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About Face

Chapter Eight The Nose The Psychology of Rhinoplasty Patients Expectations Initial Surgery Making the Nose Smaller Saddle Nose Columella Deformity Revisional Treatment Recovery

Initial Surgery

Making the Nose Smaller

The number and type of rhinoplasty operations are as various as the people who want them. I’ll explain a couple of the more popular requests for rhinoplasty, but these are by no means representative of the entire spectrum of nasal plastic surgery.

The most common request for rhinoplasty comes from people who want their nose made smaller and a bump on the bridge removed at the same time. This involves utilizing three or four of the fifty-five possible maneuvers I could do. For one, the tip of the nose will be “dropped” by surgically adjusting the parts of the nose that support the tip. This allows the tip to descend slightly, making the nose appear smaller. Once this is done, the nasal profile is checked and adjusted if necessary so that it remains straight.

To remove the bump, which is made up of an excess of cartilage and bone on the dorsum, we open up the nose to remove the excess with a hammer and chisel, and specialized cartilage shears. Once the bump is gone, the “nasal pyramid” must be reconstructed. The “pyramid” is the overall shape of the bridge of the nose as it relates to the cheeks. Reconstruction involves fracturing the nasal bones where they attach to the cheeks, then setting them to reconstitute the bony and cartilaginous “pyramid.”

Any number of tip-narrowing techniques can be employed to make a nose look smaller, depending on the size of the tip to being with and its relation to the rest of the nose. Most often, a patient will initiate surgery by complaining of the tip that looks “boxy” - square-shaped and fleshy. It is rare that simple tip narrowing will solve the problem; usually I combine this maneuver with others to achieve the best result.

Finally, facial plastic surgery can be used to make a nose look smaller by “shortening” a long nose. The nose might appear to be too long only in relation to the rest of the patient’s face. More likely, however, the nose looks long because the angle between the upper lip and the columella is less than ninety degrees. (The columella is the cartilage and soft tissue that divide the nostrils from the tip of the nose to the top of the philtrum.) When this angle is raised, it looks like the nose has been “shortened,” which leaves the impression that it is smaller. A rule of thumb is that surgeons try to give women an angle of about 110 to 120 degrees; men look best with an angle between 90 and 110 degrees.

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