Understanding the basics, history, types, and candidates for rhinoplasty procedures
Rhinoplasty is one of the most commonly performed plastic surgery procedures, with tens of thousands of cases completed annually. It is a surgical procedure that alters and reconstructs the nose, sometimes referred to as a "nose job" or "nose reshaping" by patients.
Indications for rhinoplasty run the gamut from purely cosmetic to exclusively reconstructive, with most patients having a combination of aesthetic and functional motivations. The procedure can be performed for:
● Cosmetic enhancement to improve the appearance of the nose
● Functional improvement to address breathing problems
● Correction of congenital defects
● Repair of traumatic injuries
● Reconstruction after cancer removal
According to the American Society of Plastic Surgeons, nearly 45,000 rhinoplasties were performed in the United States in 2022, making it the third most popular facial plastic surgical procedure after blepharoplasty and rhytidectomy.
Rhinoplasty has a rich and extensive history dating back thousands of years:
The first descriptions of nasal reconstruction techniques date back to ancient India, where the surgeon Sushruta described procedures for nasal reconstruction around 600 BCE. The modern era of rhinoplasty began with John Roe in 1887, who first described techniques for cosmetic rhinoplasty. Early rhinoplasty was exclusively cosmetic and relied predominantly on reduction maneuvers. As understanding of nasal anatomy advanced, a more proportional approach developed, incorporating cartilage grafting and suture refinement.
Among the pioneers of rhinoplasty are:
A German surgeon at the turn of the twentieth century who emphasized the importance of correcting the nasal septum while reducing the dorsal hump.
The founder of the American Rhinological Society in 1954, who invented the dorsal preservation technique for hump reduction and recognized the critical role of the nasal septum in shaping the external nose.
A US Army Medical Corps officer during World War I who brought his expertise in anatomy to facial surgery and made education in rhinoplasty theory and technique widely available in the United States.
Known for his seminal textbook "Aesthetic Rhinoplasty" (1978) and for opening doors to considering non-Caucasian/ethnic rhinoplasty and revision rhinoplasty.
Rhinoplasty can be categorized in several ways:
Open Rhinoplasty: Involves a small external incision on the columella, allowing for direct visualization of nasal structures.
Closed (Endonasal) Rhinoplasty: All incisions are made inside the nose, leaving no visible external scars.
Reduction Rhinoplasty: Reduces the size of nasal structures.
Augmentation Rhinoplasty: Increases the size or projection of nasal structures.
Tip Plasty: Focuses on reshaping the nasal tip.
Septorhinoplasty: Combines rhinoplasty with correction of the nasal septum.
Primary Rhinoplasty: First-time nasal surgery.
Revision (Secondary) Rhinoplasty: Corrects problems from previous rhinoplasty procedures.
Functional Rhinoplasty: Focuses on improving nasal breathing.
Cosmetic Rhinoplasty: Primarily addresses aesthetic concerns.
Reconstructive Rhinoplasty: Repairs nasal defects from trauma, cancer, or congenital issues.
Ideal candidates for rhinoplasty include:
● Generally healthy individuals without medical conditions that impair healing
● Non-smokers or those willing to quit smoking before and after surgery
● Individuals with fully developed facial growth (typically 16+ years for females, 17-18+ years for males)
● Those with realistic expectations about what rhinoplasty can achieve
● Patients seeking improvement, not perfection
● Individuals undergoing the procedure for themselves, not to fulfill someone else's desires
● Those without body dysmorphic disorder or other psychiatric conditions that may affect satisfaction
● Nose size in relation to facial balance
● Nose width at the bridge or in the nostrils
● Nose profile with visible humps or depressions
● Nasal tip that is enlarged, drooping, upturned, or hooked
● Nostrils that are large, wide, or upturned
● Nasal asymmetry or deviation
● Breathing difficulties due to structural abnormalities
The evaluation of candidates involves a thorough medical history, physical examination of the nose (external and internal), psychological assessment, discussion of goals and expectations, photographic documentation, and sometimes computer imaging to visualize potential outcomes.
It's important to note that there is no proven way to consistently recognize high-risk patients who may be unhappy with the outcome. Therefore, surgeons must physically and psychologically evaluate patients to predict whether an operation will be beneficial.