Revision Rhinoplasty:  What Are My Standards of Naturalness

I had a lady who came to me wanting to perform facial enhancement and I asked if she had any previous surgeries.  She said, “No.”  I asked her, “How about your rhinoplasty?”  She was startled that I could tell.  I reassured her that probably most people could not tell but that since I did a lot of rhinoplasties I was able to detect signs of unnaturalness that others could not.

In general, I do not push many people who come to me for other reasons to undergo revision rhinoplasty because it is a delicate subject and an arduous surgery fraught with risk for a “perfect” outcome.  Scars underneath can lead to problems in which the result is not perfectly how one would imagine it.  Nevertheless, at times revision rhinoplasty is warranted when the nose looks fake or perhaps does not function well as manifested by nasal airway obstruction.

Although there are many things that bother patients about their nose, I would like to list a few of the major things that I think make a nose fake looking in my eyes:

  1. The bridge has a overly scooped nose.  I like the saying that “God did not make scooped noses only man has.”  Noses should have a straight or humped bridged.  Rarely if ever do they have a concave shape.
  2. An inverted V-deformity.  The nose bones are short and collapse inward creating an inverted V-shape on the bridge.
  3. The “uni-tip”.  An overly tightened tip with a traditional “dome-binding suture” can lead to this weird deformity.  I use only “double dome-binding sutures” to narrow a broad tip so that the natural splay on the bottom edge of the tip is still present.
  4. Notched ala.  The nostril rims that are notched upwards are another telltale sign.  A natural nostril should curve in a gentle concave upside U shape and never in a notched V shape.
  5. Pinched nostrils.  When the nostril shape has been cut down so that the nasal sill (the part of the nostril that sits on the upper lip like a window sill) is violated or absent the nose looks fake.  This is the old Janet or Michael Jackson nose.  Using what is known as a “Sheen flap” in which the curve of the nose is maintained, this can be easily avoided.

Although the list of other fake travesties that beset bad rhinoplasty results can go on for pages, I decided to list the top offenders that oftentimes mandate a corrective rhinoplasty procedure to achieve a more natural-looking result.

Sam M. Lam, MD, FACS is a board certified plastic surgeon in Dallas, Texas. To schedule a consultation please call 972.312.8188. To Learn more about Dr Lams’ rhinoplasty procedures visit or to ask Dr Lam a question please visit his rhinoplasty forums.