On Naturalness in Rhinoplasty
9 August 2021 onur
The majority of my patients say that the most important reason why they prefer me is that they find the noses I do ‘natural’. Some of them are quite confused about the concept of naturalness.
Maybe a significantly greater number of patients than those I operate turn to other colleagues of mine because they find my style too natural.
What is naturalness in rhinoplasty?
What kind of an interaction is there between naturalness and rhinoplasty?
What kind of an interaction is there between naturalness and nasal functions?
How is naturalness achieved in rhinoplasty?
In order to understand what is natural, you need to objectively observe an object as it is found in nature. You have to leave your imagination out while doing that.
When you look at people living in nature, you see hundreds of different nose structures. The nose structure of each race is different from each other. There are major differences between men and women. Congenital problems affect 2-3% of the entire population. Traumatic deformities are observed in 80% of men and 30-40% of women.
The concept of naturalness includes diversity and imperfection in itself. For instance, a large and crooked nose is also natural. A nose that is perfectly natural for a Korean woman may be unacceptable for a Turkish girl.
So can we say what is natural is also beautiful?
Mostly we cannot.
Up to 10% of 100 noses in nature are considered reasonable by rhinoplasty candidates, while 2-3% are regarded as desirable.
Therefore, the majority of our patients actually does not want a natural nose but one that is close to the ideal nose. Our main goal in rhinoplasty is to obtain a nose structure that is close to the ideal.
Speaking of what the ideal nose structure is, the options are narrowed down, and the diversity decreases. Certain proportions/dimensions are determined by taking an average of the features perceived as beautiful by 99% of people. When we target the “ideal” in rhinoplasty, we act according to some predetermined proportions and dimensions. Mathematics, physics and biology all come into play.
On the other hand, when you look at men and women who are very beautiful and whose beauties are considered highly original and unique, you see that most of them do not have the ideal nose on their faces. You can observe a slight arch, a slightly wider nose tip, a slight asymmetry or slight deviations from ideal proportions and dimensions in the vast majority of “iconically” beautiful people.
In rhinoplasty, I like to stretch the ideal proportions and dimensions slightly, deliberately leaving minor imperfections on the nose and particularly preserving the uniquely personal features to a certain extent. You can consider this rule of flexibility for the sake of naturalness as a minor deviation of 10% from ideal proportions.
When we are to add a natural nuance to the nose, we decide on that according to the overall facial structure of the patient. It is critical to evaluate the entire face in rhinoplasty. Particularly in patients with a stunningly beautiful eye and mouth structure, it is absolutely necessary not to design a very assertive nose per se. In personal interaction, 80% of one’s attention focuses on the other person’s eyes while 15% goes to their perioral area around the mouth. In the remaining limited time, we see other structures of the face. So no one normally focuses on another person’s nose. A nose should be beautiful but not too catchy. When the nose draws too much attention, it takes the attention away from the eyes/lips and disturbs the viewer aesthetically even if it is beautiful on its own. However, there are some special cases where we want the nose to draw attention by itself. Therefore, while noses that are ‘done’ suit some faces, they may look very unnatural in others.
One of the most important criteria of naturalness in rhinoplasty is the absence of deformities in the patient’s nose to impart a nose job. For instance, minor deformities – as mentioned above – such as a slight arch, slightly wide nasal tip cartilages, symmetrical slopes in the aesthetic lines of the nasal ridge and a slightly wider nasal floor do not evoke the appearance of a nose done. However, all observers will understand when the tip of the nose is too thin or too angled, when the arch is too low or when the nasal tip is too high that such deformities cannot be found in nature and can only occur as a result of an operation.
In my practice, such deformities, which at first glance reveal that a nose has been operated, are indications for revision.
I prefer the open structural ultrasonic rhinoplasty technique in order to achieve the aforementioned natural nuances in rhinoplasty. The technical richness, mastery of details and postoperative stability offered by this approach provide great advantages on the way to naturalness.
Another point related to naturalness is the personal preferences of rhinoplasty candidates. Sometimes patients do not genuinely want a natural nose. Sometimes they are afraid of the people around them, and sometimes they cannot admit their unwillingness to themselves. However, if a person will not be happy with a natural nose, they should definitely share this with their doctor before the operation. Although I strongly respect the wishes of my patients who say ‘I don’t want a natural nose’ or who want a nose structure beyond my naturalness criteria in the preoperative simulation, I refuse to operate them for personal reasons.
In the early stages of my career, there were times when I performed surgery by prioritizing the wishes of patients. This approach has some fundamental problems. First of all, patients’ wishes and tastes change over time. 10 years from now, an 18-year-old young woman may not like a nose she loves today. A tactless comment by a person you have just met will turn you off in a second from the assertive nose shape that you have so willingly and empathetically gotten done. Patients may come back 5-10 years later and say, “Doc, I wanted this nose back then, but why did you say OK and do it for me?” or “I didn’t know that the nose I wanted would look like this on my face. Why didn’t you warn me?” Thus, I do not sacrifice naturalness just because patients want me to do so.
Finally, it is useful to know that there is a relationship between naturalness and nasal functions. Take a look at Disney characters or Japanese anime characters. You will see huge eyes but a tiny nose. Just look at the faces of babies that we all find beautiful without exception: huge eyes and a tiny nose. They may be called a button nose, which is a compliment. Small noses are often perceived to be more beautiful. Out of two noses with exactly the same shape, 95% of patients prefer the one that is 10% smaller. However, as the nose is surgically reduced, its function also decreases.
Classic “reduction” surgeries have disastrous effects on the airway. I have a surgical technique called “volumetric nasal osteoplasty” that I have developed to maximally protect the inner volume of the nose in rhinoplasty. I’m a little obsessed with this. I think it is absolutely necessary in terms of both function and naturalness to preserve the dimensions of the nose and the width of the dorsum-bone base-alar base to a certain extent. If you are enthusiastic about the recently-popular 3K or 4K (small/short/curved/upturned) surgical approaches, I recommend you consider the matter from this perspective.
Please feel free to contact us for more detailed information on naturalness in rhinoplasty.
Take good care… of yourself and your beauty.