The beautiful thing about rhinoplasty surgery is that it is extremely predictable with a very high rate of success if the finer points are understood and understanding these points is what leads to a natural rhinoplasty result.
This will be a several part series of articles that will be very detailed in defining what are the critical components 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, based on:
- the structure of the nose’s cartilage,
- the nose’s overlying skin,
- and the surgeon’s own aesthetic judgment.
I will also describe in detail how I go about making the surgical decisions of what is appropriate for a patient based on each persons 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 noses that have twisted, those noses that have irregularities on the bridge, those noses where one or both nostrils have retracted upward and those noses where the nostrils cave 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.
These problems usually leave the nose looking unnatural and can be spotted from a across the room as a “BAD RHINOPLASTY”. These problems can occur right away but more often they occur over the course of a few years following the surgery.
What to ask at your Initial Consultation
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 cartilages”? The inherent strength of the underlying cartilages 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 easily be pushed into the face when pressed on.
Often times if the tip has good support, then the tip can be refined by simply removing some of the excess and 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 and we will address that issue in a later article). This same technique applies to a nose with weak cartilage or thick skin can be disastrous and I will discuss this in the very next article.
For now, it is sufficient to say that there are indications for the older style rhinoplasty and that is the strong nose with thin to moderate skin thickness as the example below indicates