Nasal Beauty Surgery Procedures

Your nose is at the center of your face. That said, nasal beauty isn’t the first thing people look at when they see you; that is unless your nose is noticeable.

The process of scanning faces occurs within 1/25 of a second. The brain checks first the eyes, then mouth, then hair. Usually by this stage the brain has made a match with an image it has stored; identification has been made, and the scan stops. If there hasn’t been a match, the nose, chin, forehead etc… is checked and a decision is made; is this face known or unknown? The order can change if there’s a visually prominent facial feature, like the nose. This is the explaination to the frequently observation by post operative patients that surprisingly nobody noticed the difference! It also helps explain the old adage “A good rhinoplasty is seen in the eyes”.

So lets look at nasal aesthetics. To do so we will need a vocabulary. A basic understanding of nasal surface anatomy wil be needed. A look at the picture will help with the vocabulary. Some of the terms describe a very precise area of the nose, while others identify more just a region of the nose. Now lets examine the aesthetic impact of various changes to parts of the nose. A change to the size of the nose is a very commonly requested desire. Middle eastern, Indian and Europeans usually are seaking a smaller nose and their surgery is called a reduction rhinoplasty.

An exception is after a poor outcome from overly agressive rhinoplasty. These revisions are called augmentation rhinoplasty and require the addition of material, most commonly cartilage harvested from the rib or ear. Augmentation rhinoplasty is also common with Oriental and Afro-Canadian rhinoplasty, also here the material is usually a silicone implant.

What is the ideal or perfect nose? Well like art, its difficult to define, but everyone can recognize it when they see it. There are common ideal features which are seen across the ethnic groups. The ideal feminine face has large eyes and mouth, a trianglular shaped face and a small nose.

On the other hand, the ideal male face has small eyes, large jaw, square shaped face and a strong nose, but not a small nose. A small male nose is rarely desirable. There have been attempts to define the perfect face mathematically. The most successful and commonly known uses the golden ratio. This is a well known concept to painters. Once you are aware of this concept, you will start to see it throughout nature and the man-made world. It appears in the spirals of seashells and the Parthenon in Athens. For our purposes it is all over our bodies. Expressed mathematically the Golden Ratio is 1.618. It is related to the Fibonacci sequence, where every number is the sum of the two preceding numbers. F(n)=F(n-1)+F(n-2). For example 1, 1, 2, 3, 5, 8, 13, 21, 35… The Golden Ratio is related to the Fibonacci series Numbers through division. For example 1/1=1, 2/1=2, 3/2=1.5, 5/3=1.666…, 8/5=1.6, 13/8=1.625, 21/13=1.61538…, 34/21=1.61905…, 55/34=1.61764…, 89/55=1.61861… The Golden Ratio has no equivalent fraction as it is an irrational number made up of a never ending series of numbers, just like the number Phi.

It is found in the natural world and demonstrates a high degree of efficiency. The Golden Ratio is found in the patterns of sunflowers, ferns, branches, pine cones and pineapples. The Fibronnaci sequence is the best way to efficiently pack things tightly together. Take a look at petals and leaves. They are designed to maximize sunlight and water transport and they all utilize the Golden Ratio. When the Fibronacci series is applied to ourselves, we can evaluate how attractive someone is by how well they fit the Golden Ratio. Scientists have conducted several studies on attractiveness and the most aesthetically pleasing people are closely aligned with the Golden Ratio. 1.618… gets repeated throughout our bodies and appears to be the ideal for many of our body proportions. For example, the ideal distance from the pupil of a person’s eye to the center of the chin is 1.618… times the distance from the pupil to the end of the nose.

The ideal length of a face is also 1.618… times its width and 1.618… times the distance between the eyes and the person’s mouth. In other words, wherever you think classical beauty, you’re probably just responding to the beautiful symmetry and repeating mathematical perfection. It is the ratio between the length of your hand and the length of your lower arm (between your elbow and your wrist). It’s also the ratio of your total height to the distance between your head and your fingertips.

How is the size of a nose defined?

A common and good method uses length, projection and rotation. So lets examine each of these. Length is defined by the distance between the nasion (the root of the nose) and the tip defining point (the tip in common usage). This is fairly easy to determine and only the occassional nose is difficult to access.

Often in primary rhinoplasty the length of the nose is shortened. There are two ways to do this. Either the root of the nose is dropped or the tip of the nose is raised. Generally the tip is raised as this is also a very common request.

The Nasion or root of the nose is at the level of the upper eyelid. This is the ideal location. When the Nasion is lower, it causes the length and hence the size of the nose to appear smaller.

Much less frequently is the root of the nose dropped. This is fortunate as this is difficult to do since the bone in this area is thick and can at times require an electrical drill to reduce it. Furthermore as the area heals the skin tends to tent up due to the natural contraction that is associated with the healing process. Both these factors can conspire to limit to surgical reduce of the nasion.

Projection is the distance a nose projects forward away from the face. Although an easy concept to understand, its measurement is more complicated. The furthest point of the nose is clear; however the facial plane requires further analysis.

On profile view a line is drawn from the forhead to the chin to create the face platform or plane from which the distance to the furthest point of the nose can be measured. This introduces the concept of how the face modifies the appearent size of the nose. Notice if the chin or forehead is recessed, the projection of the nose is increased. Hence there is an aesthetic relationship between the appearant size of a nose and that of the chin and or forehead. As a rule, the smaller the chin, the bigger the nose looks, and vice versa. This balance will be examined later. As you can see, the further away the nose projects from the face, the larger it appears.

The third characteristic of a nose which influences the percevied size is rotation. It’s defined as the degree the tip of the nose is rotated with regard to the face. It sounds simple but the precise mathamatical definition is not. There are in fact several way to measure this. As a general rule, when there are several ways to do anything, it usually means there isn’t one best way and this is the case with nasal rotation. The commonest means to describe rotation is to talk about the nasolabial angle. The ideal varies between males and females as we would expect. The ideal feminine angle is between 110 and 130 degrees and in males it is between 90 and 105 degrees. The concept here is the female nose should be more rotated than the male. There is a common concern that rhinoplasty surgery will over rotate the nose and create turned up ‘piggy nose’ where the one can ‘see up the nostrils’. Its a common mistake, often created by young, inexperienced or overly agressive surgeons.

The flesh just below your nose and between your nostrils is called the columella. Its internal support are two strips of cartilage immediately beneath the skin. Directly deep to the columella is the end of your septum. If there is a deviation of this distal part of the septum, it can sometimes be seen just inside the nostril. Looking from the side, ideally between 2 to 4mm of the columella should be visible just below the nostril rims. If there’s more, the nose appears bottom heavy and the tip droopy. If there’s less, the nose appears retracted and abnormal. Although the columella itself is the usual cause, sometimes the alar rim is responsible for the abnormality.

The hump of the nasal dorsum or bridge is a common problem and reducing the dorsum is a commonly preformed surgery. Most times the goal is to create a straight profile, although leaving a slight bump is also acceptable, as it gives the nose a natural look. Often a slight supratip deflection or ‘break’ is desired. As with most things in rhinoplasty, there’s an acceptable range and overdoing something is a mistake and shows a lack of aesthetic sensibility on the parts of the surgeon and patient.

It is common to say the nasal tip should appear defined. What does this really mean however? It means the tip should be a pleasing width, symmetric and having a distinct ‘break’ where the profile curve makes a noticeable transition.

A defined tip also means the area above, the supratip, isn’t wide. Otherwise the overall effect is a big ball like shape. This can often be difficult to achieve with surgery. If the tip cartilages which make up this supratip width have an intrinsic convexity, there can be limitations to the degree of improvement. Cartilage has the anoying characteristic of resisting change. This is the so called ‘memory’ of cartilage. The ability of cartilage to maintain its original shape varies among people and is a common cause for failure. There are many techniques available to the surgeon to modify these cartilages. The more a surgeon has with which he is familar and has mastered, the more likely success will be achieved.

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