Nose aesthetics are among the most frequent aesthetic operation in the world. Two decades ago if somebody talks about aesthetics it is understood as rhinoplasty. At that time and today rhinoplasty are named as “nose job” in lay population.
Why nose aesthetics are popular? In every culture and race face is the most important part in terms of beauty and nose is the main point of the face. When we talk to each other usually we look at our faces. Brain always makes a decision about the appearance of other’s faces. There are no mathematical formulas or measures for the beauty of the face but nose is a key point in the middle of the face and contribute to the beauty together with eyes, mouth and brows. Small changes of the nose shape have a huge impact on the perception of the face and this fact is well known for centuries. This is why the rhinoplasty is the first famous aesthetic operation in the history.
In nineteens there was a routine approach for all rhinoplasty operations. It was a some kind reduction operation. Almost always dorsal bone and cartilages were rasped or excised, cartilages of the most pointed part of the nose (tip) were weakened, length of the nose was shortened and the distal edge of the nose was tilted upward. The same template was used in all patients and the appearance after operation was more or less the same in all patients. At that time surgeons who perform this operation were limited and the prices were high so only limited number of the population could afford this operation. To have a nose job was a privilege and patients were happy with their “operated nose” appearance. On the other hand those operations were destroying the original structures of the nose and after some time (5 to 10 years) the appearance of the nose was getting more unnatural even ugly.
After two thousands social life and medicine changed considerably and also the concept of beauty. Advances in medical education and surgery made the aesthetic operations much more affordable and “natural beauty” became the favorite concept. Consequently easily recognizable “operated noses” were no more a privilege. In this new concept the shape of the nose should be in harmony with the face and that means every individual should be operated with a custom made preoperative design to give a natural but beautiful result.
Contemporary rhinoplasty is no more a template operation. The plastic surgeon must realize the unnatural parts of the nose and change only the necessary areas. Today we do some reduction or if it is necessary we do some additions. Most of the time we do reduction and addition at the same time without disposing any material (cartilage or bone) at the end of the surgery.
Minimizing the operation area only to necessary parts reduced the post operative pain and swelling also. New materials obsoleted the nasal packs which are the most stressful part of the operation for patients.
There is one another important point also. One of the main functions of the nose is to regulate the breathing. After an aesthetic nose operation if the patients could not breath comfortably this compromises the success of the operation. On the other hand if the patient’s problem includes difficulty in breathing than the rhinoplasty operation should correct first this problem and then perform cosmetic procedures. Indeed most of the time cosmetic problems and airway problems are deeply related to each other and for successful results both should be corrected together. If we want to give an example, deviated septum usually blocks the airway and also changes the symmetry of the nose. If we correct the deviation both symmetry and air passage return to normal.
Although aesthetic nose operations noticeably improved nowadays they are still in the difficult operations category. It is not because they are life threatening operations but they are very delicate operations. Even one millimeter change of the bone or cartilage results a huge difference in the appearance. Another difficulty is the overall result may not be predicted in the operating room because of the swelling and possible changes in the healing period. Consequently most of the time surgeons see the result weeks after the operation like patients and realize the degree of success or failure.
Obviously disease of the nose is in the territory of ENT (Ear, Nose and Throat) surgeons. But treating the diseases of the nose and aesthetics of the nose are completely different areas. For example Breast Surgeons treat the breast cancers but Plastic Surgeons perform the aesthetic breast operations. So the aesthetic nose operations should be done by Plastic Surgeons.