When I was a Plastic Surgery Chief Resident, I spent a few months in Manhattan on the cosmetic surgery service of the prestigious Manhattan Eye and Ear Hospital. It was December, and since we had a newborn, and my wife was a busy Resident as well, I couldn’t really move to NYC for my rotation. So I would get up before the crack of dawn every day, and take the train into Manhattan. Sounds pretty crazy now, but what I was exposed to and learned was so exciting, it seemed perfectly logical at the time.

I was fascinated by the parade of teenage girls from Long Island who would come in for the “Christmas Rhinoplasty”. The surgeries really made a dramatic difference in their lives, and it was remarkable just how many people wanted rhinoplasty and got it at that particular vacation time.

Nose reshaping is known as Rhinoplasty, or of course a “nose job” which is the most popular procedure among 13 to 19 year olds. Since the nose essentially doesn’t change much from puberty on up, it is entirely appropriate to get this surgery as a teenager. The second time in a person’s life when the nose becomes an issue and one considers having it reshaped is later in life when the skin thins on the nose and the nose appears to grow. The old wives tale that your nose grows as you get older isn’t exactly true. What happens is the support of the tissues thins out and so the skin and the cartilage start to extend and droop.

When you are considering having your nose reshaped, it’s most important to ask about the surgeons’ comfort with doing the operation; their training; and to ask how many of the operations the surgeon has performed, as well as see the before and after photos. As with any operation, it’s always important to talk to other people who have had the surgery done if at all possible. It’s important to remember that with any facial surgery, there are fewer people who are likely to either allow their photographs to be shown or even talk to people. Often times, however you can talk to a previous patient over the phone, granting them a little anonymity.

What exactly is involved in having your nose reshaped? It really depends on the problem areas. For some people the only requirement is a minor alteration of the bone, which curves and gives the appearance of a “hump”. For others not only does the hump need to be removed, the nasal bones need to be more narrow; the tip may need a significant amount of work so that it looks more refined and delicate. This is the usual scenario and surgery can be performed either through an endonasal (“closed” approach) or an external (“open” approach) also known as a “rhinoplasty”.

Much of the decision about technique has to do with how much tip work is done, and when more tip work needs to be done, we have a tendency to do the “open approach technique” so that there is more direct visualization of the cartilages and they can be better manipulated. Otolaryngologists (ENT Facial Plastic Surgeons) have a lot of familiarity with working on the nose from inside the nostrils without outside incisions, and may have a tendency to favor the endonasal (approach) though the popularity of the “open approach” has continued to expand as we’ve trained more and more surgeons with this technique. I think some of the reason that so many have been trained in this way is that it’s a lot easier to teach, and there tends to be a slightly greater amount of predictability in the result.

What could go wrong? Well, aside from not getting the appearance you were looking for, there can be asymmetries, curves, twists and even collapse of some areas due to the “memory” of cartilage. And you can develop problems with your airway – in other words difficulty breathing through your nose. If you have septal work, you could even get a septal perforation! Most of these are unlikely, but the most common are asymmetries or crookedness. And the nose changes as we age (just look at old and recent pictures of Harrison Ford, or even Sting before he had his corrected) so asymmetries and crookedness could show up decades later. Regardless, even in the best of situations, there will be some swelling that will disguise the refinements you will ultimately see, so please be patient!

And speaking of vacation time, you should plan to take a good week to two weeks where you can hide out a bit. After surgery you will have bruising, and certainly you will have a splint on the outside of your nose, so you’ll be pretty visible. Not that that’s a problem for some people. I mean, I’ve been on airplanes and noticed people with big splints on their nose! I’ve even seen people on airplanes that have clearly had facelifts! You never know what you are going to find when you board a plane.



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