Background: In rhinoplasty surgeries patients are seeking to reshape their nose by removing obvious disproportionate features. This could be a large dorsal hump, a wide nasal tip or flared nostrils to name a few. Their goal is to bring the nose into a standard shape and proportions which has been classically described and accepted. While there may be debates about minor adjustments to these ideal nose shapes they generally do not constitute major changes.
There are, however, a few specific nasal shapes that some females may request for their rhinoplasty surgery one of which is known as the Barbie nose. As the name indicates this relates to a small nose shape like that seen in the doll so named. This is a nose shape that is radically different from that of classical nasal standards which is why it is often referred to as an over reduced nose. A concave dorsal profile and a small upturned nasal tip generally means there has been significant removal of structural support to achieve that effect.
Not any female nose can achieve such a reduced nose and even in those that can it may not happen after the first rhinoplasty surgery…as the following patient illustrates.
Case Study: This female had a prior open rhinoplasty with nostril narrowing one year previous. What her nose looked like before and what was done during her initial rhinoplasty was unknown. Her goals with a secondary rhinoplasty was more of a Barbie nose shape. She had an adequately low dorsal line but her tip did not have enough upward rotation and was still too wide.
Reopening her nose showed the expected appearance of the nasal tip cartilages which was that a mass of scar without any distinction cartilage anatomy. But in all such cases you have to be patient and meticulously dissect out the lower alar cartilages and remove as much scar as possible. Thereafter the caudal septum was trimmed and the alar cartilages reshaped through various suture techniques for a shorter and more uplifted tip shape. Once the open rhinoplasty was closed nostril narrowing was performed.
The immediate intraoperative change was encouraging for a more Barbie like nose shape.
Most plastic surgeons would point out that the over reduced shape to get a Barbie nose violates nasal structural support principles risking middle vault collapse and nasal airway obstruction long term. And that concern is certainly not unfounded and one in which every patient should be so informed before surgery.
Key Points:
1) The Barbie nose is defined as a small nose with a significant upturned tip and with a concave dorsal profile.
2) Not every nose can achieve such a shape and is largely dependent on the thickness of the overlying nasal skin.
3) Secondary rhinoplasty can usually get closer to the Barbie nose shape than the first surgery.
Dr. Barry Eppley
World-Renowned Plastic Surgeon