Rhinoplasty, Chin Augmentation, Ptosis

983461-1805611Q: I have posted some questions but I thought I’d better put everything in one post. This is me and I’m ashamed of how I look, so much that’s it’s influencing my lifestyle. I’m planning to have a chin implant, but I’d also like a rhinoplasty for my big tip, bump, low columella and large, uneven nostrils. I have ptosis on my right eye. What surgeries would I need to have and will it be possible? Thank you

A:  Dr. A

983461-1805610Just looking at your photos, I would say that you are an excellent candidate for a chin implant.  However, it might be worth your time to talk to an oral surgeon about your entire jaw positioning just to be sure you wouldn’t be better served by having your entire jaw moved (orthognathic surgery).  This would address any issues with your bite and jaw joints as well as change your appearance.  The general rule is that your chin should come out about as far as your lower lip in profile, but I rarely stick to this rule, you need to look at the individual.  The chin implant goes at the bottom of edge of the jaw bone and projects just the bottom half inch further forward.  The key is not using too big of an implant because the space between your lip and the top of the implant does not get pushed forward, and it can look oddly deep.  In your case, I would suggest moving your chin about half the distance from where it is now to a line dropped from your lower lip.  You can actually be awake for that surgery and the doctor can demonstrate sample implants in you during surgery before the final implant is placed.

983461-1805609Your nose clearly has a hump and it is unusually far down your nose.  I don’t see natural humps in this location very often.  Perhaps you had some trauma?  Either way, it would be an improvement to smooth that area.  You also have what sometime is called a tension upper lip or tension tip.  This is how your upper lip slopes out as you move up towards your nose.  Without an exam, I am not exactly sure what the cause is in you, but it usually is correctable.  Flattening this area and adding a chin implant will help to break up that line of backward slope that starts at the base of your nose and goes down to your chin.

It is hard to evaluate your eyes in these photos.  There is a lot of shadow and I can’t clearly see the measurements between your pupil and eyelid position.  I see some signs of an overall asymmetry in your eye position between the left and right which may be giving the illusion of ptosis.  It is just hard to say looking at these photos only.  If it is ptosis and is relatively mild, usually a small procedure that is done from the underside of the eyelid can correct it.  If it is an overall skeletal asymmetry of your face, it is probably best left alone.