For most of us, a nose that enhances our appearance is what we desire.
By: Dr. Scott Kay
If you have ever looked in the mirror and thought that you could change the look of your face if you only had a different nose, you are correct.
Although it is a relatively small appendage, the nose plays a significant role in how we look because of its place of prominence on our faces. Rhinoplasty is a nasal operation done to reshape the external appearance of the nose, and the results can be astounding.
The nose is an organ of both form and function. It is responsible for conditioning the air we breathe as it cleans, humidifies, warms or cools.
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‘Form and function often are related to one another. So a person with a very crooked nose will often have an equally deviated septum, which can obstruct normal breathing.’ Dr. Scott Kay
Board certified otolaryngologist Facial plastic and reconstructive surgeon The Medical Center at Princeton |
We inhale about 17,000 times in a day, which adds up to about 300 cubic feet of air. The nose humidifies each breath to within 75-80 percent relative humidity. For those among you who are mouth-breathers, you know how scratchy and dry your throat can become because the nose is not performing its function properly. For most of us, a nose that enhances our appearance is what we desire.
Form and function often are related to one another. So a person with a very crooked nose will often have an equally deviated septum, which can obstruct normal breathing. It is the surgeon’s mission to create a sound structural support under the skin from the cartilage and bone of the nose that both works well and looks good. It is helpful to understand the evaluation that takes place in order to accomplish these goals.
The aesthetic proportions of the face have existed since the beginning of history with only minor modifications over time. Perhaps the most famous artist/scientist to document these proportions was Leonardo da Vinci, whose observations of facial aesthetics are still used by both plastic surgeons and artists alike. He divided the face into thirds, noting that in cosmetically pleasing faces the forehead, the nose and midface and the mouth and chin all occupied equal areas of space. This information is tremendously important to a plastic surgeon.
Similarly, mathematical formulas have been developed to determine the so-called normal characteristics of the nose and face. With these formulas or ratios, the surgeon can determine if the nasal tip is overly projected or too long, or if this is just an optical illusion due to a tip rotated in a downward direction.
Photographs are essential to the evaluator, as most of us do not see ourselves in the mirror like the camera sees us. Unfortunately, the camera can reveal details that may be subjectively screened out when looking in a mirror.
Intra-nasal pictures can also be obtained with the use of nasal endoscopes connected to a video monitor and video printer. By this method the patient can see the nature of the anatomical obstruction and understand how surgery will correct the problem.
Once all the objective information is collected, it is time for the patient and the surgeon to discuss what cosmetic and functional problems are important. Occasionally a patient will bring a photograph of a celebrity or model, which is helpful. Often the plastic surgeon will point out a feature or a problem that the patient had not previously considered. At the end of this discussion, it is essential that both parties agree on the desired outcome or risk dissatisfaction by the patient.
Candidates for rhinoplasty surgery span many age brackets. The youngest age for purely cosmetic nasal surgery is typically between 15-17 for girls, who reach maturity at an earlier age than boys, and 16-17 for boys. It is not recommended before this age because the face is still growing through adolescence.
People of middle age may opt for rhinoplasty because they have experienced a change in life possibly due to financial or marital circumstances. Patients who are undergoing nasal surgery for sinusitis or a deviated septum may elect to have some additional surgery to change their external appearance as well.
Those people who have suffered nasal trauma and have never had their noses adequately corrected often undergo additional surgery. And finally, senior citizens who want a younger look can do so by having a large hump or honks reconstructed.
The operation is performed in an operating room either in a hospital, ambulatory outpatient facility or doctor’s office. You can have it done under general anesthesia or local depending on your surgeon’s and your own preferences. It takes one to three hours to complete, depending on how much work needs to be done. Pain is easily controlled with oral pain medication.
Within a week the dressing and splints will be removed, and you can expect your nose to feel stiff and be swollen and congested. You will be advised to avoid sun exposure or things which could cause the nose to bleed such as lifting, bending or blowing your nose.
In less than half the cases, there will be some black and blue marks around the eyes that will last for up to two weeks. After six weeks about 90 percent of the swelling in the nose will have resolved.
From this point on, a good nose job is like a fine wine it keeps getting better with age. If the cartilage and bone have been reshaped to create a structurally and aesthetically sound nose, then the skin around it will "shrink wrap" around the underlying structure as time goes on.
As with all surgeries, there may be complications. If too much cartilage has been removed, scar tissue may form and pull the cartilage together to form a buckle under the skin known as "bossing." Other problems include asymmetry of the tip, a tip that drops due to poor internal support, and irregularities in the bone along the dorsum.
If necessary, surgery can be performed again, with at least six months elapsing for full healing and recuperation. Complete reconstructions have been performed using alternative cartilage grafts taken from the ear, for example. Overall complications occur in less than 7 percent of all people who undergo rhinoplasty.
The final outcome should result in a nose that looks natural and does not distract from one’s eyes. All things considered, rhinoplasty may be just what you need to feel and look your best.
Dr. Scott Kay is a board-certified otolaryngologist, fellowship trained in facial plastic and reconstructive surgery, and on staff at The Medical Center at Princeton. Health Matters appears Fridays in the Lifestyle section of The Princeton Packet and is contributed by The Medical Center at Princeton.