Do Surgeons Always Impose Their Idea of an "Ideal Nose"?

When performing a rhinoplasty, do surgeons place more emphasis on what the patient wants or what is considered an aesthetically ideal nose? I ask because I had Rhinoplasty in which my nose was overshortened, despite my imploring to my surgeon not to shorten my nose. I then went on a consultation and the other surgeon disagreed with my desire to restore my nose to its original length, saying that doing so would create a nose that doesn't conform to agreed-upon aesthetic standards. This is frustrating; I want a nose that fits my face and is pleasing to me. Thoughts?

Doctor Answers 6

Tough question--you both are right

You are asking a tough question. Yes, you should get the nose you want, but you are also paying for the skills of the surgeon, who has studied what proportions of the nose are aesthetically pleasing.

For example, sometimes a person complains that their nose is too long, and they want it shortened. Once they are examined, however, the nose has perfect proportions, and they actually have a small chin . It would be a mistake to shorten that nose, when a chin implant would make the nose appear smaller!

Another example is a patient who does not want to remove a dorsal bump. I have had two patients ask that the bump not be taken down--they just want the tip fixed and like the strong dorsum. It would be wrong for me to remove the bump, even thought I think it would look better without it.

The answer to your question lies somewhere in between those two scenarios. Yes, the doctor should always listen to the desires of the patient, and also offer his or her opinion of what looks the best aesthetically. The bottom line, though, is you are paying the money and should get what you want.

Baltimore Facial Plastic Surgeon
5.0 out of 5 stars 40 reviews

Nose should compliment and be in balance with other facial features.

Most surgeons like to give the nose that makes the patients happy. It is important to discuss your goals and expectations prior to undergoing any elective cosmetic surgery. We put a high emphasis on making improvements on the nose that the patient desires as long as it is within reason. We strive to give patients a cosmetically acceptable and natural looking nose that is balanced with their face.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 145 reviews

Listening to the patient is the most important thing a doctor can do

I would definitely say that the most important thing a surgeon can do is to listen to the patient that he is treating. If you think your nose is too short, IT IS. Period. You're the person who has to live with your nose and you should be happy with it. I completely believe that.

Yes, there are aesthetic standards out there. But, do you know that our current understanding of aesthetics is significantly flawed? We are still using Leonardo da Vinci's theories of facial aesthetics and this was thought of in the 1400's. During my training, I saw that some famous people were appearing quite odd from surgery to make them beautiful. I thought that if the most famous people who are going to the most famous plastic surgeons are getting results like that, something must be wrong with our thinking. I was right.

Leonardo da Vinci's theories have been proven incorrect recently by many researchers that have put his theories to the test. That's why I came up with a new theory called the Circles of Prominence to explain facial beauty a lot better. This theory took several years of developing before it culiminated into my current theory of Circles of Prominence.

Philip Young, MD
Bellevue Facial Plastic Surgeon
4.2 out of 5 stars 86 reviews

Getting the nose you want

While I do not think anyone should impose their ideals on you, it is difficult to always get what you want. This can be especially true in rhinoplasty. Rhinoplasty is part science, part engineering, and part art. For each individuals particular anatomy, there are certain changes that are anatomically and physiologically possible - and that dictates the science part of rhinoplasty. The art component is the image that the surgeon performing the procedure is hoping to attain. (There is a random chance variable of healing in there as well, which we all have to account for and deal with - which is why the revision rate in rhinoplasty ranges from 10 to 20 %--even in the best hands.) All that being said, when you see a surgeon for rhinoplasty, hopefully you will be on the same "wavelength" when discussing your goals. I think this is the most powerful aspect of digital imaging--while no surgeon can promise to achieve the results shown with imaging, the surgeon who is manipulating the image should be doing so with the understanding of his/her surgical / anatomic limitations and show a possible result that they have a good chance of delivering. If the patient agrees with the goals, then surgery can proceed. If the patient has different goals, which are within reason and achievable based on other constraints, then again surgery can proceed. If the goals of the patient are either unachievable by the surgeon, or are generally considered "unreasonable", then the surgeon should inform the patient, and other opinions can be sought.

At this stage, I would suggest you consult with a few more surgeons, discuss your goals with imaging, and hopefully you will find someone who can achieve the results you are seeking.

Michael A. Bogdan, MD, FACS
Dallas Plastic Surgeon
4.9 out of 5 stars 67 reviews

Rhinoplasty...Who Should Decide What the Ideal Nose Is?

Hi Secondary Rhino in DC,

The most important aspect of a nasal consultation is the agreement between surgeon and patient about what the goals of the surgery are, and what can realistically be expected. I know of rhinoplasty surgeons who impose there will and their "idea of the ideal nose" on the majority of their patients. If you visit their waiting rooms there is usually a group of patients who have the same nose, the "Dr. So and So" nose. When you meet with the surgeon, you will likely also bump into a huge ego that fills the consultation room.

If your desired end result for your rhinoplasty is within reason, then you should be able to find a skilled rhinoplasty surgeon who can accomplish this. On the other hand, surgeons do need to impose their expertise and not follow everything that a patient may request or there is danger of coming out looking like Michael Jackson.

Good luck and be well.

Dr. P

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 36 reviews

Defining ideal in Rhinoplasty

Beauty and the concept of ideal is subjective in nature. While aesthetic standards do exist and are helpful in guiding surgical planning, no one nose will fit everyone's face. I use various techniques in my rhinoplasty operations in order to have the ability to tailor my results to the patient's anatomy and desires. Some surgeons prefer using one primary technique, which may explain the answers you received.

The reason that I do imaging as part of my consultation process is to allow the patient a visual reference point for the changes I believe will benefit them the most. When patients prefer a different type of nose, imaging allows me to understand their goals and then determine whether the change is possible. it also allows me to modify my surgical planning to accomplish the desired goal. While imaging does not always correlate exactly with the final outcome, it always reflects the essence of the change that patients receive. I find that it works as a visual language, increasing patient satisfaction.

Sometimes, despite accurate examination, imaging, and technique, more rotation of the tip occurs than you plan. And, other times, less rotation of the tip is achieved. The same is true for narrowing and profile alignment. However, in my experience, results are typically close to the desired outcome. Minor touch up revisions are required in a minority of my cases to get the extra millimeter of change that the patient and I wanted.

I am not quite sure why an ideal standard would prevent a surgeon from providing you the change you are seeking, unless the desired effect is not physically possible. However, you should be able to achieve a reasonable approximation of the nose you want. I suggest another consultation with a doctor that primarily does Rhinoplasty operations.

Richard W. Westreich, MD
Manhattan Facial Plastic Surgeon
4.9 out of 5 stars 52 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.