Each year more than two hundred thousand Americans decide to change the shape of their noses, and in the near future this number could double. The rhinoplasty or “nose job” is the most commonly done cosmetic procedure. While there is little risk for the patient, it demands a high degree of surgical skill for two very important reasons.
First, the nose is easily the most prominent feature on the human face. Regardless of which direction we are viewed from-above, below, head-on, or profile–it’s always the center of attention. So any change will affect the appearance of the entire face.
Second, the operative technique is extremely demanding, and it’s difficult to do well. Inside, the nose is supported by a delicate framework of small bones and resilient cartilage. Even a tiny miscalculation on the part of the surgeon can lead to unsatisfactory results.
In fact, some doctors never learn to do it properly, as evidenced by the unhappy patients whose noses have obviously been “done”. Some people think that they can recognize every nose job, but in reality, they can only tell the ones that are bad. With surgery it is certainly possible to create a beautiful and normal nose.
A top plastic surgeon must be able to do more than one kind of nose. He has to be proficient at changing a nose to fit the individual face. If you can look at someone and know which doctor did his nose, be wary of letting this doctor operate on you. A particular type of nose might be attractive on one face, but not necessarily on yours.
It takes a great deal of experience to effect good nose changes. Even a surgeon with extraordinary skill has to know what you want before he can comply, so be sure to discuss your expectations in the consultation.
Most doctors begin by handing the patient a mirror and requesting his or her view on what needs to be corrected. Many people are actually unaware of exactly what displeases them. Sometimes they want the impossible – a nose alteration that just cannot be done. But for the most part, any irregularity can be at least partially improved by surgery for the nose.
Of course, people are much more concerned with the “after” as opposed to the “before”. They want to see how the rhinoplasty operation will change their appearance, and there is an excellent way to show them.
Before any cosmetic surgery procedure, medical photographs are taken to provide a record of the preoperative appearance. The picture is then printed on a special kind of paper that can be written on. Prior to the plastic surgery, the doctor can draw over the photo, aptly illustrating what the procedure will do by showing the new nose on the picture of the patient’s own face.
Then, if it doesn’t look just right, it can be erased and redrawn until it does. While this technique cannot guarantee a good result, it’s the best way to ensure that both the surgeon and patient have the same idea. A similar effect can now be achieved–for communication purposes only–with computer imaging for rhinoplasty.
So if you are not absolutely certain that your doctor knows what you want, schedule another consultation before allowing the operation. If there is a lack of communication, you have only yourself to blame for an unattractive result.
While there are many ways to change the nose, all plastic surgery procedures for the nose can be done in the surgeon’s office with a local anesthesia. Moreover, the basic technique is always the same.
Almost all of the incisions are made inside the nose to prevent noticeable scars. Then through them, the plastic surgeon reshapes the underlying bone and cartilage structure and allows the skin to redraw over it.
To increase his accuracy, the doctor wears a headlight and utilizes special retractors to keep the area highly visible. Then once the operation has been completed, the nose may be packed and held in position with tape and a metal splint. The average rhinoplasty takes forty-five minutes to an hour, and it might cost considerably less than you would expect.
A surprising number of people are unknowingly suffering from a deviated septum. This condition often obstructs the air passages and hinders breathing. Other people have unremembered injuries from childhood, like old nasal fractures. In either case, they can be corrected at the same time the nose is reshaped, and then part or all of the costs will be covered by insurance.
If a nose is really done well, it should end up looking entirely natural, as if the patient were born with it. In fact, the greatest compliment a surgeon can ever receive is when his work goes unnoticed.
There are a number of nose deformities that can be markedly improved. The doctor may even make many separate corrections during any one operation. In some cases the chin or other features may also need rebuilding to balance the appearance. If so, there will obviously be some additional costs for the patient.
Here are the common problems of the nose and how they are treated.
This is by far the most frequent problem. The surgeon starts by removing some of the excess bone and cartilage along the top of the entire nose. Then he reshapes the framework, either by making it straight or else by giving it a slight curvature. Noses that are straight along the top usually look more natural, but this is up to the individual patient. Of course, there are limits as to just how small it can be made. If too much cartilage is removed above the tip, scar tissue may heap up, usually resulting in a “parrot beak” deformity.
In some cases, only one part of the nose is too prominent. If an unsightly bump is marring an otherwise good-looking nose, it can be filed down (or shaved) to create a smoother flow.
The upper part of the nose between the eyes is constructed of bone and has no flexibility. If this area is too broad, it can be slimmed down by cutting the bones a cheek level and them moving them closer together to give a more narrow appearance. But the bones must be moved equally of the nose will be crooked. Also, if the bone is not cut close to the cheek, an unappealing “step” will occur on the side of the nose.
If the bones are simply out of place from a past condition (like a fracture), the previous operation will reposition them quite effectively. But if the lower cartilaginous portion is crooked, straightening it can be difficult or impossible. The best chance is to take a strip of cartilage from the inside of the nose and then to graft it along the indented portion. If the procedure is successful, the nose should appear perfectly centered.
This is a common problem that can be improved by removing or reshaping the cartilage in the nasal tip. By doing so, a great deal of the fullness is usually refined. But the cartilage should be left essentially intact along the rim of the nostril to prevent it from looking pinched.
The tip of the nose should be slightly separated from the upper part, and it should also project slightly beyond the main body of the nose. The surgeon achieves this result by operating on the tip cartilage. If done correctly, the nose will not “fall” when the surgery has been completed.
The “wings” of the nose can be narrowed by cutting out a wedge-shaped piece from the outer base of each nostril. This is referred to as an alarplasty, and it is one of the rare times that an external cut is made on the nose. If the surgeon is careful, the ensuing scars hold be thin and hidden from view in the natural crease of the nostrils. An equal amount must be taken from each nostril or the nose will look crooked.
This is sometimes caused by an excessively done alarplasty (see previous operation). The correction involves taking a full wedge of skin and cartilage from the rim of each ear, and then grafting one of the wedges to the base of each nostril to elevate and widen it.
The nostril rims can be slimed down by making incisions in the margins of the nostrils and excising thin pieces of skin. Then the remaining skin is drawn together and sutured, leaving a slightly visible scar.
This is usually more of an illusion than a real problem. When there is a curved bump on the nose, the eye tends to follow it down to the tip, which seems to droop. When the bump is treated, the tip should assume a more normal appearance.
But if the tip really does hang down, it can usually be rectified by removing excess cartilage. This should raise it into an attractive position. However, when a careless doctor removes too much cartilage, the result my be a “piggy” nose, causing the nostrils to look wide and open.
This part of the nose is called the calomel, and it can be corrected by simply shaving off some of the cartilage that is causing the problem. Thus the columella should be elevated to its proper position.
While this condition is uncommon, it can normally be improved without difficulty. The only danger is an excessive removal that results in an ugly condition called retracted columella.
This particular problem can either be natural condition or a bad result from a previous operation if it was done improperly. It can be corrected by grafting cartilage (or inserting a piece of silicone) to bring the calomel back to normal.
When there is too little tissue along the top of the nose, the middle appears caved in or crushed. This condition is especially prevalent on Orientals and blacks, and it is almost always treated by taking cartilage from the inside of the nose and using it to build up the affected area.
Some doctors prefer using silicone implants (not injections) or bone grafts from the patient’s hip or rib to create the same kind of change; these are acceptable alternatives.
Incidentally, the “saddle nose” can also result from removing too much tissue during other types of rhinoplasty or surgery to the septum.
Unfortunately, not every plastic surgeon possesses the same degree of competence; even in the most capable hands, unexpected and less-than optimum results can sometimes occur. Many of these problems have already been discussed.
In rare cases, the damage will be permanent. But more often a poor job can be improved through a second operation. If the original surgeon makes the correction he should do it for free. But if the nose looks horrible, the patient may prefer to find and pay someone else (preferably an expert in cosmetic reconstruction).
The fee for any of these procedures should be $7400 to $8,900. If two or more are performed at the same time, there will not usually be any additional charges.
While the area is usually presentable within two or three weeks, it may take up to six months for the final result to be apparent.
Most patients can begin to resume normal activities as soon as the anesthesia loses its effect. But some people will require a day or two of rest.
Immediately after the surgery there will probably be a little bleeding, but excessive bleeding is fairly rare. A few people may still bleed up to ten days after the operation; however, bed rest and sedation are usually sufficient to stop it.
Also, patients ordinarily experience varying degrees of discomfort due to the packing in their noses or small blood clots that may be clogging their noses. But the bandages and packing, when used, are generally removed within a week, and the discomfort should quickly cease.
There will definitely be some swelling and black and blue discoloration under the eyes. While the swelling normally recedes in several days, the bruises around the eyes occasionally last for two to three weeks, rarely longer.
But the area can be hidden with sunglasses, and makeup can be applied shortly after the operation as long as the bandages are not disturbed.
The “new” nose will already look good when the bandages are removed, but the finished result will not be evident until the last little bits of swelling have disappeared, and the skin has completely contracted over the rebuilt framework.
This healing process can take up to six months, and prolonged sunlight should be avoided for the entire period. As time goes by, the patient should look increasingly better until the effect is complete.
Besides the slight possibility of a bad result, the rhinoplasty is almost always free of complications.