The patient is a 24 year old woman who wanted to have the “bump” removed from her nose and she wanted her nose to be straight. She also felt that her nose was too large and even downward pointing like a “hook nose”. The patient was relatively tall and she wanted to retain the ethnic appearance of her face and not change her natural character. She also thought that her nasal was too projecting (stuck out too far) and was too broad and not defined.
The Plan
The plan for rhinoplasty was to take down the “bump” so as to make the nose straight but not to take off more than that so that her tip stuck out past the straight line because that might take away from her character and ethnicity. The patient thought that the tip pointed downward but looking the rhinoplasty before and after photos side views, one can see that the tip is prominent but points slightly upward. Perhaps the reason some patients think their nose points downward is that they might see that the “bump” is making their nose look that way. Bringing the tip up significantly might also make the nose look too short (distance from the tip to the top of the nose between the eyes). That would also make her nose look too small, detract from her ethnicity and not harmonize with her other facial features. Rotating the tip up too much might also bring a lot of curviness to her nose which would harmonize with the other curves of her face and result in a face with too many circles. All of this could be performed via closed rhinoplasty and the patient also felt that her goals could be better accomplished with closed rhinoplasty and that the healing would be a lot faster.
Note: As with this patient, some rhinoplasty patients wish to retain the ethnic appearance to their nose but others don’t and so as with all rhinoplasty patients, the goals of the procedure are thoroughly discussed prior to surgery.
Open Versus Closed Rhinoplasty
In closed rhinoplasty, all of the incisions are placed on the inside of the nose. But the rhinoplasty surgeon can see all of the structural parts of the nose directly. There is the ability to directly see the effects of each maneuver after it is done as one can look at the skin and see the effect on the shape of the nose precisely. That is part of the beauty of rhinoplasty surgery. Open rhinoplasty is generally performed when more complicated maneuvers are required to improve the tip of the nose. An example of this would be patients who have a tip that has an irregular shape of the nostril rim edge and the tip cartilage requires complete reshaping for improvement.
Patient Reaction to Her Cosmetic Result
The patient was very pleased with her appearance after her rhinoplasty. She liked that her nose was smaller and more refined but not so narrow or short so as to have lost her ethnic appearance. She also liked that her nose “went” with her face.
How Do Patients Really Feel
We can’t know what is in a person’s mind but many rhinoplasty patients report feeling ashamed of their nose prior to surgery, especially when it does not blend with their face. They feel they can’t cover it up with their hair, makeup or clothing as it is sitting right in the center of their face. Though the nose is a small part, even of the face, rhinoplasty surgery can have a significant on a patient’s appearance, even if only to make the nose conform to the other facial features. With rhinoplasty, as with all other plastic surgery procedures, there is also the opportunity to create beauty.
