By Dr. Brian Peterson
Published on February 03, 2011
Surgery to reshape the nose is called a Rhinoplasty. The vast majority of patients seeking this operation for cosmetic purposes are women. The reason for this is that if a woman inherits their father's nose, it usually detracts from her feminine appearance. This is because there are certain features that make a nose look masculine and certain features that make it look feminine.
A strong or prominent dorsal hump or bridge is a male characteristic. Men can also get away with a larger bulbous tip that tends to hang a bit. The angle between the upper lip and the nose in women should be open, or greater than 90 degrees allowing a ‘up turn' to the tip, that doesn't work well in men. So typically we associated a small nose with a low bridge, and a slightly more prominent upturned tip a feminine characteristic.
Anatomically the nose is an interesting structure. The right and left nasal cavity is separated by the septum. If the septum is not straight a patient may experience diminished air entry through one nostril or the other, and this may be improved with a septoplasty during the rhinoplasty procedure.
The upper third of the nose is composed on bone, and the lower two-thirds consists of cartilage. The bones form the majority of the bridge of the nose, and the cartilage the middle portion of the dorsum and tip. The cartilage at the tip has the shape of the horns of a big horn sheep, and gives shape to the nostril as well. Unlike bone, the cartilage is flexible and has a memory; even though it can be changed during surgery, it tends to want to go back its original shape. This can create a late twisting of the tip months after surgery that may require a second operation.
Every nose is as individual as the patient is, and each patient has specific desires for the eventual appearance of the nose. Providing photographs of noses tat you like is a good way to give your surgeon an idea of what you would like your nose to look like. Your surgeon can then tell you whether your expectations are realistic given the appearance of your nose, and taking into consideration your facial structure and proportions.
Rhinoplasty surgery has become more refined over the past 20 years, due to use of the ‘open' technique. This technique involves a small incision that is created between the nostrils, and the remainder of the incisions inside the nose. This allows the surgeon to visualize the cartilage and bone three-dimensionally, and make precise adjustments to the bone and cartilage. These changes can be sutured in place to minimize later movement.
Rhinoplasty may be performed under deep intravenous sedation or general anesthesia on a day care basis. The majority of patients require the use of external and perhaps internal nasal splints for the first week after surgery. There is obligate bruising and swelling, especially if the nasal bones have to be fractured. This tends to resolve after the first 10 to 14 days, after which most patients feel comfortable going out in public. Swelling of the nose may persist for months, especially at the tip, and it is usually one year before the final result is apparent, so be a patient patient!