Nose

1. From the side, the bridge is straight in the male and may be straight or have a mild sloping in the female.
2. The tip comes straight out or has a slight upturn.  From the side, the tip makes a 100 degree angle with the upper lip.
3. The tip is no wider than the bridge.
4. From the front, the bridge is well-defined.
5. The nose is straight and symmetric.
6. The outer skin of the nostrils is no wider than the inner corners of the eye.
7. The shape of the skin that forms the nostrils has a roundness that compliments the tip.
8. The tip is defined.  The edges of cartilage bring it to a clear point.

COMMENT:  In no other structure than the nose are the rules of beauty so variable.  In general, the smaller the nose the better.  Classically, the nose is meant to breath and not be seen.  We adorn the eyes and the lips to increase their beauty, but the nose is not considered a center of beauty. Again, ethnic variations and different characteristics may lend unique positive qualities to different noses.  Exceptions to these rules are common.

1. Have a picture taken of your nose.  Face only.  One straight from the front and one directly from the side.
2. Draw on the profile photo and erase or increase the bridge as you desire.
3. Does the tip come out too far from your face?  Maybe the tip doesn't come out far enough.  That is a problem with projection.
4. Is the tip too high or too low?  That is a problem with rotation.
5. Check the front view.  Is the crest of your nose straight?  Does the tip point in one direction?
6. Are the nostrils symmetric?  Do they pass the corners of your eye?
7. Is there definition in your nose?  Is the base too broad and flat?  Is the tip too round and bulbous? 

1. Virtually anything can be changed but sometimes at a price.
2. If the nose is made too small breathing problems can develop.  The smaller the nose, the harder it may be to breath.  This is particularly the case if the base is reduced.
3. Thick skin can limit the appearance of definition in the nose.  Very thick skin can be thinned but mildly thick skin may not be worth the risk.
4. Perfect is the enemy of good.  So often patients tell me they don't need it to be perfect, then describe the perfect result that they want!
5. Results from revision surgery may be less beneficial than the first surgery, but not always.  Sometimes at the first surgery key changes were not made at all.
6. Scarring can occur at the bottom of the nose if the nostrils are reduced.  The more skin removed, the more tension on the tissue, and the worse the scarring.  Otherwise, all of the surgery can be done from inside the nose.
7. The breathing can always be improved by increasing the size back to the original conditions.  It amazes me how many patients would rather suffer with a blocked nose than have it widened again.
8. A perfectly straight nose can be achieved 95% of the time. Proper tip height as well.  Tip definition and other features can all be improved 95% of the time as well.  A lot depends on what you start with.

1. Rhinoplasty

In the view of many plastic surgeons, the nose is the flagship of plastic surgery, since in many individuals it sets the tone of the face and to some extent on a structural basis, is the only aspect of the face and human body that has its own unique qualities.  Whereas eyelid and facial surgery is strictly a question of removing wrinkles and folds, nose surgery involves fairly complex relationships. 

In the scheme of facial beauty, the nose has a peculiar role in that it is basically meant to breath and not to be seen.  When make-up is applied to the face, the eyes are adorned to make them alluring and lipstick is applied to create luscious lips but the nose is left to stand on its own. 

It is important to keep in mind that the nose is a functional organ as well as a cosmetic entity and that the two are connected. There is a give and take.  The nose must be big enough to breathe but small enough to look good. 

 Sometimes the patient is the culprit.  In their zeal to obtain the smallest nose possible, they persuade the doctor to reduce the size too much, thereby eliminating some of the significant structural support.  Comply with the doctor's wisdom if they suggest that some aspects of the width or the base need to remain intact. 

Most curious is the fact that sometimes a large nose can breath worse than a small nose.  When the nose itself is too long and thin, the inward motion of air may create a drafting effect.  Then, the sidewalls may collapse and reduce the airway. 

In regards to cosmetics, let's discuss each area of the nose as a separate unit.   There are three general areas of discussion from the layman's point of view. 

1. BRIDGE:  The upper portion of the nose down to the tip. 
2. TIP:  The point of the nose above the nostrils. 
3. BASE:  The width of the nostrils. 

A lot has been written about the aesthetics of the tip of the nose and the relative proportions and proper distances.  As a patient, it is probably best not to get bogged down in the discussion of these proportions with your doctor and to reach some general agreement on what your nose needs. 

There are also gradations of surgical procedures that require more or less surgery to the tip.  Less surgery is often better.  In plastic surgery, our general rule also for patients to keep in mind, as much as they fight it, is that "perfect is the enemy of good".   If the nose has small problems, little areas of crookedness or the tip is not particularly small, these defects may keep it looking natural and might be better off left alone.

 Many times when a patient will come up to me thinking they have a perfect nose, I am often delighted to find that there are many imperfections that the patient does not notice. 

1. PROTECT THE NOSE FROM DIRECT SUNLIGHT FOR THE FIRST THREE TO SIX MONTHS AFTER SURGERY.  IT WILL SUNBURN EASILY.  IF IT BECOMES SUNBURNT, IT MAY TAKE MONTHS FOR THE REDNESS TO GO AWAY. Everyone is different and some noses are more sun sensitive than others.  Make your first sun exposures short and see what happens. 
2. Continue the STEAM, once daily, for two or three months after surgery. 
3. PRESSING EXERCISES 
4. The doctor may instruct you on a pressing exercise to help the nose settle straight and smooth.  Follow this program religiously.
5. No heavy exercise for the first two weeks after surgery.  After that you can build up according to your ability. 
6. Do not play with your nose.  It will increase the scarring. 
7. If your nose gets hit again, don't worry.  It can be reset at any time.  In most instances, the nose has about the same strength as before surgery once it has healed.

NOSE COMPLICATIONS

1. UNSATISFACTORY APPEARANCE: Routinely, we wait six months to one year to make adjustments in the tip or bridge because so many problems seem to resolve with time.  Problems with crookedness may be treated earlier. 
2. BREATHING PROBLEMS: Too much tissue has been removed.  The tip or bridge area must be built up again.  Sometimes, the inside of the nose needs just a little more work, too.
3. SCARRING: If a lot of tissue is removed from the base, noticeable scarring may develop.  This may be difficult to repair.
4. LOSS OF IMPLANT: Tissue grafts may reabsorb and need to be replaced.  Plastic implants may get infected or displaced and also need revision.