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What you need to know about the nose: A guide to surgical rhinoplasty


You have lived with it your entire life, you see it every time you look in the mirror and now you have finally reached the point of doing something about it, so what do you need to know about the nose? Surgical rhinoplasty is one of many options available within the realm of plastic surgery that can completely renovate your face and impact your overall beauty. Your nose is the focal point of your face; it helps define the midline and create beautiful symmetry. Some people are born with the perfect nose and some people live with an imperfect nose. Others seek ways to improve their appearance and self-confidence, so they turn to surgical interventions to shape their face into the one they want.

It is important to remember you are not alone in your desire to change the size, shape, or symmetry of your nose. Surgical rhinoplasty is ranked the third most sought after cosmetic surgical procedure only surpassed by liposuction and breast augmentation. Your nose is the central focal point of your face, minor imperfections can have detrimental effects on your overall appearance. Fortunately, this means that small changes to the nose can have tremendous effects. Rhinoplasty is an art of millimeters. The fulcrum between a positive or negative outcome is experience.

There are several steps that are involved in the process of rhinoplasty. First, you need to determine exactly what you want to change about your nose. Second, you need to educate yourself on what types of rhinoplasty procedures are performed and what to expect throughout the process. Lastly, you need to seek expert consultation from a qualified plastic surgeon.

Determine what you want

More than likely if you are reading this you have already been thinking about what you want. Now is the time to grab a pen, paper and mirror so that you can examine your nose and write down exactly what you want to change. A few examples of ways the nose can be altered are outlined below; this list is not all inclusive but should give a general of idea of what is possible.

  • Altering or reshaping the nasal bridge (removing the bump)
  • Reducing the overall width of the nose
  • Correcting the overall shape of the nose (enlarging or reducing)
  • Reshaping the nasal tip
  • Reducing the size of the nostrils
  • Correcting the angle between the nose and the lip

Sometimes it is hard to express in words what you want, so I encourage you to go through magazines or scour the Internet for pictures of what your ideal nose would be. This is an important step and will help to convey to your plastic surgeon exactly what you desire.

Educate yourself

The Internet can be your friend, but it can also be your enemy. When undertaking such an important decision, it is crucial to do your homework and know when to seek expert consultation from your plastic surgeon. There are various ways that rhinoplasty is performed with the two most common being open rhinoplasty and closed rhinoplasty. Your plastic surgeon will evaluate your nose, your desires and will discuss which technique is most appropriate for your goals.

Open rhinoplasty consists of making a small incision in the middle of the columella (the column like structure underneath the tip of your nose that separates your nostrils). This technique allows for visualization of the internal nasal structure. Due to this open approach, the patient's own tissue, grafts and sutures can be expertly placed to correct the problem. Thus, resulting in a nose that looks more natural and will mature naturally with the patient. In a procedure where a 1-millimeter difference could have a profound impact, having the ability to see the entire nasal structure results in improved outcomes.

Closed rhinoplasty, also known as the blind approach, makes it difficult for your surgeon to see what the exact problem is with your nose and more work is done to camouflage the issue than is done to correct the problem. Because this surgical approach is done blindly, a higher revision rate accompanies this approach. Which procedural approach is better is an ongoing debate amongst the world's leading plastic surgeons. Ultimately, it is up to you and your plastic surgeon to decide which approach will give you the greatest benefit.

Rhinoplasty revision is not uncommon and you should discuss with your plastic surgeon their personal revision rate as well as how many corrective revisions they do from other surgeons' work. Even with the best plastic surgeon sometimes revisions are necessary 12 to 18 months post initial surgery to correct the way scar tissue formed during the healing process. Each surgical approach has its set of advantages, disadvantages, preoperative and postoperative care. Ultimately a consultation with a plastic surgeon will help to fill in the blank on which surgical procedure is the correct approach to achieve the results that you want.

Seek expert consultation

Not all physicians are created equally: this is an essential consideration when looking for a plastic surgeon. How do you choose a plastic surgeon? With a multitude of medical practices throughout the country you can immediately narrow your search down to physicians who are certified by the American Board of Plastic Surgery (ABPS). Since 1937 the ABPS has certified 9,077 plastic surgeons with approximately 6,600 currently practicing. The mission of the ABPS is "to promote safe, ethical, efficacious plastic surgery to the public by maintaining high standards for the education, examination, certification and maintenance of certification of plastic surgeons as specialists and sub-specialists."

Do you want an occasional plastic surgeon or someone who has gone the extra mile to attain and maintain credentialing? The ABPS has a rigorous qualification, examination and re-certification process that ensures your plastic surgeon is qualified and an expert in their field.

After reviewing qualifications, look for a plastic surgeon that either specializes in rhinoplasty or one who regularly performs rhinoplasty. There is a significant difference in the expertise of someone who performs 9 versus 90 rhinoplasties annually. Your plastic surgeon should be upfront and honest with what their specialty is and what their experience is within that specialty. I would recommend 2-3 consultations before making your final decision. This is an interview process and you are evaluating plastic surgeons that are going to suit your needs. Always remember you are the boss.

Deciding to undergo surgery to alter your appearance is a big decision and should not be taken lightly. As an educated consumer, you must do your part to determine what you want, do your homework and seek expert consultation. By following the above steps, you can rest assured that you are making a well-informed decision.

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