Nose (Rhinoplasty)

The term rhinoplasty is derived from a combination of the Greek word rhino, meaning nose, and plasty, meaning to shape or form. The rhinoplasty procedure reshapes the outward appearance of the nose and is one of the most common cosmetic procedures.

The appearance of the nose is largely consequent to the underlying bone and cartilage over which the skin is draped. The structure of the lower part of the nose is derived by two pairs of cartilages supporting the nostrils which in turn are supported by the septum, the partition separating the right and left sides of the air passage. The upper part of the nose is determined by the size and shape of the nasal bones. The huge variation in all of these structures is reflected in the vast differences you see in peoples’ noses. In all cases, a rhinoplasty procedure is where the underlying cartilage and bone is surgically sculpted to achieve the desired shape and appearance.

As the nose sits in the middle of the face and largely defines one’s profile, its appearance greatly affects the attractiveness of the face. Any nose that is disproportionately large, crooked, or has two wide a tip or a large hump, usually detracts from an otherwise attractive face. Restoring the size and shape of the nose into harmony with the rest of the face can make a huge improvement in the overall beauty of the face.

The art of rhinoplasty combines a surgeon’s technical skills with their judgment of both what is surgically feasible, and what changes will best harmonize with the rest of the face. The most important issue in preoperative evaluation is to know exactly what specific things bother patients about their nose. Only then do I evaluate the underlying cartilage and bone structures to determine what is technically achievable from a surgical standpoint. Considerations include ideal nasal tip position, length of the nose, how much to narrow the tip and upper nose, how much to reduce any hump, and the shape and angle the nasal profile forms with the lips.

Considerable judgment and expertise is required to achieve the ideal balance for each face. As examples, the ideal male nose is straight and has an upturned angle of 90 to 95 degrees with the upper lip. Women look more feminine with a slightly more upturned nose. Shorter women often look better with a little more upturn than taller women, who look best with straighter noses, upturned somewhere between men and shorter women. The size and shape of the nostrils as well as skin thickness must also be considered. As thicker skin does not drape as well, more sharply defined changes in the underlying cartilage is required for visible definition in these patients. Understanding the subtle changes that always occur in the healing process is also very important.

The procedure is done under either IV sedation or general anesthesia as an outpatient. Most patient’s have mild pain for a few days and primarily complain of a stuffy nose for the first week. Packing is rarely required and patients return in one week for removal of a small cast placed on the outside of the nose at the time of surgery. Any bruising is usually gone after one week when normal activity and work can be resumed. While the nose usually looks pretty normal after one week, further improvement occurs over the next few months as skin swelling resolves.

Insurance will not pay for a rhinoplasty unless the nose has been broken, but usually will cover surgery for a deviated septum when it obstructs breathing. As a deviated septum can affect the result of rhinoplasty, it is important that this be assessed preoperatively. More often than not, septal surgery is performed along with rhinoplasty.

As there are limitations to how much a nose can be changed, it is important that each patient understand exactly how much their surgeon can realistically achieve for them.
 

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