Nose Reshaping: An Overview

Your nose is perhaps the most defining characteristic of your face, and if the size or shape of your nose is out of balance with the rest of your facial features, you may be self-conscious about it. Of course, this is all relative. For some individuals, a small bump on the bridge of the nose is embarrassing, while for others, a slight bump may not be an issue. One person may be embarrassed about having a large nose, whereas another person may not be bothered by it.

If you have long been uncomfortable with the size or shape of your nose, you may be considering nose reshaping. For years, surgery to reshape the nose has ranked among the five most popular facial cosmetic surgery procedures. In fact, each year more than 300,000 Americans undergo procedures to sculpt the nose.

What Is Nose Reshaping?

Nose reshaping, called rhinoplasty, is a surgical procedure that redefines the contours of your nose. Rhinoplasty, commonly referred to as a "nose job," can be performed for purely cosmetic reasons, to create a nose that is more harmonious with the rest of your face. It can also be performed to improve a person's breathing function if structures inside the nose block the passage of air. In most cases, rhinoplasty can address both cosmetic and functional issues.

Among facial plastic surgeons, nose reshaping is considered to be one of the most complex of all facial cosmetic procedures. Why? Because the nose is a complex structure, including bones, cartilage, skin, mucous membranes, hair follicles, glands, muscles, ligaments, blood vessels, and nerves. Making changes to any of these elements can affect the other structures within the nose and can ultimately affect functionality as well as appearance. When making refinements to a nose, a surgeon must consider all of these elements in order to achieve a pleasing, aesthetic result while preserving function.

Improvements to your nose may be subtle or dramatic depending on your circumstances. However, even minor alterations to your nose can significantly enhance your appearance and self-confidence.

It's important to understand that having nose surgery isn't like shopping for a new outfit. There is no catalog of noses in different sizes and shapes that you look through to choose your new nose. A surgeon can make improvements — softening a hump, straightening a crooked nose, or reducing the size of the tip, for example. In general, your surgeon will fine-tune specific features you don't like about your nose while maintaining its uniqueness and character.

Ideally, following surgery, your nose should look natural and be more balanced with the rest of your face. It shouldn't look like you've had a nose job. Following rhinoplasty, you may be surprised to discover that friends and coworkers don't realize that your enhanced appearance is due to nose surgery. Your mom or best friend may be the only one to notice the difference in your nose.

Types of Rhinoplasty Procedures

Although each procedure is tailored to individual needs, there are two basic types of rhinoplasty: open and closed. The type your surgeon chooses to perform will depend on the complexity of the reshaping to be done to your nose and on his or her personal preferences.

Closed Rhinoplasty

When closed, or endonasal, rhinoplasty is performed, all the incisions are made inside the nose. Working solely within the nose means that the surgeon has a limited view of the bone and cartilage that is being reshaped. In spite of the challenges presented by the limited view, many surgeons are well trained in this method and achieve excellent results with it. In general, closed rhinoplasty may be considered sufficient for simpler rhinoplasty procedures but may not be the best choice for complex procedures or revision of a previous nose surgery.

Open Rhinoplasty

In open, or external, rhinoplasty, the surgeon makes incisions inside the nose but also makes a small incision across the columella, the strip of tissue at the base of the nose that separates the nostrils. The nose skin is then lifted away from the underlying nasal structures, providing the surgeon with a clear view of the cartilage and bone to be reshaped. Greater visibility is a major benefit that allows the surgeon to make precise refinements. This method leaves a small scar from the incision on the columella, although it is often virtually invisible when completely healed. Open rhinoplasty may also lead to increased swelling. Open rhinoplasty is often preferred for more complex or challenging procedures, including revision of a previous nose surgery.

Making Functional Improvements

Whether open or closed rhinoplasty is used, your surgeon may use various surgical techniques to improve the function of your nose in addition to enhancing its appearance. Functional improvements are intended to allow you to breathe more freely. The most common functional improvement made during rhinoplasty involves correcting a crooked ordeviated septum. When the septum, which separates the two nostrils, is deviated, it can create a blockage in one of your nostrils. This airway obstruction can lead to breathing problems. During your procedure, your surgeon may also make functional improvements involving other tissues within the nose.

Ethnic Nose Reshaping

Rhinoplasty can change ethnic nasal traits. Depending on your particular desires, it can build up the bridge of your nose or narrow the width of your nostrils. However, if you're hoping to completely eliminate the ethnic character of your nose, you should be aware that this usually can't be done and still maintain a balance in the facial features. In most cases, refinements can be made to certain traits, but the nose won't lose all of its ethnic characteristics. Be sure to discuss any concerns about maintaining or eliminating ethnic characteristics with your doctor.

Limitations of Nose Reshaping

There are limitations to what rhinoplasty can correct. The amount of correction that can be achieved with your nose depends on certain characteristics and traits, such as your skin texture and thickness and the underlying support system of bones and cartilage in your nose. If your skin is very thick, it may limit the amount of fine tuning that can be accomplished, especially in the nasal tip. Think of it this way: If you put a shoe on a bed and cover it with a sheet, you can probably still tell that it's a shoe. However, throw a blanket over the shoe and you probably won't be able to identify it. It's the same principle with noses. A surgeon can refine the underlying bones and cartilage within your nose, but if you have thick skin covering them, the changes may not...