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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

C H A P T E R E I G H T

The Nose

RHINOPLASTY, ANY GOOD DICTIONARY will crisply define it as “surgery of the nose.” The word comes from Rhino, the Greek word for nose, and plasto, the Greek word for formed, or molded. It is always a bit of a shock for me to see Rhinoplasty reduced to such simple terms, as though you could describe love as a strong predilection, or murder as a deplorable activity. In fact, Rhinoplasty is such an emotionally charged area of a cosmetic surgeon’s repertoire that it often encompasses love, and occasionally extends to murder.

The Psychology of Rhinoplasty Patients

Dr. Mary Ruth Wright, associate clinical professor of psychology at Baylor College of Medicine in Houston, and a long-time friend of mine, has written some fascinating material on the psychology of patients who undergo Rhinoplasty. As I mentioned earlier, Dr. Wright and others have spent years analyzing the psychological significance of the nose. Their conclusion is that the nose is an important as the sexual organs to an individual’s self-image or body-image. It makes sense if you look at it in a kind of cursory, scinical way: like the vagina, a nose is an orifice that sometimes emits mucus and has a tendency to bleed; like the penis, a nose undergoes a spurt of growth in adolescence, it contains erectile tissue that can be affected by psychic influences (for example, fear or anger), and it protrudes from the body. This last bit of physical detail, the fact that the nose protrudes, might be the key to understanding why male patients are much more likely than female patients to be upset by the outcome of Rhinoplasty. Some psychologists maintain that all features of the human body that are “extended” - such as the penis, fingers, toes, even arms and legs - are the subjects of a deep, subconscious fear that they might be lost, or separated from the body. Hence, a male who subconsciously fears castration might transfer this fear, without understanding it, to his nose. If he is psychotically disturbed, this could elicit an unreasonable rage against his “castrator,” the rhinoplastic surgeon.

Female patients, when they are disturbed by Rhinoplasty, rarely exhibit this kind of rage. But they do show other signs of deep-seated, subconscious worry. Cosmetic surgeons are warned to watch for the female patient who seems upset by examination with a small nasal speculum (a metal instrument that we use to enlarge and examine the interior of the nose). It could be that she is equating the examination with genital mutilation and it probably would be unwise to proceed with surgery.

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