Read an Excerpt
Your Complete Guide to Nose Reshaping
By William Truswell, Paul S. Nassif, Jon Mendelsohn, David Ellis, Harrison Putman II, Jack Kusler Addicus Books, Inc.
Copyright © 2007 William Truswell, M.D., F.A.C.S; Paul S. Nassif, M.D., F.A.C.S; Jon Mendelsohn, M.D., F.A.C.S; Harrison Putman, M.D., F.A.C.S; and David Ellis, M.D., FRCSC.
All rights reserved.
ISBN: 978-1-943886-33-3
CHAPTER 1
Nose Reshaping: An Overview
Your nose is perhaps the most defining characteristic of your face, and if the size or shape of your nose is out of balance with the rest of your facial features, you may be self-conscious about it. Of course, this is all relative. For some individuals, a small bump on the bridge of the nose is embarrassing, while for others, a slight bump may not be an issue. One person may be embarrassed about having a large nose, whereas another person may not be bothered by it.
If you have long been uncomfortable with the size or shape of your nose, you may be considering nose reshaping. For years, surgery to reshape the nose has ranked among the five most popular facial cosmetic surgery procedures. In fact, each year more than 300,000 Americans undergo procedures to sculpt the nose.
What Is Nose Reshaping?
Nose reshaping, called rhinoplasty, is a surgical procedure that redefines the contours of your nose. Rhinoplasty, commonly referred to as a "nose job," can be performed for purely cosmetic reasons, to create a nose that is more harmonious with the rest of your face. It can also be performed to improve a person's breathing function if structures inside the nose block the passage of air. In most cases, rhinoplasty can address both cosmetic and functional issues.
Among facial plastic surgeons, nose reshaping is considered to be one of the most complex of all facial cosmetic procedures. Why? Because the nose is a complex structure, including bones, cartilage, skin, mucous membranes, hair follicles, glands, muscles, ligaments, blood vessels, and nerves. Making changes to any of these elements can affect the other structures within the nose and can ultimately affect functionality as well as appearance. When making refinements to a nose, a surgeon must consider all of these elements in order to achieve a pleasing, aesthetic result while preserving function.
Improvements to your nose may be subtle or dramatic depending on your circumstances. However, even minor alterations to your nose can significantly enhance your appearance and self-confidence.
It's important to understand that having nose surgery isn't like shopping for a new outfit. There is no catalog of noses in different sizes and shapes that you look through to choose your new nose. A surgeon can make improvements — softening a hump, straightening a crooked nose, or reducing the size of the tip, for example. In general, your surgeon will fine-tune specific features you don't like about your nose while maintaining its uniqueness and character.
Ideally, following surgery, your nose should look natural and be more balanced with the rest of your face. It shouldn't look like you've had a nose job. Following rhinoplasty, you may be surprised to discover that friends and coworkers don't realize that your enhanced appearance is due to nose surgery. Your mom or best friend may be the only one to notice the difference in your nose.
Types of Rhinoplasty Procedures
Although each procedure is tailored to individual needs, there are two basic types of rhinoplasty: open and closed. The type your surgeon chooses to perform will depend on the complexity of the reshaping to be done to your nose and on his or her personal preferences.
Closed Rhinoplasty
When closed, or endonasal, rhinoplasty is performed, all the incisions are made inside the nose. Working solely within the nose means that the surgeon has a limited view of the bone and cartilage that is being reshaped. In spite of the challenges presented by the limited view, many surgeons are well trained in this method and achieve excellent results with it. In general, closed rhinoplasty may be considered sufficient for simpler rhinoplasty procedures but may not be the best choice for complex procedures or revision of a previous nose surgery.
Open Rhinoplasty
In open, or external, rhinoplasty, the surgeon makes incisions inside the nose but also makes a small incision across the columella, the strip of tissue at the base of the nose that separates the nostrils. The nose skin is then lifted away from the underlying nasal structures, providing the surgeon with a clear view of the cartilage and bone to be reshaped. Greater visibility is a major benefit that allows the surgeon to make precise refinements. This method leaves a small scar from the incision on the columella, although it is often virtually invisible when completely healed. Open rhinoplasty may also lead to increased swelling. Open rhinoplasty is often preferred for more complex or challenging procedures, including revision of a previous nose surgery.
Making Functional Improvements
Whether open or closed rhinoplasty is used, your surgeon may use various surgical techniques to improve the function of your nose in addition to enhancing its appearance. Functional improvements are intended to allow you to breathe more freely. The most common functional improvement made during rhinoplasty involves correcting a crooked ordeviated septum. When the septum, which separates the two nostrils, is deviated, it can create a blockage in one of your nostrils. This airway obstruction can lead to breathing problems. During your procedure, your surgeon may also make functional improvements involving other tissues within the nose.
Ethnic Nose Reshaping
Rhinoplasty can change ethnic nasal traits. Depending on your particular desires, it can build up the bridge of your nose or narrow the width of your nostrils. However, if you're hoping to completely eliminate the ethnic character of your nose, you should be aware that this usually can't be done and still maintain a balance in the facial features. In most cases, refinements can be made to certain traits, but the nose won't lose all of its ethnic characteristics. Be sure to discuss any concerns about maintaining or eliminating ethnic characteristics with your doctor.
Limitations of Nose Reshaping
There are limitations to what rhinoplasty can correct. The amount of correction that can be achieved with your nose depends on certain characteristics and traits, such as your skin texture and thickness and the underlying support system of bones and cartilage in your nose. If your skin is very thick, it may limit the amount of fine tuning that can be accomplished, especially in the nasal tip. Think of it this way: If you put a shoe on a bed and cover it with a sheet, you can probably still tell that it's a shoe. However, throw a blanket over the shoe and you probably won't be able to identify it. It's the same principle with noses. A surgeon can refine the underlying bones and cartilage within your nose, but if you have thick skin covering them, the changes may not be clearly evident.
In some instances, the need to maintain nasal support and function can limit the degree of sculpting a surgeon can perform. In addition, the structures of the nose have "memory" and may try to reassume their presurgery shape. For example, a very crooked nose may look vastly improved following a surgical procedure. But as time goes by, it may have a tendency to bend again.
Are You a Candidate for Rhinoplasty?
If you feel self-conscious about your nose for any reason, you may be a candidate for nose reshaping. For instance, if you think your nose is too large for your face, if you have a bump on the bridge of your nose, if your nose is crooked or asymmetrical, if the tip droops or appears to be too thick, or if your nostrils seem too wide, you may want to consider rhinoplasty. Likewise, if you've broken your nose, or if you don't like the way it's changed due to aging, you may see improvements from nose reshaping. In addition, if you suffer from breathing problems, your surgeon may be able to correct these. To determine if you're a good candidate for nose surgery, a surgeon will evaluate several things, including your expectations, your age, your health, your mental well-being, and your attitude.
Expectations
A realistic level of expectations is the single most important thing facial plastic surgeons look for in rhinoplasty patients. If you realize that the goal of nose reshaping is to improve the traits you currently possess rather than to create a "perfect" nose, you're more likely to be satisfied with your results. In addition, it's important to understand that rhinoplasty will change your nose, but not your life. It may give you a boost in confidence, but it won't improve your relationships, earn you a promotion at work, or solve your other problems.
Age Requirements
Nose surgery can be performed on men and women of almost any age — from teenagers to seniors. In general, rhinoplasty patients tend to be younger than patients seeking other types of cosmetic plastic surgery. More than 60 percent of rhinoplasty patients are under the age of 40, and rhinoplasty is overwhelmingly the most common cosmetic surgical procedure performed on people under the age of 20. However, surgeons usually prefer to postpone surgery on very young persons until they've stopped growing — at around 13 to 15 years of age for girls and about 16 to 18 years of age for boys. Waiting until an individual has reached maturity is extremely important. Why? The septum in the nose affects the growth of the midface, including the cheeks. Any changes or injuries to the septum before it has reached full maturity can affect the development of the midface, leading to imbalances in your facial features. In some cases, young patients who have suffered injury to the nose can undergo rhinoplasty to correct the nose alignment.
On the other end of the age spectrum, however, there's no limit. Even if you're in your golden years, you can see improvements with rhinoplasty. No matter what your age, it's important to be in good overall health.
Emotional Health
Your mental well-being is another important factor in determining whether surgery is right for you. In general, if you're happy with your life and you're emotionally stable, you're likely to be considered a good candidate for surgery. Your motivation for seeking rhinoplasty is a good indicator of your mental well-being. If you're seeking cosmetic surgery to please yourself as opposed to trying to please a spouse, boyfriend, or girlfriend, you're likely to be viewed as a good candidate.
A good attitude is another factor surgeons consider. It's important to be willing to take an active role in the cosmetic surgery process. It's your responsibility to research the procedure, to choose a qualified surgeon, toask questions, to communicate clearly what you'd like to change about your nose, to follow pre- and postoperative instructions, and to show up for any follow-up appointments. When you take an active role in the process, you're more likely to be pleased with the results.
When Rhinoplasty May Not Be Right for You
In some instances, rhinoplasty may not be appropriate for you. Unrealistic expectations, chronic health conditions, or a poor attitude may indicate that surgery isn't the best option for you. However, these factors won't automatically exclude you from having nose surgery. In some instances, you may need to consider postponing surgery, or you maybe required to undergo additional medical testing to ensure that it's safe for you to have surgery.
Unrealistic Expectations
If your expectations are unrealistic, you probably won't be satisfied with your results. For example, if you're hoping to come out of surgery with your favorite celebrity's nose, you're going to be disappointed. Similarly, if you're hoping that a nose job will save your marriage or make your friends like you more, you're setting yourself up for a letdown. This is why it's so important for you to communicate specific things you'd like to change about your nose rather than simply saying, "It's too big" or "I hate it." Based on your specific goals, your surgeon can inform you whether or not your goals are attainable.
Chronic Health Problems
In some cases, health conditions may be a factor. If you suffer from uncontrolled heart, kidney, lung, or liver disease, you may not be a suitable candidate for any elective cosmetic surgery. Uncontrolled high blood pressure or diabetes and autoimmune, endocrine, or connective-tissue diseases may also be cause for concern. Suffering from any of these conditions doesn't completely rule out nose surgery, but you may be required to undergo additional medical testing before a surgeon will accept you as a patient.
If you're a heavy user of nasal sprays to combat breathing troubles, your surgeon will have to carefully evaluate your case. In some instances, routine use of nasal sprays can cause functional problems and make nose surgery unadvisable. Be sure to discuss your use of such sprays with your surgeon.
Questions to Ask Yourself
[] Whom are you hoping to please by undergoing rhinoplasty?
[] Can you clearly communicate what you would like to change about your nose?
[] Are you seeking improvement or perfection?
[] Are you hoping to alleviate breathing problems with nose surgery?
[] Are you willing to do your part to ensure the best possible results?
[] If you smoke, are you willing to quit for several weeks before and after your procedure?
Timing of the Surgery
If you've suffered an injury to your nose, this may be a factor in the results you can expect. For example, scar tissue within the nose or missing cartilage or bone may affect your results. If you've recently suffered an injury, such as a fracture, you may be advised to wait until the swelling has completely subsided before making surgical refinements and repairs to your nose. Depending on your specific injury, this could take weeks or months. Minor injuries to the nose usually aren't cause for concern. Be sure to discuss all previous injuries with your surgeon.
Are You a Smoker?
If you're a smoker, your surgeon will urge you to quit for a certain period of time before and after surgery. Smoking reduces blood circulation to the skin, which slows the healing process and increases the risks of complications after surgery. In rare cases, smokers can experience skin death, or necrosis, due to a lack of adequate blood supply to the skin on the nose. Similarly, if you use recreational drugs, especially cocaine, you'll need to stop. Cocaine restricts blood flow, which slows the healing process and increases the risks of surgery. Cocaine can also lead to a perforated septum, which is a hole in the septum.
Mental Health
If you aren't feeling emotionally stable or you're in the middle of a highly stressful situation, you may want to delay surgery until you're feeling stronger. If you suffer from depression, you have to realize that changing your nose isn't going to make your depression vanish. However, mild depression or anxiety won't automatically rule you out as a candidate for rhinoplasty. It's important to make your surgeon aware of any mental or emotional issues.
Finally, if you aren't willing to do your part to ensure the best possible results, you may not be a good candidate for nose surgery. For instance, if you aren't willing to follow the pre- and postoperative instructions, surgery may not be for you.
What's the Next Step?
To find out more about rhinoplasty, you may wish to begin your search for a facial plastic surgeon and arrange a consultation. Before your consultation, learn as much as you can about the procedure by visiting reputable websites, such as those listed in the Resources section of this book. As you research rhinoplasty, make a list of questions to ask during your consultation. Also, spend some time looking at your nose in the mirror and write down specific things that bother you. Having questions in hand and specific goals in mind will help you make the most of your consultation.
CHAPTER 2
Choosing a Cosmetic Surgeon
f you choose to further explore having a rhinoplasty procedure, one of the most important decisions you'll make is the selection of a surgeon. Choosing a highly qualified and experienced facial plastic surgeon is key to ensuring the safety and success of your procedure. Because this is such a crucial step in the cosmetic surgery process, you should be prepared to spend some time on it. With thousands of surgeons and physicians throughout the nation offering cosmetic surgery procedures, singling out the right one can seem like a daunting task.
Ways to Find the Right Surgeon
There are several ways to find a qualified facial plastic surgeon. To begin your search, you should tap into trusted sources. One of the best ways to find a good facial plastic surgeon is through "word of mouth"; ask for recommendations from friends, family members, and personal acquaintances. If a trusted friend or acquaintance has had a good experience and a good result with a particular surgeon, you may wish to put that surgeon's name on a list for further investigation. However, note that if your friend had a great experience and a great result with a procedure other than rhinoplasty, such as breast implants or liposuction, it doesn't necessarily mean that the surgeon is equally experienced in performing rhinoplasty. When you ask for referrals, it's best to ask specifically about surgeons who perform rhinoplasty.
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Excerpted from Your Complete Guide to Nose Reshaping by William Truswell, Paul S. Nassif, Jon Mendelsohn, David Ellis, Harrison Putman II, Jack Kusler. Copyright © 2007 William Truswell, M.D., F.A.C.S; Paul S. Nassif, M.D., F.A.C.S; Jon Mendelsohn, M.D., F.A.C.S; Harrison Putman, M.D., F.A.C.S; and David Ellis, M.D., FRCSC.. Excerpted by permission of Addicus Books, Inc..
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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