Planning Your Rhinoplasty By K. Conrad, M.D., F.R.C.S., F.R.C.S.C., F.A.C.S. lastic nasal operations are among the most complex and intricate cosmetic surgical procedures performed on the human body. Rhinoplasty is a popular operation and requested by both women and men regardless of age. It is performed on patients usually not younger than 16 years but under some circumstances it can be carried out on females 14 years young. My oldest patient was a 76 year-old widow who had a desire to change the size and shape of her nose all her life but was prevented from it by her husband. She remarried 6 months after her rhinoplasty, which not only rejuvenated her emotions but also her appearance. The nose is the central feature of a human face. Its size and character have profound impact on our appearance. Men may look quite handsome even with a large, strong-looking nose suitable for their body frame, especially if it is well balanced with other facial features. On the other hand, regardless of the changeable trends in fashion, women have always preferred a delicate, well-shaped and elegant nose emphasizing their femininity. This esthetic preference has been documented by a recent survey carried out at the University of Toronto, Facial Plastic Surgery Section of the Department of Otolaryngology. The decision to undergo a nose refining operation must be made by a mature, realistic individual prompted by strictly personal analysis and desire for self-improvement. First, you research surgeons according to their special training, board certification and compare their results with others. Word-of-mouth, your family doctor or Internet are usual sources of information. Remember, some of the pretty photographs seen in the advertisements are models and not examples of surgical outcomes. The
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results of nasal refinement where you can see either a subtle improvement or a dramatic change must have a natural unoperated appearance. In most instances you will not see enough examples on the Internet. If you arrange a consultation, the surgeon who has been performing many of these procedures should be able to show you numerous examples relating to your particular concerns. Here too you will be able to compare your own idea of a desired result to that of the surgeon's. Computer imaging serves well to stimulate your imagination but by itself does not reveal the surgeon's talent in visualizing the details to be created during the operation. Furthermore, you are not buying the computer image; you are relying on the surgeon's ability to apply appropriate surgical technique to create the most natural possible outcome. The desired appearance is best planned carefully, allowing your own input to make drawings using the surgeon's hands and mind - "the tools" he or she will need for reproducing the agreed contours during the operation. Hand drawing of the suggested final result with superimposing it on your preoperative photograph serves an important purpose. It will not only help you to visualize the degree of the proposed difference, but also will reveal the surgeon's intention and ability to make judgement regarding the extent of alterations in various areas of your nasal anatomy. Utilizing this information, you should see 2 or 3 surgeons who you think have the highest qualifications, experience and the results you like best to make your final choice. Some surgeons irrespective of the complexity of the operation perform a rhinoplasty using the "open" or "external approach" with an incision between the nostrils. Others reserve this method only for complicated revision cases and routinely use incisions totally inside the nose. Most rhinoplasties today are performed under general anaesthesia with the patient totally asleep. A specially equipped, accredited facility is needed to assure safety of such operations unless it is done in a public hospital where accreditation is obligatory. continued on next page
10 - REVIVE Magazine
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