Rhinoplasty - Nose Surgery



Ninety percent of the rhinoplasties performed are to reduce the volume and define the shape of those underlying structures. In a closed rhinoplasty all the incisions are done inside the nostrils. An open rhinoplasty with an external incision through the columella is usually done for more difficult cases such as a revision rhinoplasty, a nose with asymmetries, or a long nose where the tip needs to be elevated (rotated).  You may be tempted to bring magazine pictures to your consultation. But keep in mind that most surgeons inwardly grimace when they see those clippings. That's because no surgeon can give you someone else's nose. But it is possible to refine the nose you do have. The appearance of the nose is always a relection of proportions, as well. The proportions of the rest of the face (projection of chin, prominence of cheekbones, spacing of eyes, length of the upper third, middle third, and lower third of the face, etc.) greatly affect the perception of the nose. This concept is often referred to as "facial harmony." So when you whip out that perfect looking model's face, remember it's not your face. Only video imaging can give you a true picture of your surgical options. The goal of a good rhinoplasty is to bring your nose into harmony with your face - not someone else's face. That's why pulling out pictures of other people's noses doesn't work. Within each ethnic population are different norms or standards of beauty, in part because facial structures differ between races. The best rhinoplasty is the one that looks like you were born that way. What you want to avoid is the "I bought my nose" look. A narrow, skeletonized tip or bulbous lower third or reattached nostrils are all dead giveaways. Even more importantly, you don't want to sacrifice function. Inability to breathe through the nose after cosmetic rhinoplasty is usually the result of too narrow a tip - photogenic but not operational. The extensive removal of tip cartilage causes the nostrils to collapse on inspiration. An example of this is the once popular Goldman tip. Perhaps the number one concern is turning out like Michael Jackson. Successive surgeries have removed too much cartilaginous structure. Jackson's desire for an infantile, caucasian nose, and the surgeon(s) who agreed to repeatedly attempt it, were unrealistic. Have you ever remodeled a house and considered taking out a wall? There are certain partitions which are called load-bearing walls. Take one out and the whole house may collapse. In a way, this is what has happened to Michael Jackson: his nasal house is falling down. Successful rhinoplasty depends on realistic goals. Beware the inexpensive nose. Rhinoplastic surgical expertise evolves over time and benefits from experience. An inexpensive rhinoplasty can bring a fate worse than your original nose, and be much more difficult to correct. If you want to find the best, choose the surgeon who performs the most revision rhinoplasties on other colleagues' patients. Correcting someone else's mistakes takes far more skill and expertise than operating on a non-traumatized nose. A surgeon experienced in revision (secondary) rhinoplasty is much more likely to provide a superior primary rhinoplasty.


Article by
Minneapolis Facial Plastic Surgeon