A Rhinoplasty or reshaping the nose, is generally regarded as one of the most difficult procedures in cosmetic plastic surgery. It requires years of training, skill and expertise to perform this procedure to get it right, but it all comes back to expectations.

All faces are asymmetric, and that asymmetry is reflected in the nose. Whilst plastic surgeons strive to create a symmetrical nose, there is always some difference between the two sides. Whilst this is not apparent to the casual observer, some people become obsessed with the appearance of their nose post rhinoplasty. They focus on these features even though no one around them takes any notice or has any clue. Unfortunately, this can lead them to push their surgeon or multiple surgeons for repeated operations, striving to find the perfect nose.

Dr Jack Gunter, a surgeon from Dallas Texas, (who is commonly regarded as the father of modern rhinoplasty surgery) was heard to remark “I try to make every nose perfect and I’ve never made a perfect one yet”. This is after a 30+ year career as one of the world leaders in this difficult and demanding type of surgery.

So, it all comes back to expectations. Whilst I will always strive for the perfect nose, it’s best to keep your expectations realistic to start with.

If you watch how our eyes track onto the face of someone we are engaging, we tend to look first at the eyes. Eye contact is kind of the universal greeting. Generally, we tend to look next at the lips because we are communicating, and we are watching what each other says and our expressions. Subconsciously, we read the outline of the face because that’s a good guide to age and to some extent health as well.

In the overall picture, the nose is well down the list of the places on a face that our eyes go to. That’s because it’s never the most attractive part of the face and it’s not the part of the face that we use for expression or communication. However, we tend to find the nose catching our eye sooner if when we are looking at the eyes it acts as a distraction. An excessively large nose or one that is deviated to one side tends to do this and it can therefore in that context have a negative impact on the overall perception of the face.

Another time when the shape of your nose can be an issue is when photographs are taken. People who have a large hump on their nose tend to avoid the profile shot as they are very conscious of this aspect of their appearance. However generally they are much more comfortable front on (the more common position for interaction with others) as they know that their nose looks fine from that angle.

So, like all rhinoplasties, I try to make each nose as perfect as I can, and I know that I will invariably fail. A realistic goal is to make a nose that blends seamlessly into the proportions of the face and doesn’t distract from the more attractive parts of the face such as the eyes and lips. I generally tell patients I want to make the nose “invisible” – that is for it to become part of the face that doesn’t catch the eye.

nose job dr scamp

A strong focus of modern rhinoplasty surgery is to preserve the nasal airway. There are three main choke ”zones” in the nasal passage. Most surgeons act to protect, support and enhance these zones in the techniques they use during the operation. Whilst a nose that is made smaller will generally involve a trade-off to decrease airflow to some extent, optimising nasal shape can go hand in hand with preserving the nasal airway.

In the best of hands, about 10% of all rhinoplasty surgeries undergo a revision procedure. This is generally done a year or more after the first operation. The reason for this delay is that the result is not apparent until significant time has passed.

The rhinoplasty procedure essentially changes the scaffolding to the nose being the bones and cartilage. It relies on the overlying skin to fall back and fit that new framework. This takes time. The skin will have been pushed into one shape for many years and it must fall back and find a new shape. Intervening too soon can lead to uncertainty and disastrous results.

It’s also important to keep in mind that a nose “lives” in a face. Our ethnic background determines to a large extent, not only the shape or our face but the proportion of the nose that should belong there. In rhinoplasty surgery, respect for that overall facial shape and ethnic background should lead to a nasal shape that is harmonious with the face.

Dr Terrence Scamp

Body dysmorphia is something that requires careful consideration, especially in Rhinoplasty patients. Statistics have shown that rhinoplasty patients have a higher than average percentage of body dysmorphism disorder. This can be problematic as expectations versus reality are often worlds apart. I take a lot of care to discuss issues with my patients during consultations to make sure we are on the same page and part of the same team. Whilst my ability to achieve amazing results is high, there will occasionally be some patients that surgery is not a suitable option for.

To sum it all up, a rhinoplasty is a tricky operation, and can be demanding for both the surgeon and the patient. I like to clearly articulate with patients during my consults that expectations need to remain realistic. No one is perfect but I will utilise all my years of training and expertise to get you one step closer. If you are considering having a rhinoplasty, it would be best to book in for a consultation to discuss the options available. When expectations are realistic and achieved, it’s a win-win for all involved.

[This article has been re-shared from the Trusted Surgeons Blog.]

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