A nose that a patient may feel that is too big for their face can be reduced in size. The nose is the focal point for the face and can throw the aesthetic balance off for appearance. Any changes to the nose should be considered in three dimensions with the end goal of improving the general facial balance as well at the shape of the nose.
When evaluating a large nose for potential correction, the height of the nose, length of the nose and width of the nose should be considered. All dimensions can be reduced in a rhinoplasty (nose job) but should be done incrementally and in a step wise fashion. The height of the nose can be decreased by filling bone and shaving cartilage on the dorsum or bridge of the nose (dorsal reduction) and the tip can be decreased in projection by a Lipsett procedure which overlaps the central tip cartilages. The length of the nose can be decreased with shortening the septal cartilage (caudal septal resection) and rotating the nasal tip cartilage up and back. Narrowing of the nose can be performed with cutting or breaking the bone inwards (osteotomy) while bringing the middle cartilages in with sutures (upper lateral cartilage refinement). The tip is narrowed through removing bowed cartilage (cephalic trim) and then suturing it together (domal sutures). Nostrils are typically narrowed when making the nose smaller through removing the outer lower nostril skin (alar base resections).
These steps to decreasing the size of the nose can be combined with airway improvements, like a septoplasty, and the nose should be structurally reinforced with cartilage grafts. On open rhinoplasty would be the ideal procedure to accomplish this, with a very limited to no role of a non-surgical approach with fillers.
An open rhinoplasty is done in the operating room with general anesthesia and does take approximately 3 hours. It is an outpatient procedure with initial recovery of 7 days and long term recovery of 6 months to one year.
