Rhinoplasty: A Matter of Time, Expertise and Vision

Rhinoplasty is widely considered one of the most challenging plastic surgery procedures. What then separates a good surgeon from one who is great?

According to Dr. Stafford Broumand, a board certified plastic surgeon in New York City, it is a matter of time, expertise and understanding the evolution of the nose. “Expertise in rhinoplasty takes years of practice and experience seeing how noses evolve,” he explains. “When you move cartilage around, it has a memory…it’s not like building blocks that remain where you put them.”

When the subject is nose reshaping, foreseeing pitfalls and anticipating how the tissue, bone, and cartilage will act in the future takes an enormous attention to detail and familiarity with the territory.

A Operation of Finesse

The size, shape and contour of the nose is influenced by heredity, trauma, or previous surgery. Creating a beautiful nose is more than a series of prescribed surgical steps—each nose is unique, and when done well a rhinoplasty can enhance other facial features bringing more harmony to a patient’s total look. “This is a finesse operation,” says Broumand. “It takes a lot of experience. It isn’t a static operation – it morphs and changes. So you want a surgeon who has done a lot of noses…someone who has had time to understand his or her outcomes.”

A poor result can be attributed to poor communication or lack of technique, or both. As a patient it is important to carefully vet the surgeon before making a final choice. “Having in depth experience of what each nose will look like when it’s done is part of my discussion with the patient during their consultation,” explains Broumand. “Over time the nose can lengthen, tissues can thin, the tip might become more glandular. Talking through the possibilities translates into better patient understanding of their eventual outcome.”

Can One “Order” a Celebrity Nose?

Often Broumand’s prospective patients bring in pictures from magazines or celebrity photos to demonstrate the nose they desire. “It’s a bit more complicated than copying a nose,” he admits. “Sometimes that celebrity nose will not look good on a particular patient. Facial structure dictates the optimal size and shape of the nose for a specific patient. You cannot put a cute little upturned nose on someone with thick skin and wide cheekbones.” In addition, Broumand makes the point that between lighting, makeup, and air brushing, many of the rich and famous don’t really look like their photos in person.

On the flip side, Broumand sees patients who want to remain incognito. He hears, “’I don’t want people to know I have had a nose job – I just want it to fit my face better than the nose I was born with.’” These patients are usually put at ease when Broumand discusses the general philosophy of great rhinoplasty operations. “I emphasize that I am here to tailor the operation to the demands, requirements and needs of the individual patient. Everyone doesn’t get the same nose. The nose I create for them will be tailored. One that enhances their personality, bone structure and other facial features.”

The Perfect Centerpiece

The nose is the most prominent part of the profile and should be proportionate and in relation to the overall appearance. Nose reshaping is one of the most interesting procedures compared to other facial surgeries primarily because both form and function are involved. The sculpting of the nose must be highly individualized to complement other facial features.

The size and shape of the nose can often have a significant impact on a person’s entire facial aesthetic. In addition, structural issues within the nose can lead to functional concerns such as impaired breathing. While a popular cosmetic procedure, nose reshaping can also correct structural abnormalities like a deviated septum, which can lead to breathing problems, chronic stuffiness, post-nasal drip, and even snoring.

According to Broumand, specifics of this procedure vary greatly depending upon a person’s concerns and desires. The overall size of the nose can be increased or decreased, bumps can be eliminated, nostril shape may be improved, and the bridge can be lowered or raised. The tip of the nose can be turned up or down and reduced or enlarged. His main priority is to reshape the nose to enhance a patient’s facial aesthetics without changing his or her “look”.

Technique vs. Expertise

Rhinoplasty revisions are feared by doctor and patient alike because quite simply mistakes are hard to hide. Doing it right the first time is paramount. The confidence of expert rhinoplasty surgeons is a function of both training and time. An experienced surgeon will take all the time necessary during surgery to deliver the best outcome, while anticipating the changes that may become evident over time as the nose evolves.

“I’ve done hundreds of rhinoplasty operations over the last 20 years,” shares Broumand. “Conceptually some think it is all about technique, but really time is the cornerstone of expertise.”

What Dr. Broumand wants you to know about rhinoplasty:

• It is a finesse operation that requires both experience and technique
• A wealth of experience helps the surgeon predict how the new nose will evolve over time
• Noses should be distinctive and tailored to the individual