Why is rhinoplasty difficult?

Rhinoplasty is certainly the most challenging surgery plastic surgeons perform. There are many reasons. The nose is a complex structure of skin cartilage and bone. It is three dimensional. It is unforgiving and any problems are easily visible and hard to hide. Training in rhinoplasty varies tremendously so some plastic surgeons starting out in practice have had more extensive experience than others. And it’s an operation that can take years to knock the bugs out of. As a result many plastic surgeons don’t really promote that strongly as a part of their practice and prefer to do less risky things. There are surgeons that do fifty noses or more a year and those who do only a few or none. Fortunately you can readily determine who does many good noses by looking on their websites. It’s a smart way to narrow down the field of surgeons to consult with.

Rhinoplasty is one of the most challenging operative
procedures
we do in plastic surgery. Careful attention must be taken when working with noses.
As an art, it is a matter of millimeters and experience with little to no
margin for error.
When it comes to your nose, it’s essential to try to get it right the first
time. You need a
true expert to do your Rhinoplasty. An expert is one who is Experienced and performs this
operation frequently at least 2-3 times a week, has Expertise and has written and teaches
others about the rhinoplasty, and one who can show you Excellent results.

Rhinoplasty involves shaping multiple layers of a three dimensional structure. We shape or reduce or augment bone, cartilage and soft tissue. Further, the skin can occasionally compromise the result during the healing process. We're also trying to reduce and shape your nose without compromise the structure that allows you to breathe. The bottom line is that there are many moving pieces of the rhinoplasty puzzle and they need to be put together perfectly and they need to heal in a predictable fashion. Experience is critical to ensure the best possible outcome. I hope this information is helpful for you.Stephen Weber MD, FACSDenver Facial Plastic Surgeon

The quick answer is that rhinoplasty surgery is not cookie-cutter surgery where one size fits all. To perform rhinoplasty well, a plastic surgeon has to perform a proper assessment of the problem(s) at hand, make the correct decisions of what maneuvers must be performed, have the technical prowess to execute said plan and be able to address any curveballs in the healing process. The nose is a three-dimensional structure that can change over time, sometimes healing in unexpected ways. Furthermore, issues such as nasal breathing and patient satisfaction are very subjective and may not be optimal, even after a successful surgery from the surgeon's perspective.

 Rhinoplasty is a very unique operation that requires not only surgical skill and experience, but artistry and the ability be able to think in a three-dimensional approach. There 2 nasal bones, 4 cartilages, the septum and the skin lining on the inside and the outside of the nose and they're all factors in the healing process. In addition, different skin types contract and heal differently over the cartilaginous framework of the nose. The contraction forces of healing can also distort the nose months later from when the procedure was finished at the end of the surgery. In addition, thin skin allows minor little irregularities to show through, while thick skin thickens even more so, and blunts the effect of the surgery. Since the nose is a three-dimensional structure, it must look good in all dimensions, and it must breathe appropriately. Experience performing rhinoplasty  is of the utmost importance, so choose a rhinoplasty surgeon based on that premise

Thank you for your question. Rhinoplasty is a very
technical and precise procedure that requires a certain degree of modeling artistry. To be
able to perform a rhinoplasty with precision a plastic surgeon must have an
extensive knowledge of the nasal anatomy, expert technical ability, a vision
for the final outcome that will harmonize with the patient’s overall appearance,
and a passion for the procedure. I
recommend that you make an appointment with a board certified plastic surgeon
in your area to discuss your goals.

Rhinoplasty is a very difficult operation. I think it’s widely acknowledged that rhinoplasty is the most difficult of the facial plastic surgery procedures. The nose is very complicated. It’s not like a piece of marble that can be carved, it’s a three-dimensional jigsaw with multiple pieces, all of which have difficult shapes, face in different directions and have joins with all other bits of the nose. If you change one bit of the nose in a way that you wanted to change it might twist another bit of the nose, so we’re sometimes borrowing from Peter to pay Paul. The skin has to change, the lining has to change, there is a limit to how elastic the structures are and that’s why rhinoplasty is really difficult.

Because every nose is different. A proper sense of aesthetics, technical expertise and judgment are important. There is no book to tell you, on this nose, how much dorsum , lateral crus or caudal septum has to be removed, and from which part, to get the best results. Then there are grafts to internal valve, tip and radix. Grafts can be unpredictable due to  the paucity of donor cartilage from the septum and the  quality of this cartilage.You change one part of the nose and it affect another part.The surgeon had to know how to deal with the very thick-skinned, shapeless tip and the tip with paper thin skin.Its an endless variety of choices one has to make to get the best outcome.

Rhinoplasty surgery is difficult in all stages from planning through performance of the operation to managing the slow recovery. Whilst most prospective rhinoplasty patients have a general idea of how they want their nose altered (smaller, straighter, more petite etc) few have a precise idea of what is needed and the initial consultation requires time and patience. Changes in the shape of the nose can have a profound effect on the balance of the other facial features so planning must be taken carefully in that context. Digital imaging helps a lot with that discussion and at least two visits are needed to finalise a plan.Once a plan has been agreed upon it needs to be executed with precision. The nose is a hollow structure with mobile soft tissues overlying thin flexible rubbery cartilage and small fragile bones. Unlike a piece of solid marble it cannot just be sculpted down to the desired shape but rather is disassembled, trimmed or augmented(often both!) repositioned and then rebuilt all the while preserving its important functions of airflow and sense of smell in a manner stable enough to resist the potential of distortion by scar. All of this needs to be done with great accuracy as each millimeter counts.After going through all this the result is not instant so patience is needed over many months as the initially swollen, numb stiff nose gradually settles to its final shape. Even this is not the end of the matter as an operated nose may not age the same way as an unoperated one.All operations are a journey not just an event and rhinoplasty is trickier than most. It's also a journey you choose to take rather than being absolutely necessary so choose carefully

Hi, I have performed and taught Rhinoplasty, to surgeons in training, for many years.  It is true that Rhinoplasty remains one of the most challenging plastic & cosmetic surgery procedures.  Here is a list of the reasons why.Complex nasal anatomy.Unpredictable post Rhinoplasty healing which leads to excess scar tissue and reduced aesthetic results.Complex aesthetic relationship between portions of the nose (bridge, tip, nostrils) with one another.Complex aesthetic relationship between the nose and other facial features.Misconception on the ability of a "better looking nose", in and of itself, to make the face more attractive.All of the above highlights why one seeking Rhinoplasty needs to find a Rhinoplasty Surgeon with the proper aesthetic judgment, significant experience and the right training.  Hope this helps.