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The Right Nose for the Face, or Adventures in Rhinoplasty

09/06/2016 1:31 AM IST | Updated 09/06/2017 2:42 PM IST

Rhinoplasty, commonly known as a "nose job," is not just a 20th-century cosmetic procedure. In fact, the earliest rhinoplasty was recorded in ancient India, by an Ayurvedic physician Sushruta (c800 BC), who described the necessity for reconstruction of the nose due to the mutilation of a criminal's face, religious, political or military punishment.

From the rudimentary beginnings, Rhinoplasty has evolved from strictly a repair procedure, which was perfected by an English physician, Joseph Constantine Carpue. His technique is now referred to as "Carpue's Operation." It involved using a flap of skin taken from the forehead and placed over the nose to reshape or repair damaged cartilage.

Changes in Rhinoplasty Procedures

Today, centuries later, there are multiple surgical techniques that can repair breathing or damage as well as perfect the aesthetics of the nose. Particular attention is being paid to the ethnicity of the patient. "I custom design each nose for each face. For example, a scooped nose would not look natural on a Middle Eastern male and even some females. Latinos can sometimes have thicker nasal skin, which makes it important to do certain tip maneuvers specific to these patients" says Dr. Richard Zoumalan, a double board certified facial plastic surgeon in Beverly Hills.

Plastic or cosmetic surgery, in general, has enjoyed a larger field of acceptance for women as well as men. Overall, 15.6 million cosmetic procedures, including both minimally-invasive and surgical, were performed in the United States in 2014, an increase of 3 percent since 2013, according to the American Society of Plastic Surgeons (ASPS).

Of the various procedures performed, rhinoplasty has led the list. In their 2015 survey, the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) showed that rhinoplasty is the most requested surgical procedure, followed by Blepharoplasty (eyelid surgery) and facelifts.

It's all in the details

For cosmetic procedures, just straightening a crooked nose or narrowing the sides is not enough. There is much more to reshaping the nose that a plastic surgeon must take into account. In addition to the physical and aesthetic point of view, surgeons want to be sure the patient is realistic about what the changes will mean to them beyond altering their features.

A helpful tool in this regard is the advent of a 3-Dimensional imaging device. The 3-D camera allows the patient and the surgeon to see what various noses will look like on the patient. They can "try on various options such as a smoother slope, narrow tip and smaller or wider nostrils before undergoing the knife.

Surgical planning

As the number one requested cosmetic procedures, rhinoplasty is considered the most challenging. Over time, a myriad number of surgical approaches to artistically modify and alter the contour as well as the function of the nose have been created.

Ethnicity is just one fundamental added to the custom styling of nasal contours, but not the only factor when considering alterations desired in rhinoplasty..

Cosmetic and reconstructive code of practice is the fundamental basis for all surgeries taking into account the many advances made in performing all cosmetic procedures and especially for rhinoplasty. Advancement in materials and technique for nasal analysis has grown. Practitioners can now see into the nasal reconstruction in more detail, thereby improving the options for refinement with better information.

Prerequisites of rhinoplasty

The basics of a rhinoplasty procedure are required for every patient. It begins with an analysis of the whole patient, including the ethnicity of the patient and how that may determine important factors like:

· How much of the bump to remove.

· Whether the patient would look good with a strong bridge or a smaller one.

· How narrow to make the nose.

· Whether nostrils need to be reduced.

Ethnicity, whether it be Caucasian, Latino, Middle-Eastern or any other race will determine the overall design.

However, Dr. Zoumalan says, "In the final analysis, the nose must fit the face."

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