Nasal surgery has a long tradition in plastic surgery, beginning thousands of years ago when victims of nasal amputation underwent reconstruction by use of forehead flaps. Things have come a long way since then, even as recently as in the past 25 years as I have personally observed a number of changes, both in what patients request and in how the plastic surgery is done.

• Patients are asking for a more natural look today than they did 25 years ago. No longer do I hear a request for the removal of an ethnic look. Instead the request is usually something like, “I’d like to preserve my ethnicity but tone down the hump, wide bones, and the broad tip.” In part this may be due to the fact that our country is becoming more ethnically diverse and various ethnic looks are coming to be accepted as normal.

• 30 years ago, virtually all rhinoplasties were done by means of the closed technique with no external incisions. Today, 70% are done by the open technique with a small incision made on the undersurface of the nose that allows the surgeon to better visualize the interior of the nose and to do a better job of changing it. The scar that results is usually non-detectable.

• Nasal packing after surgery is not used as often. When I tell my teenage patients this, their mother will inevitably say, “You’re so lucky! Taking the packing out was the worst part!!” As an added bonus, today’s rhinoplasty is usually minimally uncomfortable unless extensive septal surgery is required.

• There is less damage to the nose with today’s nasal surgery. Surgical techniques of 25 years ago would frequently produce breathing problems and also would damage the internal structures that led to appearance problems after surgery. Today we try to avoid techniques that irreversibly damage the cartilage since the surgeon may need to undo something in the middle of an operation. Whereas you couldn’t do that in the past, today it’s as simple as untying a stitch that’s holding a cartilage in a particular shape. We also understand more about how to make sure that a nose breathes well after surgery and have changed our surgical techniques to allow that to happen.

• Today imaging of the nose is frequently a part of the consultation process. Instead of bringing in a photo of a person whose nose the patient likes, we take a photograph of the patient and change their nasal appearance with computer software. That way a patient can visualize what a certain change in the nose would look like on their face, much the same way you try on a dress before you buy it. You don’t settle for the way it looks on a mannequin, but try it on to see how it looks on you!

The rhinoplasty of today is the best it’s ever been, and improvements continue. Should you have any questions, please contact me.
George Sanders, M.D.