Beauty By a Nose by Elvira Maricic Rhinoplasty can have a dramatic effect on your appearance; just make sure you're realistic about the results print article      send to a friend

More than 130,000 people each year undergo rhinoplasty, the term used by plastic and cosmetic surgeons for nose surgery.  And while some opt for drastic changes like Grey's, others choose a more subtle effect.

A work in progress

In the procedure, the surgeon removes excess cartilage and bone in the nose to give it a straighter, smoother, and often smaller appearance. During the one to three-hour surgery, the surgeon may change the appearance of the nose by removing bumps, increasing the projection of the nasal tip, reducing or elevating the nasal tip, lengthening or narrowing the nose, and fixing deformities.

Most surgeons choose to do the procedure from within the nose, and the incisions are made inside the nostrils or at the base of the nose. The "open" or external procedure is usually performed in more complicated cases, and involves an incision that is made across the columella, the strip that separates the nostrils.

Rhinoplasty is done with either local anesthesia with sedation, or with general anesthesia, and the patient can usually get back to his or her regular life within one to two weeks.

Paul Pin, MD, a Texas cosmetic surgeon, says that rhinoplasty is a large part of his practice. "The two kinds of nasal surgery are things to make you breathe better, like straightening your nose if its crooked, and that would include septoplasty. Also, people have these things called turbinate which are like polyps (a mass of tissue that bulges or projects outward or upward ), and then there are operations to change your nose aesthetically.  Sometimes people have septoplasty just to improve their breathing, some people have a rhinoplasty to just improve the appearance of their nose, and other times they have a septo rhinoplasty, which would  kind of do both," he says

Mirror, mirror

Most cosmetic surgeons agree that the best candidate for rhinoplasty is one who has realistic expectations about the results of the surgery and is psychologically stable. Otherwise, the surgeon may refuse to operate on them. "If someone is very wound up about their nose and points out imperfections that you can't see, that's when it's best to turn them away," Dr. Pin says. He works closely with patients in determining what their nose will look like after the procedure. "There are several different ways to do this. Sometimes I will just give them a mirror and they'll show me what they don't like.  It's good to be ambiguous a little bit because it's difficult--it's not like an architectural plan where you say 'I want this to be 4 mm and this to be 2 mm'-- it just doesn't ever work out like that.  It's better if they say 'I want this part of my nose narrower, this to be more protruding, this to be more obvious.'" he says.

"Other patients want to be more specific. You can take pictures of them and go over the pictures with them and change things with shadowing.  Some people use computer imaging. I don't, because it's too easy to do on the computer and too hard to do in real life.  And once people see themselves [on the computer] with the nose they want, they tend to be displeased with anything less or different," he adds. 

The younger crowd

According to the American Society of Plastic Surgeons (ASPS), cosmetic surgery procedures increased 50 percent over the last two years to more than 1 million, and have risen 47 percent in the 51 to 64-year-old age group. While rhinoplasty wasn't one of the top five procedures requested in this group, it is a big hit with those 18 and younger.

Nose reshaping, or rhinoplasty, with 8,074 procedures in 1998, has held the top spot among this age group since 1992, when 5,519 procedures were performed, notes the ASPS. "Although we have seen an increase in procedures performed on this age group since 1992," says Paul Schnur, MD, ASPS President, "teenagers accounted for only 2 percent of plastic surgery patients in 1998."

Some surgeons, like Paul Pin, MD, flat-out refuse to operate on teenagers. ASPS advises parents whose teens are considering plastic surgery to appraise their teenager's physical and emotional maturity.  "The two most important things teenagers, parents and doctors need to understand are what the patient's motivation is to have surgery," says Dr. Schnur, "as well as a full understanding of what the realistic outcome will be."

According to the Society, the most rewarding outcomes are expected when the following conditions exist:

·         The teenager initiates the request. While parental support is essential, the teenager's own desire for plastic surgical improvement must be clearly expressed and repeated over a period of time.

·         The teenager has realistic goals. The young person must appreciate both the benefits and limitations of plastic surgery, avoiding unrealistic expectations about life changes that will occur as a result of the procedure.

·         The teenager has sufficient maturity. Symptoms of emotional distress must be reduced to a level that will permit the teenager to tolerate the discomfort and temporary disfigurement of a surgical procedure. Plastic surgery is not recommended for teenagers who are prone to mood swings or erratic behavior, who are abusing drugs and/or alcohol, or who are being treated for clinical depression or other mental illness.