This is a really great question! I'll do my best to answer it based on my opinion (different surgeons will likely feel differently). I think alot of the controversy arises in the balance of doing what the patient wants/desires vs concerns about the longevity of what some see as a "trend" in rhinoplasty. On one hand, my number one goal is to the patient and achieving their ideal nose. At the same time, I want to do whats right for the patient and sometimes that means trying to guide their decision based on my medical and surgical expertise. If you paint your wall a certain color because its trendy, you can easily repaint the wall in the future if you change your mind. A rhinoplasty is a lifelong decision and while it can be changed or corrected in the future, there is definitely risk associated with subsequent surgeries. I do feel like the "barbie nose" is at high risk of being a trend that may be out of style in the next 10 years. The second aspect is that there is certainly a spectrum of these "Barbie noses". Some are very subtle and actually balance well with the rest of their face. Unfortunately though, there are many that are overdone or performed on the wrong patient in term of their overall facial harmony and are likely to lead to issues down the road both aesthetically and functionally. At the end of the day, the most important decision for the patient is choosing the right surgeon with specialty training in rhinoplasty who has an understanding of these trends and can have a thorough discussion with each patient about their unique goals and desires. I hope this helps! Kyle Kimura, MD