Rhinoplasty, or nasal re-shaping surgery, is arguably the most challenging and complex operation in facial plastic surgery. The nose is a defining feature of the face.
In no other area are both function and appearance so intimately related. When the nose is straight, appropriately proportioned and aesthetically pleasing, the nose blends into and balances the other facial features. The nose doesn’t draw attention and focus remains ideally on a person’s eyes. However, when the nose is deviated to one side, twisted, too large, too small, or otherwise out of proportionate with a person’s other facial features, the nose draws attention away from the eyes.
There are a number of reasons a person may seek to change the appearance of their nose. They may dislike a hump on the dorsum of the nose, or feel the bridge is too wide. They may feel the nose is too short or too long for their face, or have concerns about the width, size, or shape of the nasal tip. And in many cases, they may have a number of these concerns.
The nose is also functionally important. Our noses breathe for us, warm, humidify and filter the air we breathe, and provide our sense of smell. It is critical to preserve and sometimes improve these functions when crafting a new nose. Because nasal function is intimately associated with nasal form, a nose that does not breathe well often has structural problems that contribute to a less appealing appearance as well. For this reason, the facial plastic surgeon must be well-versed in facial analysis, nasal analysis and the surgical techniques required to meet both a person’s cosmetic and functional objectives.
AESTHETIC VS. FUNCTIONAL RHINOPLASTY
As previously mentioned, the nose is both a defining element of our unique outward appearance and serves a number of functions. Patients typically seek consultation for one of these reasons or the other, only to find that both may be an issue. Many cosmetic nasal surgeries do not need to improve nasal breathing, but they certainly must maintain it when a nose is already functioning well. Similarly, improving the nasal airway in certain patients may also translate into an improved outward appearance. It is important for your surgeon to evaluate all of these factors at your consultation, and educate you on the steps needed to reach your goals.
PRIMARY VS. REVISION RHINOPLASTY
Most patients seeking their first (primary) surgery to improve the appearance of their nose are generally younger. This can be due to many factors. Many patients notice their nose changes in shape and size as they age from early adolescence, through puberty, and into early adulthood. It is during this time in life that family and ethnic traits may become more pronounced as the nose grows. In addition, some patients may have suffered a trauma to their nose at an early age, which can adversely influence nasal growth. These cases are challenging for a number of reasons, but your surgeon does have the luxury of knowing that your nose has not been surgically altered before. This type of nasal surgery is rewarding for both you and your surgeon as the outcome can improve nasal function, facial harmony, and self-confidence!
Revision nasal surgery should produce the same results, but the surgeon must face the added challenge that the nose has been operated on before. In these cases, there is often uncertainty about procedures previously performed, the nose may have been weakened, the amount of material (cartilage) that remains in the nose can be unreliable, and scar tissue will undoubtedly be encountered. Each of these factors, and many others, collectively increase the complexity and risks of revision rhinoplasty. You should trust your nose to an experienced facial plastic surgeon like Dr. Stallworth, to you help achieve the cosmetic and functional outcome you desire.
AGE OF RHINOPLASTY PATIENTS
There are special circumstances and considerations for nasal surgery at different ages of life. In general, nasal surgery is avoided in pediatric patients. Surgery, itself, is traumatic, and manipulation of the pediatric nose can have deleterious effects on nasal growth – having an impact on bone, cartilage, and the skin (soft tissue envelope). Even so, there are specific circumstances where nasal surgery cannot be avoided. These include instances when children are born with congenital anomalies like a cleft lip and nose or in cases of certain growths and tumors found in infants and young children. In addition, trauma or another factor that impacts nasal growth can lead to complete obstruction of nasal breathing and distortion of nasal appearance. In these cases, surgery may be the only option to reconstruct the nose and provide a child with the ability to breathe.
More commonly, young patients present with an interest making cosmetic changes to their nose. Despite good health and appropriate motivation, though, young men and women may not be old enough to undergo nasal reshaping surgery. Ideally, rhinoplasty is not undertaken until facial and nasal growth has completed. In general, nasal growth in young women is typically complete between fifteen (15) and seventeen (17) years of age. For young men, this may be at a later age of sixteen (16) to eighteen (18) years old. These ages are only guidelines and may vary greatly from person to person. Ultimately, Dr. Stallworth will need to meet with a patient to determine their candidacy for surgery.
Rhinoplasty is not limited to the younger patient, but, rather, is possible at any age. In the more senior patient, though, new considerations must be taken. There is some evidence that nasal cartilage growth may continue throughout adulthood, leading to an increase in nasal size. More often, though, the suspension ligaments of the nose weaken with time leading to a drooping of the nasal tip and an apparent lengthening of the nose. This cannot only make the nose look less appealing, but also negatively impacts breathing. Patients suffering from these unwanted changes are also good candidates for rhinoplasty to help restore their nasal appearance and nose function.
Nasal shape is a product of genetics, sex, and ethnicity. Thus, altering nasal characteristics may alter a person’s ethnic appearance and familial traits. While some patients may seek rhinoplasty for this very reason, they should discuss these factors with their surgeon to ensure they understand the risks and benefits of nasal surgery, and to ensure they convey their wishes to their surgeon. Cartilage length, width, and orientation, nasal bone length, skin thickness, and even nasal strength are all factors impacted by ethnicity. This is particular true for patients of African, Asian, and Latin descent. Practicing rhinoplasty in San Antonio, Dr. Stallworth is especially well-versed in the anatomy of Hispanic, Latino, and other Mestizo noses. Working together, he can help you achieve improved nasal aesthetics and function while working to maintain your ethnic and familial heritage.