22 Jun By a Nose
BY Dr Terrence Scamp
The conspicuous location of the nose and the inability to conceal it means that those who have been burdened with a nose of excess proportion or poor shape feel the impact of this deformity on their interactions with others every day. You can hide a poor complexion with make-up, mask thin lips with zealous lip liner and draw your eyebrows any shape you like, but you simply can’t hide the nose.
Rhinoplasty is the name given to the operation to reshape the nose. It is a commonly performed cosmetic procedure, usually performed under general anaesthetic as a day patient. Despite the sensitivity of the nose itself to contact, the modern surgical procedure to reshape the nose is usually associated with only modest pain or discomfort post-operatively. The nose itself commonly feels numb and somewhat blocked but excessive pain is rare.
Prior to his tragic death, Michael Jackson was perhaps as renowned for his plastic surgery as his music, and you had only to mention the words “nose job” and his name would rapidly be brought to the fore. Michael Jackson underwent a series of rhinoplasties over many years. A review of his album covers will chart his progress from an initially heavy Afro-American nose and then on to a more handsome but racially appropriate shape, followed by a descent into what can only be described as the bizarre. At the same time his skin was changing colour remarkably and there was probably a common thread in these directions.
Sadly, plastic surgeons would regard his nasal reshaping as epitomizing everything that is wrong in Rhinoplasty and in plastic surgery in general. A good nose job creates a nose of appropriate size, shape and racial origin for the given individual. The nose should blend in harmoniously with the other features of the face and there should be no suggestion of the overdone or odd look.
A nose job can also improve the function of the nose as well as its appearance. Many types of nasal deformity are also associated with restriction of the airway and one can both improve the appearance and the breathing by appropriate surgery at the same time.
The nose consists of cartilage (Gristle), bone and skin. The cartilage and bone can be reshaped but the skin has to shrink spontaneously to fit the new structures there. If too much reduction in size is attempted an excess of skin may be left behind and this will not shrink well, particularly if the skin is heavy as seen in some people from the Mediterranean, Middle East or Africa. Here a much wiser course is to maintain a little more size and build an attractive shape, as a larger nose of better shape will always look more attractive than a small nose of poor structure.
The modern nose job commonly uses a small scar between the nostrils. If the nostrils themselves need to be reduced there may be further fine scars around the base of these. These scars are usually very difficult to see and are hidden by the natural contours and shadows of the nose.
The small scars give access to the structures of the nose and these can then be reshaped under direct vision. The bones can be reduced and narrowed, the septum (middle wall) of the nose straightened and the cartilage reformed to build an attractive shape. Pieces of cartilage are commonly relocated to create this newer, more attractive shape.
Usually a small plaster has to be worn on the nose for a week after surgery and some bruising around the eyes is to be expected. This may take a week or more to disappear. For this reason most people who work face to face prefer to have a week or more away after surgery.
Watching old films or television shows will often provide a parade of nasal deformities associated with an era when nasal surgery was focused on reducing the size of the nose at all cost. The “pinched” tip or the “scooped” profile have hopefully these days given way to a straight nasal bridge line and a well shaped and supported nasal tip.
Strangely enough, quite remarkable changes in nasal shape can be achieved and many people will not notice. This is because the eye doesn’t miss what is no longer there, if what is there is in harmony with the rest of the face.
In the example illustrated a young lady of Greek ancestry has had a significant change to her nasal shape and whilst the nose is smaller it is mostly the improvement in shape that is the striking feature. By maintaining appropriate size here the skin is well supported and the result looks quite natural.
Realistically it is never possible to make a nose “perfect”. In many ways the operation is designed to restore the face to harmony so attractive eyes or well shaped lips become a more prominent feature rather than being overshadowed by an unsightly nose.
Finally, for a nose subject to several surgeries without a successful outcome, modern injectable products may provide a safe, predictable and non-surgical tool to fashion an acceptable nasal shape.