How to get the most Natural-Looking Rhinopalsty Results
Article by Behrooz Torkian, MD
Beverly Hills Facial Plastic Surgeon
“Doctor, I like everything about my nose except the tip, can you just cut off this part right here?” said Mrs J. as she pointed to the tip.
"Lets just see what the problem is Mrs. J” I said as I examined her nasal anatomy up close. “There may be something I can do about your tip, but Mrs. J. I cannot just cut it off!”
As a rhinoplasty specialist I have heard several requests for changes only in the tip of the nose, but it was the first time anyone had asked me to “cut it off”. In recent years, both rhinoplasty surgeons and the general public have developed a sophisticated taste for results of rhinoplasty (nose job) surgery. Gone are the days of “smaller”noses, “cute” noses, and “dainty” noses. The most common request in my practice is to have the most natural looking nose possible – “I want it cute, and natural”. But what defines “natural” in a rhinoplasty result? What makes one person’s nose look obviously altered by surgical manipulation and another’s elegant, refined, and more balance with his or her facial features?
Historically, the Egyptians, and Greeks, followed by Rennaisance artists such as Michelangelo, and Da Vinci, have studied countless faces, and preformed countless cadaver dissections to derive the anatomic features most pleasing the human eye. In recent times, several of my colleagues have attempted to answer this very question. For example, Drs. David Pearson, and Peter Adamson of Toronto, Canada published such a study in the Archives of Facial Plastic Surgery in 2004, exploring what type of nasal profile the general public considers most aesthetically pleasing.
The study presented digitally enhanced photographs of Caucasian female volunteers in profile view (from the side) with their bridge, and tip depicted in five different variations. The bridge was depicted as convex (with a hump), flat, or concave (with a scoop, or slope). The tip variations were depicted as tips that were overprojected (too far forward) to underprojected (too close to the face), and overrotated (pointing up) to ptotic (pointing down). The features that the survey returned were combined in order to draw the most beautiful nose as determined by the study’s participants. The results of studies such as this are not surprising.
—A flat to slightly concave bridge, a subtle break or transition between tip and bridge, and a tip angled slightly above the horizontal.—
As someone who doesn’t let a nose pass by without formulating a complete analysis and surgical plan, I can tell you that achieving a “natural and beautiful” nasal appearance after surgery is not as easy as studies like these would suggest. This is why there are specialists, and so called “dabblers” in rhinoplasty surgery. If you have been considering rhinoplasty, here are some tips and facts you should know to help you get your ideal result.
Have your own plan.
At the beginning of every consultation, I ask my patients some relevant medical history, then, I ask the patient “what would you do if you were me?” Simply put, what do you think is required to give you a result with which you would be happy?
For some, a simple “shaving” or reduction of a hump on the bridge is enough, for others, a narrower tip, less visible nostril skin from the side view, so on and so forth. In some cases, when the patient does not have a clear view of what they would change in their own, I would recommend using morphing software to digitally enhance and change features of the nose to facilitate discussions of the detailed changes they may and may not experience after rhinoplasty.
In this digital age, photos are easily obtained, and reviewing them is extremely helpful in the consultation with your doctor. In fact, some patients notice new things they don’t like about their nose during this part of the consultation. Whatever it is that you don’t like about your nose – the consultation with your potential surgeon is the time to put it on the table. At this time you should hear a few confirming comments from your surgeon and a plan for how to execute the surgery to fit your needs.
Know what you like.
When it comes time to look at the doctors before and after pictures, some offices have a patient coordinator, or consultant review the pictures with you, while some doctors prefer to review the pictures themselves. Regardless of how it is done, you must see a fair number of before and after pictures from each doctor with whom you consult. If the results you see are not to your liking, don’t have your surgery done there -- plain and simple.
Although most rhinoplasty surgeons have a fair knowledge of the aesthetic ideals and know the measurements that comprise this ideal, each persons ideal that they consider beautiful is different. The old cliché “beauty is in the eye of the beholder” holds true in regards to surgical results. If there are any doubts in your mind that your bridge might be too scooped for your liking, or your tip may be to forward, etc., then continue shopping – you owe this much to yourself!
Selecting your Doctor.
The American Board of Medical Specialties, who overlooks all specialty boards, considers diplomates of two specialty boards qualified and capable of performing plastic surgery on the face and nose. These are the American Board of Otolaryngology – Head and Neck Surgery, and the American Board of Plastic and Reconstructive Surgery. Some diplomates of the former are also certified by the American Board of Facial Plastic and Reconstructive Surgery indicating that they have completed a special examination and review process for competency in Facial Plastic and Reconstructive Surgery.
Despite specialty training, board certification, and membership to professional societies, the real abilities of surgeons are generally determined by many other factors. One factor you should include in your decision is the doctors overall experience with the nose. Patients have repeatedly asked my staff “how many has he done overall, this year, this month, and this week.” Of course, there are no magic numbers that can be used as a measure for experience, but you wouldn’t want to have surgery in a practice whose specialty is tummy tucks.
In general, for elective procedures, I recommend that patients find a good personality fit for them. You should be comfortable with your doctor, and he or she should be comfortable with you. There should be no embarrassment, or hesitation for you to discuss problems with your surgeon. He or she is committed to your best interest, and to getting you the best possible outcome. This requires good communication, and overall personal comfort in the doctor-patient relationship.
Know your anatomy.
Prior to consultation with your surgeons, you should have a good knowledge of your nose. Just as you should know what you would do if you were operating on your own nose, you should know if you have had fractures, breathing problems, or possible allergies. One of my standard questions during a consultation is “Which side is harder to breathe through?”. It may be your right side, your left side, or even switch sides. You may not have breathing problems at all.
Because of the anatomy of the nose, its form and function are very closely related. Any change in the appearance of the nose may translate into a change in its function. If you are undergoing elective surgery to improve the appearance of your nose, you deserve your surgeon’s careful consideration of your nasal airway and nasal passages during your surgery. After all, what good is it beautiful nose if you cannot breathe through it?
Know the risks.
As with any other surgery, there are some potential risks associated with rhinoplasty. General risks include bleeding, infection, scarring, and blood clots under the skin. These and other specific risks should be carefully reviewed prior to rhinoplasty surgery. Not to scare you, but to inform you of things you should bring to your doctor’s attention in the postoperative period. These may also help you decide if the changes you are requesting are worth taking the risk to improve. Your surgeon should also honestly discuss the risk-benefit balance of your specific desired outcome during your consultation.
Recovering from rhinoplasty is generally not painful, but can certainly be uncomfortable due to nasal congestion within the first few weeks. Bruises generally resolve within a week, and then there is the swelling. Swelling can mask the true result of your nasal surgery for months. It is generally thought that about eighty percent of your swelling resolves in the first six weeks, and the remaining twenty percent within one year from your surgery. Depending on how you heal, and the thickness of your skin, you should see a nearly complete result by six months from surgery.
Taking the plunge into a surgery that will change the central feature of your face can be relatively stressful, but rhinoplasty is among the most common elective surgeries preformed today. The key things to remember in choosing the right surgeon for you will also help you to feel more comfortable trusting your face to your doctor. Also remember to keep your goals subtle. Dramatic changes can lead to increased risk of an operated appearance, and a nose that is unbalanced with the rest of your face. Train yourself to use the “–er” words like “smaller”, “cuter”, “flatter”, “straighter”, and you will be happier in the end.