Rhinoplasty - I want a smaller nose. Why do rhinoplasty surgeons suggest only minor changes?

As my colleagues have mentioned, there are many reasons why someone's nose cannot or should not be made as small as they'd want. Skin thickness and cartilage strength are two of the primary structural reasons that may limit the amount of change possible. Aesthetic considerations--how the nose would look in proportion of the rest of the face--are other considerations.

Here's a helpful tip, I think: consider a rhinoplasty consultation as if you're commissioning a piece of sculpture. By that I mean take a critical look at the surgeon's before and after photos and ask yourself these questions:

• Do the surgeon's results all have the same "look?" Rhinoplasty should be customized to the individual. If they all have the same cookie-cutter look, stay away.
• Does the surgeon's aesthetic sense agree with yours? Each surgeon has his or her own style, to some degree.
• Does the surgeon tend to make consistently major changes to patients' noses? Consistently minor changes? Or does that surgeon's results span the gamut. Ideally, the surgeon should be able to make both major and minor changes depending on what's required or possible. (If they're all too conservative a change, maybe the limitation is the surgeon, not the patient).
• And remember, much like a piece of sculpture, once carved you can't get the original piece of marble back. So consider your choices carefully and listen to the surgeon.

In rhinoplasty shape matters more than size.

Experienced rhinoplasty surgeons may promise you a more subtle change in size for a number of reasons:

• You may have thick skin which will limit the degree of size reduction as it will not conform to a smaller size framework
• You may have weak cartilages that cannot be further reduced in size without causing collapse of the nose
• You may have internal nasal problems such as septal deviation and nasal valve collapse which would put you at more risk for nasal obstruction if the nose is significantly reduced in size

First of all, there's certainly nothing wrong with a second opinion, as it's always important to find a surgeon that you are comfortable with.

When it comes to rhinoplasty, smaller does not necessarily equal better. The key is to balance not only the aesthetic units of the nose with each other but also the nose to the face as a whole. With this in mind, just making the nose smaller or shorter may take away from the overall shape of the nose and its relationship to the face.

The bottom line is to relay your thoughts to your surgeon, listen to his or her recommendations, and then consider proceeding with the procedure only when you're comfortable with the plan.

Best of Luck!

Dr. S

It is very often the case that patients dislike their noses more than they should and percieve problems with them that are really very minimal.  They will frequently say "I've always hated my nose!"  In these cases, the surgeon should be very honest and try to redirect the expectations of these patients to accept a conservative and natural change in their nose.  

Certainly, you should seek multiple opinions but if other well-qualified doctors are telling you the same thing, please listen.  If you see enough doctors you will eventually meet one who will tell you that you can have whatever you want...you will likely be unhappy with the results this surgeon gives you. 

Plastic surgeons often discuss with their patients maintaining their “facial harmony” when exploring various rhinoplasty options. By this, it’s important to consider maintaining the overall symmetry and proportion of your nose with the rest of your facial characteristics. It is my opinion that putting a nose back into such a harmonious relationship with the rest of the face is often more attractive than creating a “new” nose.

There are anatomic restrictions that should be respected when your surgeon performs your reductive rhinoplasty. Our experience in rhinoplasty has taught us that preserving those structures which are important toward maintaining long-term fundamental support shouldn’t be taken for granted – “do what is necessary, and nothing more.”

In summary – sometimes a little change lends a better result than a drastic change.

A thorough evaluation of your nose will place the size and shape of the nose in the context of the other features of your face. It may be that your nose does 'fit' your face, but that your attention is directed only to your nose.

I would suggest asking your plastic surgeon to comment on the size and shape of your nose as it relates to your face as a whole. Your hair style, makeup application and seasonal skin coloration may also affect your perception of the size of your nose. These issues are important to sort out before consenting a rhinoplasty.

Yours,
Scott Sattler MD FACS