The aesthetic surgery of the nose, known as Rhinoplasty, is directed toward the improvement of the nose’s shape, size & general appearance. The surgeon’s objective is to get a natural appearance of the nose that offers a harmonic balance between the other facial structures. Today’s techniques are more conservative than years ago, and it is possible to use various access paths to the nasal structures.  

Normally, it is recommended that the patient wait at least until s/he is 14 or 15 years old, and preferably slightly older in a man’s case, before undergoing this procedure. The reason is none other than the underdevelopment of the nose in the early years. 

There’s no age limit for adults to undergo a rhinoplasty procedure, as long as no risk or danger with the anesthesia exists. Rhinoplasty is sometimes carried out together with a facial lifting or along with another type of facial rejuvenating procedure.  

In many cases, nasal ventilation problems can be corrected at the same time that a shape correction is being made. Among the main indicators to undergo a rhinoplasty operation are:

• The nose appears to be too long for the face.

• When a hump is observed on the nasal dorsum profile.

• The appearance is too wide on a frontal view.

• The nasal tip has a plunging or drooping aspect.

• The nasal tip is thick or broad.

• The nostrils or nasal wings are very wide.

• The nose is not in the center of the face or its profile is broken.

• The nose appears to be too short for the face.

• A wound or previous traumatism has altered the nasal morphology. 

CLINICAL EXAMINATION:

In the clinical examination it is important to make a psychological appraisal of the patient, in order to understand what his/her wishes and expectations are, betting up for moderate & reasonable corrections. The best candidates for rhinoplasty are those people who are looking forward the improvement of their appearance, not “perfection”. Besides good physical health, the patient’s psychological stability and a realistic attitude regarding his goals are matters of vital importance. 

The psychiatric and dismorphophobic patients are an indication against surgery.  

On the other hand, it is necessary to make an exhaustive study of the balance and harmony of the face. The shape, position, dimensions and volumes of the forehead, the orbitary frames, cheekbones, lips and chin have to be carefully examined. 

In the nasal profile must be evaluated, the nasofrontal angle, the nasofacial angle, the tip, the columella-lobular complex and the naso-lip angle. 

In the profile view, the nasal root, the dorsum, the tip (projection & width) and the alar-columella complex must be appraised. 

It is also necessary to be aware of the skin thickness. The fine and translucent skin, characteristic of Caucasian patients allows better showing of the cartilage, scraps, while the thick skin, more common in our environment, and generally associated with abundant fat, tends to be less elastic and masks the underlying structures. The touching and pinching between the fingers may allow one to appreciate the grade of skin thickness. 

The thickness of the skin that covers the nasal pyramid is primordial to get an aesthetic and functionally correct result.  

The tip support is also an important aspect to evaluate to obtain an adequate tip projection. By touching it, the surgeon can tell the difference between a tip that has good support and strength, and one with inadequate support. The one with poor support is a candidate to get cartilage implants and in case of not being able to obtain them from the septum or from the ear, inert materials such as silastic implants or goretex can be used.