In the Media

Plastic Surgery Update:

The Artistic Nose

By Dr. Steven Bloch, M.D.

The nose is the first facial feature other people notice, not only because it's in the middle of the face, but also because it does not lend itself to camouflage. There is no such thing as the "perfect" nose. Different people have different features, and the purpose of a rhinoplasty is to create a natural harmonious look that doesn't look "operated." Very often patients come in complaining of their profile. They look like one person from the front and a totally different person from the side. The object of the surgery is to get the two views to match.

The use of computer-simulated images is a major advance in taking the guesswork out of what the surgical result will look like. It allows the patient to see their profile and allows the surgeon to show the patient what he or she has in mind. In order to achieve a harmonious result, it is often important to modify other facial features such as the chin and neck.

The nose should be viewed in the context of the entire face. A turned up, scooped out, little nose may look very attractive on some women, but on someone else it may look totally out of place and unnatural. Most patients seek a "refinement" or natural look. The three most common flaws addressed by rhinoplasty are a hump on the bridge, a bulbous tip, and a nose that is too large when compared to other facial features. Regardless of the flaws fixed, the goal is to achieve a natural-looking outcome.

The surgery itself is usually done on an outpatient basis under IV sedation. The techniques vary but consist of filing down excess bone, reducing excess cartilage, and adding additional cartilage or bone when needed. Each case is unique and millimeters count. Most patients have a splint in place for one week, and there is some bruising and swelling, but it is usually minimal. Most noses look good at the end of one week, yet it can take nine months to one year for every last bit of swelling to subside, as well as for the skin to shrink to the smaller structure. To balance out the profile, often some modification of the jawline or chin is done. If the chin is too small, a mini incision is made under the chin or through the mouth.

A pocket is created over the chin and an implant is inserted. The implant is made out of solid silicone and feels like the underlying bone. If the chin is too prominent, then the chin can be filed down from inside the mouth. If the neck is poorly defined, then liposuction can be done at the same time to give greater definition. Rhinoplasty is probably one of the most challenging procedures plastic surgeons perform, both technically and aesthetically. It is also one of the most gratifying. It has the potential to significantly enhance one's appearance and give them the self-confidence to better enjoy their life.