Surgical nose jobs, also known as a rhinoplasty, are among the most frequent plastic surgery operations in the face. Due to the prominent position of the nose in the center of the face dramatic improvements in appearance can be accomplished by surgical nose jobs.
Surgical nose jobs have a quite long and distinguished history as a reconstructive procedure of far more than two thousand years if Indian sources a taken as a reference. The birth of surgical nose jobs for cosmetic purposes took place in Berlin after World War I and is detailed in Jacques Joseph’s book “Nasal Plastic Surgery and other Facial Plastic Surgery Procedures”, a true milestone in plastic surgery in general and surgical nose jobs in particular.
But it was only in the past three decades that the operative techniques of surgical nose jobs have experienced the revolution that resulted in the contemporary, natural surgical nose jobs performed by rhinoplasty surgeons worldwide. The results are more natural, longer lasting and fraught with far fewer complications than in those maybe not so good old days.
Joseph’s original surgical nose job technique was primarily a reduction of the nose in all its dimensions. Joseph developed many of his techniques in response to the problems which confronted him. And these problems were primarily big, wide and long noses with humps of considerable proportions as well as wide, often bulbous tips. A surgical nose job according to Joseph aimed to reduce all of these exaggerated features. As a consequence of the emigration of surgeons from Germany prior to World War II, Joseph’s surgical nose job techniques were spread widely over the western hemisphere. These techniques were certainly not trivial, but from a surgical standpoint not particularly difficult either, because they aimed to do something all surgical specialties are good at: cut something out, remove something, make it shorter, smaller etc.
Unfortunately noses do not have a lot of tolerance as far as excessive reduction of any of its components during surgical nose jobs. This is again similar to a house. Once too many of the important beams, gables or other structurally important parts of the framework are cut, weakened or removed, the house generally collapses. The exactly same thing may happen when a surgical nose job whittles away more and more of the beams and structurally important parts of the framework of the nose. The collapse is not evident immediately as the skin needs time to shrink and the load bearing parts now deprived of stability are pulled down by scar and strain. So often the results do not look bad after nose job surgery, but the collapse due to excessive reduction becomes evident over a couple of months. The infamous “overoperated” look results. The bridge is too low, the tip too pointy, turned too far upward without a real distinctive break between bridge and tip. More often than not patients breathe with more difficulty after the surgical nose job than before. Only a select few of the best rhinoplasty surgeons can reliably correct an “overoperated” nose resulting from surgical nose jobs with excessive reduction and subsequent instability of the framework of the nose.
The big conceptual quantum leap in the development of modern surgical nose job procedures was set off by Jack Sheen in the mid seventies of the meanwhile last century. The summary of his experience and concepts in the famous “Milestones” paper (Plast Reconstr Surg. 2000 Apr;105(5):1820-5) as well as his book “Aesthetic Rhinoplasty” meant the beginning of a new era in nose job surgery. More and more it became evident that balancing the nose instead of only reducing it is key to improving results. To this end, very often the framework of the nose, particularly the parts consisting of cartilage, has to be strengthened and augmented instead of destabilized and reduced. The “overoperated” look became a beast that could be tamed, mainly by keeping away from its lair – destruction, reduction and removal.
Today’s modern natural surgical nose job techniques are a skillful rearrangement of the parts of the nose together with techniques to strengthen the critical parts of the framework of the bridge and the tip. Often very little bone or cartilage are removed. Cutting cartilage is avoided and predictable suture techniques effectively reshape the pliable tip cartilages without destroying their structural integrity. Natural nose job surgery benefited tremendously from improved techniques to transplant the body’s own cartilage, connective tissue or bone into the nose to augment the nose’s framework. The best rhinoplasty surgeons no longer try to make the entire nose fit its smallest component, but nose job surgery today brings the parts of the nose in balance by augmenting what is too small and only reducing what then still is in excess and balances the nose with the rest of the face. At all times nose job surgery now emphasizes avoidance of the “overoperated” look.
Modern surgical nose jobs achieve more natural results, noses which are more in harmony with the face, noses through which patients can breathe well and most importantly can avoid complications and reoperations to a much greater extent than ever before.
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