s first such procedure (considered primary), the fees will reflect that, while a more complex and time-consuming second or third procedure (considered a revision) will cost more.
Also reflected in this fee range is the cost of living where the practice is located. For example, a surgeon operating in Manhattan will typically charge more for surgery than a surgeon in a small city.
Consider, too, that a more experienced surgeon performing surgery to alter a large nose will typically charge more than a less experienced one, as achieving a satisfactory outcome is more likely and the need for follow up surgeries is minimized.
Refer to Dr. Williams’ Famous Fireside Chats regarding nose surgery for additional information.
Contact Lenses or Glasses Following Surgery for a Large Nose
Due to the need for patients to wear a splint or cast after surgery to address a large nose, Dr. Williams encourages his patients to tackle the problem of wearing glasses with the following adjustment. Put a small piece of tape on the bridge of the glasses, which will allow them to hang from the forehead.
When the splint is removed, usually about one week after surgery, patients who wear contact lenses can resume normal use.
How is Computerized Imaging (CGI) Used in Large Nose Surgery?
For surgery to address a large nose, Dr. Williams relies on patient images captured digitally and modified to better communicate potential or ideal outcomes.
Dr. Williams finds CGI an extremely beneficial communication tool and has used computerized imaging to aid in surgery for almost 25 years.
In Dr. Williams’ book, Rhinoplasty: Everything You Need to Know about Fixing and Reshaping Your Nose, he addresses additional questions regarding surgery correcting a large nose and covers this in his Fireside Chats series available on our YouTube channel.
Complications and Risks of Large Nose Surgery
While rare, complications from surgery correcting a large nose are usually fully discussed with the patient. Most reputable surgeons will review such issues with a patient prior to surgery.
There is a possibility of some bleeding or infection with any surgical procedure. Dr. Williams stresses that these are uncommon in surgery to address a large nose. Another possible concern discussed with each patient is the chance for revision or touch-up surgery. According to recent studies, five to 10 percent of patients who undergo surgery for a large nose will request or require a touch-up procedure to achieve desired results. This is often a minor procedure and can be done in the doctor’s office. Of course, this is far less likely to occur if you have chosen a surgeon who specializes in rhinoplasty, but it is good to remember that despite the skill of the surgeon, surgery correcting a large nose is not a perfect one. There are numerous variables to consider, and the surgeon must bring together their entire repertoire of talent and skill and their vast knowledge of anatomy.
Without effective communication about what nose surgery can and cannot accomplish for an individual patient, we run the risk that the patient will be unsatisfied with the outcome.
By managing expectations in the consultation process, where details about the surgery’s outcomes are explored and any concerns are fully aired, we ensure the likelihood of a happy and contented patient experience.
More information on complications following surgery to address a large nose is available on Dr. Williams’ Famous Fireside Chats.
Anesthesia in Large Nose Surgery
Rhinoplasty to correct a large nose is usually performed on an outpatient basis, allowing the patient to head back home after surgery.
During surgery, local anesthesia is used. However, twilight or general anesthesia, administered by a credentialed provider, may also be used depending on the choices discussed by the patient and surgeon. Many surgeons find general or twilight anesthesia to be the best option, as the patient is asleep during the surgery.
This surgery is explained in more detail in Dr. Williams’ Famous Fireside Chat on anesthesia for rhinoplasty.