Rhinoplasty, or cosmetic nose surgery, is not just about improving the outside appearance of the nose. An equally important goal is to preserve normal breathing functions, which is possible with proper patient selection, honest communication between a surgeon and his patient, and careful planning.
Proper patient selection is the first step to achieve desirable results. Aside from being physically fit, the right candidate for rhinoplasty or any elective plastic surgery should have realistic motives and expectations. For this reason, a prudent surgeon will turn down patients seeking secondary or tertiary procedure even their result is attractive by normal standard just because it does not conform to their unrealistic goals.
Patients who have had several rhinoplasties generally have a significant amount of scarring or skin contracture that is further aggravated by another surgery. Aside from higher risk of breathing disturbances, it is expected that the degree of cosmetic improvement would be limited, making another procedure no longer ideal.
Correct surgical planning also plays a crucial role in the prevention of postop complications such as breathing problem and unnatural appearance or deformity. Inland Empire plastic surgery expert Dr. Tarick Smaili says over-resection of the nasal cartilage is one of the most common causes of breathing disturbances.
Over-resection of the cartilage, which is the main structure supporting the lower two-thirds of the nose, is often the tool of “over-enthusiastic, inexperienced” surgeons whose only goal is to deliver the cosmetic goals of their patients without considering the architectural integrity of the nose.
In some cases, over-resection of the cartilage delivers the desired outcome short term, only to result in deformity (twisted nose, collapsed nostrils, droopy tip, etc.) and/or breathing problems later down the road because the structural integrity has been compromised.
Over-resection commonly occurs in reduction rhinoplasty in which the goal is to create a nose that looks proportionate to the rest of the facial features. To avoid a wide range of complications, it is important not to remove too much cartilage and to always take into consideration the changes that could occur due to natural aging of the face.
Reduction rhinoplasty should address bumps on the bridge, droopy tip, and/or excessively flared nostrils without affecting the architectural integrity of the nose.
Rhinoplasty is believed to be one of the most difficult plastic surgeries due to the involved anatomies and how they limit the amount of improvement. Further complicating things is the expectations of patients and doctors that are not always corresponding.