Rhinoplasty is considered as the most challenging and skillful plastic surgery. It is a nose reshaping procedure that is primarily used to correct surface aesthetics. Rhinoplasty has been practiced by surgeons since the past 100 years, but even today it is surrounded by unresolved controversies regarding indications and techniques.
This procedure has largely remained elusive to many plastic surgeons as the procedure demands meticulous planning and a very high level of expertise to get the desirable results. In essence, the surgery itself is not difficult to carry out, but it is very challenging to get consistent outstanding outcomes. Very few surgeons are the masters of the procedure who can produce outstanding results.
John Orlando Roe is considered the father of aesthetic rhinoplasty for the first known procedure to correct a pug nose through the endonasal approach, which was reported in 1887. From then the procedure has seen the introduction of many techniques and instruments to achieve refinement.
However, aesthetic rhinoplasty is recorded as the procedure that has elicited the most number of dissatisfied patients. Some of the peculiarities of rhinoplasty may be described as follows:
- The motivation for the surgery may be functional or aesthetic. Functional problems involve nasal congestion, dry mouth, and a reduced sense of smell.
- Aesthetic rhinoplasty is an extremely personal decision. It is not clear what motivates a person to accept the inconvenience, risk, and financial burden involving aesthetic rhinoplasty.
- Essentially functional rhinoplasty should take care of the aesthetics aspect. However, the surgeon can achieve this goal only if he/she understands the direct linkage between surface aesthetics, underlying anatomical structures, and functional factors.
- An attractive nose is created by lines and shadows; it highlights covering the nasal dorsum, tip, and base. These features should be maintained, and corrections should be made during the rhinoplasty surgery.
- After undergoing functional aesthetic rhinoplasty, meeting the aesthetic expectations is generally more important than meeting the functional expectations.
- Surface aesthetic rhinoplasty is more of an art, which can elicit appreciation from the beholder. However, art does not elicit similar responses from all. Therefore, dealing with an unimpressed patient can be an extremely difficult task.
- Aesthetic rhinoplasty is based on angles and proportions that are perceived to be attractive. Most doctors adhere to these principles. However, some doctors believe that there is no such thing as a universal standard of proportion. They opine that the nose should be in harmony with individual physiognomy, gender, and character.
- The surgeon should exercise precaution in selecting the patients for rhinoplasty. An experienced surgeon will know by his/her intuition whether the patient is a fit candidate or not.
- A perfect postoperative result may change after a couple of months mainly due to the dynamics of healing. This procedure involves different types of tissues such as bone, cartilage, skin, fat, nerves, vessels, mucosa, fascia, perichondrium and periosteum. The surgeon may not have control over all of these. Hence, the predictability of the outcome is limited.
