The Surgeon Minute

The Magic of Rhinoplasty

The Magic of Rhinoplasty

“Rhinoplasty is my absolute favorite operation. It’s the perfect combination of artistic ability and technical plastic surgical skills,” says board certified plastic surgeon Dr. Brooke Seckel of Boston, MA. Not only must your surgeon have a good sense of what it is you want as well as what’s going to look appropriate on your individual face, but he or she needs the technical know-how to actually achieve that result. To that end, Dr. Seckel discusses the key to a successful “modern” rhinoplasty.

Reasons for a Rhinoplasty 

Your nose occupies crucial real estate on your face. When it is “off” – either because it is out of proportion to the rest of the face or has some sort of deformity like a hump or bump – it can adversely affect a patient’s self-esteem. A rhinoplasty is a surgical procedure that can treat the following aesthetic issues:

  • A nose that is either too big or too small for the face
  • A bridge that is too wide
  • Nostrils that are too large or malpositioned
  • A nasal tip that is bulbous
  • A hump or bump
  • A nasal tip that is upturned, droops or hooks in one direction
  • A nose that is asymmetric

A rhinoplasty can also address functional issues with the nose such as trouble breathing due do to problems like a deviated septum.

Rhinoplasty patient.

It’s All About the Tip

The key components of a rhinoplasty have traditionally been:

  • removing a bump or a hump from the top of the nose
  • refining the tip
  • narrowing the tip

What surgeons have learned over the last 30 years is that the crucial component of a nice looking nose is that the tip defining point must be the high point of the side view of the nose. Patients will come in to see Dr. Seckel for a rhinoplasty consultation complaining that they can’t stand their profile. In fact, if someone is taking a picture of them from the side, these patients will hold up their hands to block the view. They are that self conscious.

The problem, for them, is that because the nasal tip is not the high point on their nose, any hump or bump automatically becomes more prominent. So, yes, you can remove that hump or bump, but if the surgeon doesn’t do something to elevate the tip, he or she won’t get an extraordinary result and the patient won’t be happy.

115 Degrees Is the Goal

Surgeons today know that the ideal angle between the lip and the tip of the nose is 115 degrees. While most people are around 90 degrees, “115 degrees is the ideal aesthetic angle for the tip,” explains Dr. Seckel. In order to achieve a long lasting, successful result, the surgeon must not only reduce the hump or bump, but he or she must also provide support for the tip. This is done by harvesting a piece of cartilage called the strut graft from the septum.

Rhinoplasty before and after.

Dr. Seckel describes it to his patients as “a little tent pole” since this is a concept that they can quickly and easily comprehend. Putting this tent pole of cartilage under the tip prevents it from dropping down. Without this support, over time, the tip will simply return to its former position. Your nose will once again look as if it has a bump or hump which defeats the whole purpose of a rhinoplasty.

Choosing the Right Nose for Your Face

It’s important to see a surgeon with a lot of experience and training for many reasons. One of the biggest, when it comes to rhinoplasty, is that you need a surgeon who can choose the right nose for your individual face. It’s great to have pictures or video of your “dream” nose. This helps to give the surgeon a clear picture of your ideal outcome, but this does not mean that your dream nose will actually work with your anatomy. During your consultation, it is up to your surgeon to explain exactly what can and can not be achieved.

Rhinoplasty patient - Dr. Seckel.

The right nose is all about balance.  The face can be divided into thirds: the right cheek, the left cheek and the nose or middle portion of the face. Generally speaking, the width of the base of the nose and the width of the two cheeks should match. Oftentimes, patients with a fairly wide nose will come in with a photo of their desired nose and it’s a picture of a person with a tiny, thin, aquiline nose. It’s up to the surgeon to explain “that nose will look abnormal on your face” because it will make your nose looked pinched.

The modern rhinoplasty involves technical skill as well as artistic ability. For Dr. Seckel, a well done rhinoplasty – where the patient doesn’t put his or her hand up when a photo is taken from the side – is “one of the biggest achievements that I can make in cosmetic plastic surgery.”

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