Rhinoplasty

Rhinoplasty is a surgical procedure that modifies the visible shape of the nose. This operation may be classified as either cosmetic or reconstructive surgery, depending on the reason for its performance. When changing the external nose is done to make this prominent facial feature more attractive, it is a cosmetic operation, but when surgery is required to improve breathing or correct a fracture or gross deformity, it is considered reconstructive surgery. Sometimes, reconstructive and cosmetic procedures are combined. If a person has a crooked nose that interferes with airflow, straightening the nose would be considered reconstructive-but, if at the same time the surgeon sculpted some of the cartilage of the nasal tip to give a more refined appearance to the nose, that portion of the surgery would be considered cosmetic. The difference is not just an academic one, the cost of the cosmetic portion of the surgery would not be eligible for reimbursement or coverage by most insurance or national health service plans.

The proverbial phrase "plain as the nose on your face" indicates the importance of the nose in a person's appearance. In fact, that central importance has been used to punish criminals in several ancient societies. The first rhinoplasties were recorded in India, and were performed as reconstructive surgery on such penalized individuals.

Up until the 20th Century, elective surgery was fraught with a nearly prohibitive amount of pain and danger. With advances in Anesthesia, the use of sterile technique and the invention of antibiotics, rhinoplasty- along with other elective surgery, experienced an enormous increase in safety.

How can noses be changed with surgery?

Cosmetic rhinoplasties throughout most of the 20th Century were done to reduce, straighten and refine the nose. Towards the end of the 20th Century, more interest in augmenting rather than reducing, aspects of the nose arose.

In the 19th and in part of the 20th century, a slim Northern European Caucasian nose of very refined proportions was the aesthetic ideal in the western world. Noses with shapes and underlying structures typical of most other ethnic groups were considered less attractive. In the earlier portion of that period, the unattractiveness of nose shapes identified as "semitic" or "negro" was openly discussed in both lay and professional publications. Later in the 20th century, wide and hooked noses were no longer overtly labeled as a detrimental mark of ethnic origin, but still, such features were routinely described as showing "deformities". Some surgeons have were willing to surgically modify these features. For example, a 1996 manual describes "correction" of the "Jewish nose", while another manual notes that two patients with noses that "have acute nasolabial angles, plunging tips, or foreshortened nasal tip pyramids" were "of Jewish ancestry" or of "Jewish descent."

Goals in rhinoplasty

Whether the reason for performing this operation is the desire for improved appearance or the reconstruction of an amputation, some aspects of the goal of surgery are always the same. A long-term outcome of a natural and attractive appearance along with a healthy nasal airway are both desired. The adjective "long-term" deserves emphasis, because the early decades of cosmetic rhinoplasty have demonstrated that the appearance of the nose in the first months or even years after surgery may not be representative of the long term result. This is primarily due to two general factors: 1) shape changes from loss of supporting structure, and 2) changes that occur with aging of the skin.

Techniques in rhinoplasty

Operations on the nose may be done in which all incisions are in the mucosa along the lining of the nose, a time-honored technique called internal rhinoplasty. External rhinoplasty involves making an incision in the skin of the nose or face.