Richard E. Davis, MD FACS - The Center for Facial Restoration in Miramar, Florida

Is Rhinoplasty Right for You?

The decision to undergo rhinoplasty is a highly personal one. Only you, in consultation with your surgeon and your closest friends and family, can make that important decision. For many patients, the increase in confidence, self esteem, and self-assuredness after a successful rhinoplasty can be truly life-changing, making rhinoplasty a worthwhile and gratifying experience for patient and surgeon alike.

Have You Considered the Potential Risks?

But don’t just dwell on the positive. You should also give careful consideration to both the potential risks of surgery and to the appropriateness of your expectations. Because virtually no surgeon can produce an anatomically perfect nose, it is best to think in terms of cosmetic improvement, rather than absolute perfection. At best, an accomplished surgeon can only achieve near-perfection, and that monumental task requires a fateful combination of artistic talent, technical skill, strong cartilage, forgiving skin and a little luck. Surgical risks are present in all patients, but youth, robust general health, a clear complexion, clean living and an otherwise healthy nose tend to favor a satisfactory outcome. On the other hand, remember that all surgeons employ a scalpel, not a magic wand. All rhinoplasty outcomes, even dramatic ones, have persistent flaws to a greater or lesser degree, and even an accomplished rhinoplasty surgeon cannot guarantee perfection under any circumstances.

Are Your Expectations Realistic?

Over the years I have observed that expectations are often most reasonable in patients with the worst-looking noses. Unfortunately, the inverse is also true – patients with reasonably attractive noses often have completely unrealistic expectations. In truth, a near-perfect cosmetic result is more likely in a nose that is already straight, reasonably well-proportioned and symmetric, but the improvements still demand exacting skill despite their smaller magnitude. Perhaps a modest improvement explains why these patients are sometimes disappointed with a skillful and arguably terrific cosmetic result. Although the likelihood of a near-perfect nose is much smaller in a nose that is substantially oversized, crooked, thick-skinned, previously injured, or lacking healthy cartilage, even a moderate cosmetic improvement in this circumstance will often dramatically transform the face. Ironically, despite the persistence of modest cosmetic flaws, expectations are often satisfied or even exceeded in this typically grateful patient population. Although the pre-operative nasal architecture will largely predetermine your prospects for a near-perfect outcome, expecting a "perfect" outcome is unrealistic regardless of your starting nasal contour.

Are You Looking for Improvement or Perfection?

Although millions of rhinoplasty patients now enjoy the lasting benefits of a natural and attractive, if still slightly imperfect, nose, for some the quest for perfection becomes a dangerous obsession. For individuals obsessed with having a "perfect" nose (or what they perceive as the perfect nose), the cumulative effects of repeated surgery may lead to progressive deformity and eventually to permanent disfigurement. A growing number of celebrities, whose extreme wealth allows them to indulge in this dangerous obsession, have become a public reminder of the hazards of unrealistic or distorted expectations.

While many disfigured noses can now be restored with modern reconstructive surgical techniques, patients that have been restored to a near-perfect appearance would be wise to avoid the risk of further surgery. Although the decision to revise any nose is derived jointly between patient and surgeon after a careful assessment of the risks and prognosis for success, each additional surgery increases the likelihood of unforeseen complications or adverse wound healing events, and not all noses make good candidates for surgery. In short, some noses are just better off left alone.