RHINOPLASTY FOR MEN AND WOMEN - RESHAPING THE NOSE
Today, nose surgery or rhinoplasty is one of the most popular cosmetic procedures. A few years ago, the redesigned noses looked very un-natural, but this is no longer the case today. Now “tailor-made” and therefore natural looking noses are possible.
Because of its placement in the center of the face, the nose is not easily overlooked. That is why the nose and plastic surgery have a very close and complex relationship. Almost everyone has a complex surrounding their own nose. The test is easy to perform: ask a group of people “who is happy with their nose?” Positive responses are rare, very rare … and yet, we all live with our nose “in the center of our face” with a varying degree of acceptance, and sometimes no acceptance at all.
The nose is the part of the face that is seen most even though it is not expressive like the eyes or the mouth for example, it still has a very large impact on the harmony and balance of the face.
With rhinoplasty for men and women, the surgeon has to face all types of requests. Patients generally having a precise idea of the “ideal” shape of the nose they wish to have. The surgeon must study each case with great care and attention, to identify the motivations that drive patients and to be as explicit as possible about the possibilities and limits of this surgical operation of the nose, as well as about the psychological changes that it can occur. Our nose is an essential element of our personality. This small piece of flesh weighing a few tens of grams weighs so much heavier on our conscious and unconscious representations of ourselves. The request for a surgical operation of the nose is essentially feminine. Requests by men are much rarer and can sometimes mask a case of body dysmorphia, a disorder where one excessively exaggerates a benign physical defect. Another type of nose surgery involves changing the appearance of a racial trait by, for example, narrowing of the nostrils.
It is often near the end of adolescence that the desire to change one’s nose emerges. As a result of derogatory remarks from others, or in response to an internal “fantasy” of having the perfect nose.
The general harmony of the face is constituted by its volumes – the nose, the chin, the mouth, the cheekbones – and an imperfection of one of these can cause an unbalanced appearance. Most of the time, an intervention on one of these elements makes the whole facial appearance more harmonious. However, it is the nose that is the main focus of attention. First, the physical reasons: the nose is “in the center of the face”, but also, for psychological reasons: this small organ is emotionally charged and represents filiation. It occupies a very special place on our body. Today, the remodeling of the nose, called “rhinoplasty for men and women” is among the most popular of the cosmetic procedures even though only a few years, most of these procedures produced very un-natural results. Thankfully this is no longer the case today. Rhinoplasties are “tailor-made” and therefore produce very natural results.
Minimum changes
All requests for rhinoplasty deserve and require reflection. In order for the new nose to conform to the patient’s requests should be very clearly defined after a long dialogue with the surgeon who performs the nose surgery. During the interviews, we examine the face in great detail, analyzing its contours, its proportions, its balance. Then, we explain to the patient the changes which, considering the characteristics of his face, seem to us the most beneficial, while keeping the modifications to a minimum. The nose is at the center of our appearance and therefore a large part of who we are as people. If we change our nose we must be sure that we can still recognize ourselves.
The changes we propose before a rhinoplasty may not exactly match those that patients initially considered because their request often concerns a specific area of their nose, a bump considered too prominent, nostrils considered too wide, a length considered excessive etc. If we intervene on a specific area of the nose it could unsettle the balance of the face. Simply “shortening” a nose cannot give a fully satisfactory end result; likewise, the removal of a hump causes an apparent increase in the tip of the nose which makes it necessary to act on its whole and not only on the hump. The final joint decision is therefore always the result of a long dialogue between the practitioner and the patient. The use of computerized simulations to visualize the possible changes and the results after surgery of the nose, face and profile, on a computer screen, is a valuable but not a sufficient aid in carrying out this dialogue.
Surgical operation of the nose: a delicate and technical procedure
Among all of the plastic surgery procedures, rhinoplasty for men and women has the particularity of intervening onto a hollow organ, therefore this remains one of the most delicate procedures, but also one of the most creative. Creating a new cartilaginous structure that will give the nose its final shape requires extreme precision. It also requires the surgeon to anticipate and plan for the future nose of the patient because the nose changes through the years, like the rest of the face. Before surgery on the nose, we must project ourselves into the future to create the new nose, not only of today but also of future years. For example, with aging, a modified nose can become more pointed and its shape reduced. All these parameters must be taken into account. Today, nose remodeling techniques are numerous and safe. Since the 80s, they have developed both in complexity and finesse thanks to an increasingly precise manipulation of nasal tissues. It is also a huge consideration for the surgeon, to ensure that the surgical operation does not affect the respiratory function of the nose. Rhinoplasties make it possible to respond more closely to the requests of the patients and give harmonious and extremely satisfactory results. Important progress: today, nose modifications are less and less noticeable.
Before any rhinoplasty procedure, we always use photographs either black or white or digitized on a computer. The patient and the surgeon together define the desired corrections.
The surgeon cannot in any way completely guarantee the results nor can he perform an exact replication of another nose from a photograph. The results depend, and are limited to, the state of the patients nose and nose tissues. The procedure of nose remodeling is preceded by a careful examination of the respiratory function including the nasal septum. If the septum is deviated, it can be corrected during rhinoplasty. The skin must also be carefully examined because the greater the elasticity, the better the skin will settle on the new bone structure.
This surgical procedure of the nose is performed under general anesthesia, but in some cases local anesthesia may be sufficient. Incisions are made either in the nostrils or sometimes, under the upper lip. The surgeon exposes the framework consisting of bone and cartilage by detaching the skin that covers the outside and the mucous membrane that lines the inside of the nose. The surgeon can then reshape the bone and cartilage, which is the solid infrastructure of the nose, giving it the desired shape. This part of the procedure has an infinity of processes and possibilities, which are chosen according to the corrections to be made and the surgeons own technical preferences. But to reduce the size of a nose or to change its appearance, it is necessary to break the bones of the “nasal pyramid”. This gesture that scares many patients, requires extreme precision and is the only way to correct or reposition the nose. This gesture corrects many issues for example, the narrowing of a nose that is too wide, to perform the removal of a hump or lump, to correct a deviation, to shorten a nose that is too long, to lengthen a nose that is too short, to straighten a crooked section, etc. The correction may require the use of a cartilaginous or bone grafts to fill a depression, improve the shape of the tip, or to support a portion of the nose.
The next step is for the skin covering the nose to readjust and settle onto its new osteo-cartilaginous framework. Finally, a dressing is made using adhesive strips and a brace and a protection splint is molded and attached to the nose.
Remodeling the nose: no scars
Rhinoplasty usually leaves no visible scars on the skin. If the patient suffers from a nasal obstruction disturbing their breathing, this will be treated at the time of the operation, whether it is due to a deviated septum or a “hypertrophy of the inferior turbinate”, these bone formations present in the nasal passage.
This nose surgery can be performed on both women and men once growth has ceased, usually around 16 or 17 years of age.
During a remodeling of the nose, each part of the nose, i.e. the base, bridge, tip, nostrils etc. can be treated separately to achieve the greatest possible harmony of the appearance as a whole. The new nose that patients discover when bandages are removed does not have its definitive shape. It is very fragile and will remain so for three to four months after the surgery when the final results will appear.
The nose is a unique organ, that has two sides: right and left and are never symmetrical. The same can be said for the face in general where one side is usually different from the other. There is also the adult nose that tends to be larger and wider as opposed to the child’s nose that is more narrow and higher. As a result of these differences, certain techniques are more applicable to certain types of noses for example a lateral osteotomy, more often applied to an adult nose, or the execution of a micro liposuction more applicable to adults with prominent nostrils.
