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Evolution of Rhinoplasty

One of the most popular surgeries requested in facial plastic surgery is rhinoplasty, and I thought I would comment briefly on this popular procedure. Rhinoplasty, commonly known as a “nose job,” is not just a 20th-century cosmetic procedure. As a matter of fact, the earliest references to this surgery were recorded in ancient India, by Sushruta, an Ayurvedic physician, around 800 B.C.

He described the need to reconstruct nasal defects that resulted from the mutilation of a criminal’s face, as a consequence of religious, political or military punishment. It’s interesting to note that in those ancient days, criminals had hope to medical care. One would think these criminals were forced to live with their defect as a price for their punishment.

From those beginnings, rhinoplasty has evolved from strictly a repair procedure, which was perfected by an English physician named Joseph Carpue. Dr. Carpue’s technique is now referred to as “Carpue’s Operation.” It involved using a flap of skin taken from the forehead and placed over the nose to reshape or repair damaged cartilage. Today, his contribution has matured to the paramedian forehead flap, a workhorse of major nasal reconstruction.

Today, centuries later, there are many surgical techniques that can improve breathing or damage, as well as enhance or change the aesthetics of one’s nose. In the early days of cosmetic rhinoplasty, every surgery was performed to create a thin Caucasian nose.

As cosmetic surgery has evolved, along with impact of globalization and integration of multiple cultures, emphasis is now being paid to the ethnicity of the patient. What may look great on a Caucasian nose may not look right on a Latin or Hispanic face. Hispanic (or Mestizo), Asian, and African American faces have their unique beauty standards, and a good rhinoplasty should respect those.

Plastic surgery, in general, has enjoyed a larger field of acceptance for women as well as men. According to the American Society of Plastic Surgeons (ASPS), 15.6 million cosmetic procedures (including both minimally-invasive and surgical) were performed in the United States in 2014–an increase of 3 percent since 2013.
Of the various procedures performed, rhinoplasty was the top procedure.

In their 2015 survey, the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) found that rhinoplasty was the most requested surgical procedure, followed by blepharoplasty (eyelid surgery) and facelifts.

For cosmetic procedures, just straightening a crooked nose or narrowing the sides is often not enough. There is much more to reshaping the nose. In addition to the physical and aesthetic points of view, surgeons want to be sure the patient is realistic about what the changes will mean to them beyond altering their features.  A helpful tool in counseling the prospective rhinoplasty patient is the use of image morphing software.

These allow a surgeon to manipulate a patient’s photograph to predict what the results will be. It allows the patients to see how various changes will make their nose look. This strategy is debated among plastic surgeons, with some advocating its use while others feel it may create an unrealistic expectation on the patient’s part.

I offer this tool. I believe it’s critical the surgeon counsels the patients that the images are NOT a guarantee. Furthermore, it’s paramount for the surgeon to produce a realistic outcome on the computer. After all, it’s easy to create any nose on the computer.

As the most popular requested cosmetic surgery, rhinoplasty is considered the most challenging. Over time, a myriad number of surgical approaches to artistically change the contour as well as the function of the nose have been created.

Advancement in materials and technique for nasal analysis has grown. Our understanding of the complexity involved in nasal function and healing after surgery continues to grow, accounting for the better and more natural results that can be achieved.

Dr. Kenneth Yu Facial Plastic and Reconstructive Surgery is a qualified team of experts serving the San Antonio, Texas area. To schedule a consultation, please contact our Concierge Patient Coordinator at (210) 876-6868 or