"THE HARDEST OPERATION"
Most surgeons who perform rhinoplasty say that it is the most difficult operation that they do, for different reasons. Some say that the operation is hard because the incisions are so small, which has led to increased popularity of the "open" rhinoplasty technique (which I do not perform), designed to give the surgeon better visibility. Some say the operation is hard because the anatomy is so intricate.

Others say that rhinoplasty is difficult because patients' cosmetic expectations are so high; and some surgeons believe that rhinoplasty is difficult because the nose, unlike other body areas, has "a mind of its own," so that the surgeon has relatively little control over the final outcome.

I disagree with all of these theories, and over the span of my teaching career I have tried to convince rhinoplasty surgeons of a different explanation. Rhinoplasty is hard, I believe, because we (patients and surgeons alike) have been thinking about it in the wrong way.

THE PROBLEM WITH THE TRADITIONAL RHINOPLASTY OPERATION

Traditional nasal surgery relies on the concept that the preoperative nose is too big, too wide, too bulbous, or too long. It logically follows, therefore, that if the surgeon reduces the skeleton, and the skin shrinks to take on the shape of that new skeleton, the nose will be smaller and prettier. Unfortunately, it doesn't work out that way. Nasal skin can shrink to some degree, but much less than we have believed. Further, as it shrinks, the nose gets blunter and rounder and generally has less shape, not more shape. Nasal anatomy is so interrelated that changes in one area produce changes in other areas that may or may not be desirable and that can decrease the airway and affect the nose's appearance.

Both patient and surgeon must remember that a good nasal shape is not the shape of the skin itself; it is the shape that the underlying cartilage and bone impose on the skin. When viewed this way, nasal surgery becomes more understandable, controllable, and predictable. The surgeon and patient must think in terms of reducing the areas that are too large and supporting or recontouring the areas that are too small to create the best possible shape and nasal balance, while improving or preserving the airway, all in the background of a safe operation and the patient's own aesthetic goals.

For more information about primary rhinoplasty, please click here.

Or, for more information about secondary rhinoplasty, please click here.

Would you like to read what some of Dr. Constantian's patients had to say about being in his care? Please click here.

This site also includes answers to questions about rhinoplasty.