Nasal surgery is one of the most demanding cosmetic surgeries as it involves both form and function. It also requires considerable skill and agreement of minds between the surgeon and the patient. The concept of nasal refinement has changed dramatically in recent decades. When I was a teenager, the operation was considered a ‘reduction rhinoplasty’, so everyone I knew came back from summer vacation with a dramatically different, smaller, and often ski slope-style nose. Modern rhinoplasty techniques allow the surgeon many more options for reshaping the nose. Some noses need to be lengthened, enlarged, or narrowed to obtain the best cosmetic result. It is much more possible to have a natural looking nasal correction, rather than the very obvious ‘nose job’ look of yesteryear. In fact, I see many clients who are terrified of going under the knife again to correct a previous rhinoplasty because they weren’t happy with the first one.
A large proportion of rhinoplasties performed today are revision operations to improve a previous surgical result. Rather than erase all signs of ethnic origins, many patients today prefer to retain some of the character and ethnic qualities of their original noses while undergoing subtle refinements. The main limitations in terms of what you can expect as a result of a rhinoplasty procedure have to do with your skin type, the thickness of the skin, the thickness and position of the nasal bones, as well as the skill of the surgeon you select. and his his sense of aesthetics. A surgeon will study your facial features along with your specific concerns to determine the best way to achieve your surgical goals. If your nasal bones are wide or large, they may need to be narrowed to achieve a more refined look to the shape of your nose. In some cases, adding a chin implant can better balance your facial features. Nasal implants made of solid silicone rubber or cartilage grafts from the nasal septum, ear, or rib cartilage are often added to improve the shape of the nose during surgery. Additionally, dermal fillers such as Restylane and Radiesse can be used to fill in subtle defects in the nose, for example a dent in the bridge.
When a surgeon evaluates your nose, they will study both the front view and the profile, as well as the shape and projection of the chin, cheekbones, and upper lip. Plastic surgeons generally recommend that patients wait until they are at least 13 to 15 years old, and possibly longer for children, before doing so. The nose may not be fully developed at a younger age. Assuming you are in good health, there really is no age limit to reshaping your nose and I have many clients in their 60s and 70s who are interested in a little tweaking. With age, gravity and downward growth can cause changes in the shape and position of the nose. The nose gets longer and the tip eventually droops, not a figment of your imagination! It is very common to have a small nasal adjustment at the time of a facelift. A simple lift of your drooping end can give you a smoother and younger appearance.
There are two basic ways to perform a rhinoplasty and many variations. The open technique includes an incision through the columella, the small strip of skin between the two nostrils. One of the main advantages of this technique is the ability to fully visualize the internal structures of the nose and place sutures precisely where they may be needed. With this type of rhinoplasty, the swelling at the tip can take much longer to subside as some of the tissue has been broken down. The scar is usually hidden in the lower part of the nose, so it is not very visible. The advantages of this method are that the surgeon can better visualize the internal structures of the nose and can sometimes produce a better and more predictable result using a greater variety of surgical techniques. The closed technique does not require external incisions, so it does not disturb the tissues as much. Instruments are passed through the nostrils to resculpt the bones, cartilage, and nasal structures. My philosophy is simple: don’t pass up an “open rhinoplasty” for having a small incision if the best doctor recommends it. That little scar is a small trade-off if the end result will be a great-looking nose that you’ll love for a long time.
When choosing a surgeon for your rhinoplasty, there is no substitute for experience. Look for a board-certified plastic surgeon or facial plastic surgeon who is well-versed in nasal surgeries. Ask to see pictures of the surgeon’s work to see if you like his sense of aesthetics.