Rhinoplasty: What a good one entails


Rhinoplasty is the surgical procedure that is designed to improve the external appearance as well as the function of the nose. The nose is arguably one of the most prominent features of the face. As such, any imbalance between the nose and the rest of the facial features will immediately be noticeable and could potentially be disfiguring. Whether lengthening, shortening, narrowing or refining a nose, this challenging procedure is intended to restore balance. As the nose is one of the most important parts of our respiratory system, one commonly overlooked but important facet of rhinoplasty is restoration of proper airflow. Internal corrections made to the nose not only improve breathing but also improve deviations of the outside of the nose. The cosmetic goal of the rhinoplasty operation is to give patients natural results that DO NOT draw attention to the nose but another defining feature of the face such as the eyes.

One of the most basic goals of the rhinoplasty operation is to restore balance between the face and the nose. In order to achieve that “aesthetic normal”, facial plastic surgeons use rough guidelines that allow us to plan procedures and set goals. We roughly divided the face into (3) vertical thirds and (5) horizontal fifths. The nose should fall within the middle third in terms of vertical length and within the central fifth in terms of horizontal width. There are of course other more refined and subtle mathematical formulas to determine nasal dimensions but those are beyond the scope of this article. Keeping in mind that these cannons or guidelines are not absolutely critical in giving patients excellent results allows us to understand that the operation itself is about giving patients significant aesthetic improvement more than mathematical precision. In doing this, we enhance beauty. Notice in my before and after examples how lengthening the nose improves facial harmony.

As important to improving the cosmetic appearance of the nose during rhinoplasty is improving the breathing function of the nose. Many times, either through birth or trauma, the structure that divides the nasal cavity into two sides (the septum) can become deviated and obstruct the flow of air through one or both sides of the nose. On other occasions, the structures that line the walls of the nasal cavity (the turbinates) can become enlarged and also obstruct the flow of air through the nose. These problems are usually addressed during the rhinoplasty operation and result in improved breathing. Many times, as in the case below, the deviation of the septum can cause the tip of the nose to tilt to one side of the face.

Natural results are extremely important not only in achieving high satisfaction from the patient but in making the nose look as if the patient was born with it thus hiding the operation in plain sight. As a facial plastic surgeon, I strive to never “give away” the fact that my patients have had any cosmetic surgery. This is a very challenging part of my practice that ads to the demands of the specialty but also one that has always attracted me to the specialty. There are always very visible examples of celebrities or prominent people who have had unnatural results from their procedures. I use these examples as cautionary tales of what patients should not look for in facial cosmetic procedures. I prefer for my rhinoplasty patients to hear comments like “you look rested” or “ your eyes look beautiful”. "After" photos will often illustrate how refinement of the bridge and tip of the nose allows the eyes to appear larger and the face to have more harmony.

Article by
Jacksonville Facial Plastic Surgeon