This is a sad complaint that I hear from many patients who have had rhinoplasties.  Too drastic a change is one of the things that patients fear most before surgery.  Just recently I received two emails from patients who have undergone surgery in the last month and feel that the change was just intolerable.  They feel totally disoriented when they look in the mirror.

It happens that both of them are men, and this phenomenon is probably more common in males, though females experience it also.  The nose is a central facial feature and it is an identifiable personal, familial, and racial characteristic.  Some years ago I published a paper in Plastic and Reconstructive Surgery where I reviewed the charts of 150 consecutive secondary rhinoplasty patients to see what their motivations were for having another operation.  Fifteen percent felt that they didn’t look like themselves anymore.

Often this feeling is because the bridge has been reduced too much and a familiar bump has become a scooped profile instead.  Many men believe that the nose has been feminized.  Sometimes patients dislike the new tip–a familiar rounded tip has become narrow, angular, or pointed.

This sense of unrecognizability is avoidable—but doing so requires the surgeon to discuss with each patient what his or her goals are before surgery, area by area: profile, tip, length – – anything that the patient cares about.  The patient determines the normal, not the surgeon.

Secondly, delivering a result that the patient has requested requires a surgical approach that allows the surgeon to see exactly what he or she is producing with the least chance of creating a new problem.  I believe and teach that these are two of the major advantages of closed rhinoplasty—but the principle of identifying what the patient wants applies regardless of the surgical approach.