Shape vs. Size In Rhinoplasty
3 December 2019 onur
Under ideal conditions, the resulting noses after rhinoplasty are close to ideal in terms of both shape and size. But under ideal conditions.
So what are these ideal conditions? In what percentage of patients are the conditions ideal?
Under ideal conditions in terms of rhinoplasty, the nose already has a size compatible with the face, the skin is neither too thick nor too thin, the cartilages are strong, the nostrils are small, the transition between the forehead and the nose is neither too high nor too low, there is no serious curvature or cartilage damage in the nose that will result in the loss of structural height.
When we deviate from ideal conditions (almost 80% of patients have one or more non-ideal structural features), it may not be possible to achieve an ideal result. In that case, as in all areas of life, it is necessary to decide between options and determine priorities.
In our geography, patients who are candidates for rhinoplasty (nose job) generally like and desire smaller noses. However, the noses of most of the candidate patients are initially quite voluminous and large. A significant portion of patients who preoperatively show me a photograph and say “I want this nose” desires small noses compared to their faces and their current nose structures. Reducing the nose comes with its own set of problems, and patients have little knowledge of the risks and limits of reduction. This article is written to make up for that lack of information.
We do not cut or reduce the skin in rhinoplasty. So the skin remains intact. We shape the underlying skeleton and hope the skin remodels on this new skeleton to cover it nicely. The skin has a certain potential for shrinking or “pull”, and this potential varies from one person to another. If we reduce the nasal skeleton excessively, the skin covering a large surface preoperatively may appear loose and misshapen on the new, smaller skeleton. Imagine that you bought a leather jacket when you weighed 100 kg and then you lost 50 kg. The jacket will look makeshift on you. In rhinoplasty, there is something that is somewhat similar to this example. Although there are exceptions, as a basic principle, the total volume of the nose should not be changed by more than 10-15%. The nose may lose its angular character, edges, corners and light distribution, in other words, its ‘definition’, in cases where the skeleton is reduced too much but the skin cannot shrink enough and fail to adapt to the new skeleton.
Another result of excessive structural reduction of the nose is the narrowing of the airway parallel to the nasal volume, and even exponentially sometimes. It would of course be delusional to switch from a very large nose to a small one and expect the tiny nose to breathe as good as it did before.
Particularly in patients with wide nose wings and large nostrils, it is useful to be more careful when reducing the nose. When the nose gets smaller, the wings will appear relatively larger. Therefore, if the nose is reduced and the height of the nasal tip is decreased in a patient who already has wide nose wings, it will definitely be necessary to reduce the wings as well. Wing reduction both leaves a permanent scar behind and is an irreversible step. So if you don’t like it, it cannot be restored.
Reducing the nose excessively is not a strategy we like very much in these respects, but some patients rarely and unavoidably require dramatic reductions. I have had patients with very large, monumental noses, and I had to reduce the nose by 30-40% at the expense of causing the disadvantages above. If this reflects your case, you can take risks and limitations into consideration and still prefer to get your nose reduced.
We consider many other details while determining the new shape of the nose. For instance, we lose volume while lowering the nasal ridge but gain that value from another region by raising the tip of the nose. For instance, we fill and raise a low radix (the junction of forehead and nose) which makes the nose look as if it is arched, and instead of lowering the arch, we eliminate the arch illusion.
One of my academic fields of study is the re-adaptation of the nasal soft tissue system to the skeleton. I developed a relevant surgical technique called “Scroll Reconstruction”, which has been inducted into the medical literature after being published in the “Aesthetic Surgery Journal”, the most respected scientific journal on aesthetic surgery. Put briefly, the contribution of the study to the literature is to provide a more balanced adaptation of the soft tissue ligament system to the skeleton in patients who have undergone nose reduction surgery.
Rhinoplasty aims to achieve a beautiful nose. The beauty of the nose is mainly related to its shape and – to a lesser extent – to its size. Thus, the goal to obtain a beautiful shape precedes the goal of achieving the desired size. If you are not a candidate having the “ideal” features I mentioned above, you should know that you may need to be flexible during the examination and planning phase about “size” in order to reach the shape you desire. That is exactly why each of the stages of examination, information and planning is of critical importance.
We routinely tell you – with justification – in the pre-operative computer planning phase the kind of shape and size we plan, and you go into the operating room knowing that no surprises are awaiting you after the surgery.
Please feel free to contact us any time for detailed information about rhinoplasty.
Take good care…
… of yourself and your beauty.