BOARD CERTIFIED BY THE AMERICAN BOARD OF FACIAL PLASTIC AND RECONSTRUCTIVE SURGERY
BOARD CERTIFIED BY THE AMERICAN BOARD OF OTOLARYNGOLOGY - HEAD AND NECK SURGERY
FELLOW OF THE AMERICAN COLLEGE OF SURGEONS
As a Los Angeles and Beverly Hills rhinoplasty specialist in the Beverly Hills and Los Angeles area, I see many people who have unnatural results from old school rhinoplasty techniques that could have been easily avoided. The beautiful thing about rhinoplasty surgery is that it is extremely predictable with a very high rate of success, but only if the finer points are understood; and understanding these points is what leads to a natural rhinoplasty result.
This will be a series of articles consisting of several parts, which will be very detailed in defining what the critical components are that need to be considered when performing rhinoplasty surgery in order to achieve a natural, pleasing, and long term result. We will address how to create a natural looking nose that will stand the test of time, which is based on the structure of the nose’s cartilage, overlying skin, and the surgeon’s own aesthetic judgment. I will also give a detailed description on how I go about making the surgical decisions of what is appropriate for a patient based on each person’s desires and unique anatomy. Finally, I will conclude by discussing the “non-surgical rhinoplasty,” and where and when it is appropriate in facial plastic surgery.
The most critical component to achieving a natural, pleasing, and long lasting rhinoplasty result is to create a nose that has good support. We have all seen those unnatural noses that are way too small and pinched at the tip or scooped, those that are twisted, have irregularities on the bridge, and those where one or both nostrils have retracted upward or even caved in upon inspiration. These are some of the most common problems that occur with first time rhinoplasty surgery that are almost always caused by a weakening of the nose and, therefore, loss of support. They usually leave the nose looking unnatural and can be spotted from a across the room as a “BAD RHINOPLASTY.” They can occur right away, but more often, they occur over the course of a few years following the surgery.
There are several important questions to answer at the initial consultation. I will first address what I think is the most important question to answer, “What is the strength of the underlying cartilage?” The inherent strength of the underlying cartilage will determine if the nose has good support. A nose with good tip support is a nose that is very resistant to downward pressure with your fingers. A tip with poor support will be easily pushed into the face when pressed on.
Oftentimes, if the tip has good support, then the tip can be refined by simply removing some of the excess cartilage. The result will look more refined and still maintain its natural shape. Here, I will give an example of an inherently strong nose that was intentionally made more refined by weakening the tip to make it smaller. This technique is ideal for strong noses with strong cartilage, provided the skin is not too thick; we will address this issue in a later article. This same technique applied to a nose with weak cartilage or thick skin can be disastrous; I will discuss this in the very next article.