Noses are an unusual part of our anatomy. They sit in the centre of our face and are generally obvious on our face mostly because of there function. They are designed as something to breath through and to smell through. This means that they are essentially features in our faces which have a convoluted shape on the inside to humidify air as we breath in and to detect odours at the same time. They are not designed for an aesthetic purpose.
They come in a variety of shapes and sizes. Women’s noses are generally thought to be more petite than men’s noses. This is in the context of female facial characteristics as apposed to male characteristics which are generally larger and thicker set.
Ethnicity plays a significant part in the shape of our nose. Middle Eastern noses, Asian noses, European noses, Aboriginal or Islander noses are all distinctly different variations on a theme.
They also seem to changes as we grow older, obviously the cute button nose of our childhood changes through youth to a more defined adult nose and adult noses do seem to change progressively with time.
For some people the nose can present a problem. That problem may be one of function, it may be one of appearance or it may be a combination of both.
The most common functional problems relate to the airway. These can be simple but disturbing problems like hay fever causing blockage of the nose through to more complex and persistent problems such as distinct anatomical narrowing of the airways. The narrowing can be so severe to result in a virtual inability to breath through the nose.
The sense of smell is more rarely a cause for concern but there are individuals who suffer the condition of Anosmia and who are therefore unable to distinguish different odours.
Trauma is a common cause of problems to the nose. Most of the facial bony structure is fairly solid, but the nose is much less so in that the bones are thinner and there is a substantial component of the nose made of cartilage. This means that trauma can relatively easily bring about a distortion of the nose both in its external appearance and its airway.
The other reasons that a nose can be a problem for any individual relate to its shape and size.
Many people are concerned about the size of their nose and in particular what they refer to as the “dorsal hump”. People are concerned about the shape of the tip, the width of the nose and how much the tip hangs down.
Some people find the size of their nose disturbing in relationship to the overall size of their face, usually this is a problem where the nose appears too large in the respect to the proportions of the face.
In general to correct anatomical deformity of the nose where it affects the breathing or the appearance of the nose, surgery is the only real solution.
Where the problem is purely one of airway restriction, surgery can be performed to straighten the septum(septoplasty) of the nose or to reduce the size of the bones which sit inside the nose and whose job it is to humidify air as it is breathed in. This sort of surgery is generally performed by Ear Nose and Throat Surgeons or Plastic Surgeons.
Where the external appearance of the nose is a concern, surgery is most often performed by Plastic Surgeons.
Plastic Surgery to correct the shape of the nose is called Rhinoplasty. This may mean alterations to the bone, the cartilage, the skin or even all three.
Rhinoplasty is commonly performed as an open rhinoplasty where there are cuts inside the nostril and a small cut across the tissue between the nostrils to allow open access to the underlying skeleton of the nose, or as a closed rhinoplasty where the incisions are essentially the same but without the cut across the lower part of the central piece of tissue.
Surgery to correct the shape of the nose may involve removal of the dorsal humpby filing it down or removing it using a scalpel, a saw, and a chisel. Occasionally pieces of cartilage or other splinting material are placed into the dorsum of the nose to build the dorsum of the nose up. The tip of the nose is often reduced by removing some of the lower cartilage. Similarly it is also often reshaped or built up at the very point of the tip to give the tip a subtle prominence over the dorsum of the nose. Occasionally the nose requires narrowing by using a chisel to fracture the lateral nasal bones inwards.
There are a myriad of minor variations that can be carried out during a rhinoplasty to optimise the affect. Indeed rhinoplasty is one of those operations where a certain amount of work is done and the nose is then resembled and reassessed before more work is done. This process might be carried out a number of times during the operation.
After the operation whether it be for septoplasty, a rhinoplasty or a combination of both, the nose is usually packed and there is usually an external splint applied to the nose. These dressings will stay on for a variable period, which may be as long as two weeks.
The nose is one of the areas of cosmetic plastic surgery where I find it can be exacting to meet the expectations or desires of the patient. For this reason I feel it is very appropriate that patients do have realistic expectations of the operation. It is important that patients are able to except that their nose is very individually their nose and it may not be possible to achieve Michelle Pfeiffer’s nose on their insistance. I have had consultations where patients have brought photographs from the internet suggesting that they would like there nose to look like one of the noses from the internet. Almost invariably the patient’s nose does not bear any resemblance to the internet nose prior to its operation.
Furthermore, patients are often somewhat disturbed by their nose in the early post operative period. They are no longer looking at the same person when they are looking in the mirror and it may take a little while for their body image to adapt. I have had patients who have in the first couple of weeks post operation been quite worried by the changes produced but at 6 months they have been absolutely delighted.
I think rhinoplasty is one of the most intricate, challenging and enjoyable operations in the spectrum of Cosmetic Plastic Surgery. The operative period can be stressful but to be able to breathe more easily through a nose which you like the appearance of, is a very pleasing outcome.