Rhinoplasty: Aesthetic Ideals
and Ideas
By David A. Newman, M.D.
One of the most beautiful
attributes we possess is our
nose. It is the only structure
which extends from our otherwise
flattened facial form. Our
nose defines who we are, and,
as we move forth both in time
and space, our nose leads
the way. And though studies
have documented that the nose
changes slightly as we age,
it still retains most of its
youthful charm.
It is such a blessing to have
a beautiful nose that many
patients seek to improve their
nasal shape with surgery.
At consultation, most patients
note that the nose “just doesn’t
fit the rest of my face.”
This insight certainly reflects
patient’s awareness that the
nose may just be too big for
their face or somehow doesn’t
provide a good match with
their other facial features.
But this keen perception on
the part of the patient may
also reveal a
deeper understanding of the
complex interplay between
nasal shape and the facial
form.
One goal for rhinoplasty (nose
surgery) is to achieve harmony
between the nose and the face.
The nose should exhibit a
beautiful shape within itself
and it should “go” with the
rest of the facial form.
Noses come in all forms and
sizes but we can identify
some key concepts for an aesthetically
pleasing nasal shape. The
more a patient can verbalize
what specifically bothers
them about the shape of their
nose, the more we can make
comparisons to these key concepts
and this discussion lays the
groundwork for improving nasal
form. It must be remembered
that there is no perfect nose
and no ideal nose but rather
a nose which may complement
and improve nasal shape.
We must also work and create
change within the limits of
what a patient’s anatomy will
allow us to do and also with
the understanding that we
wish to retain the most important
function of the nose which
is to humidify and allow the
passage of air for breathing.
Many patients complain that
“the bump on my nose” is not
nice, or that the bump ‘makes
the nose appear too large.”
It makes sense, then, that
a smooth nasal bridge or one
that is slightly bowed in
is pleasing to the eye. As
we gaze directly at the face,
we are first drawn to the
eyes, and then we follow the
gentle curve of the brow or
the upper eyelid towards the
nose. The gaze is next directed
downward and follows along
the side of the nose toward
the tip. These sight lines
on either side of the nose
which extend from the eyebrows
to the tip should be roughly
parallel. The observing eye
may find a flaring out of
these lines to be discordant
and make the nose appear short
as well.
The nose occupies a small
part of the face and its tip
is a small part of the nose.
The nasal tip therefore holds
position of a very small part
of the facial landscape but
it has its own geography and
its own form. One of the
most important “points” about
the nasal tip relates to its
projection, which is how much
the tip sticks out. One does
not want the tip to stick
out too much and, of course,
we do not want too little
projection because this will
make the tip smaller in relation
to the bridge of the nose.
Besides requiring good projection,
the tip should be symmetrical,
which means that both sides
should mirror each other.
There are almost as many different
tip shapes as people on the
earth but one’s nasal tip
should relate to the rest
of the nose in terms of thickness
and width so the width of
the tip should relate in some
way to the width of the upper
part of the nose.
But as the tip relates to
the nose, the nose must relate
to the face. When the nose
is too large for the face,
it is reduced, usually in
all dimensions to achieve
proper form and proportion.
This diminishes the dominant
effect of the nose over the
face and allows other beautiful
features of the face to come
into view. A too large nose
may bring it too much attention
and by decreasing its size,
attention may then be directed
towards beautiful eyes.
The vertical length of the
nose should be preserved in
patients with a vertically
long face. In this fashion
nose and face won’t clash
and each reinforces the beauty
of the other. The same goes
with nasal width. A wider
nose is a good option as long
as it sits on a face which
is not narrow.
As we breathe, we collect
air through our nostrils.
These structures also add
beauty and support to the
nasal form and they have their
own intrinsic beauty. They
should also relate to the
width of the tip and to the
lower part of the nose as
they play a major role in
its width.
A clear understanding of what
a patient doesn’t like about
their nose is a good springboard
for discussion and lays the
groundwork for successful
nasal refinement surgery.
Poets and scientists have
both attempted to define exactly
why the nose is beautiful.
Defining what constitutes
a pleasing shape may be elusive
but rhinoplasty can help improve
many nasal shape issues.
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"I researched
several surgeons before selection
Dr. Newman, I had many questions
and concerns leading up to
my surgery and Dr. Newman
and his staff always took
the time to answer every questions
truthfully. It was very personal
and intimate experience and
Dr. Newman and staff always
made me feel like a friend
as opposed to a patient. Most
importantly I could not be
more pleased with my new look….I
has breast enlargement."
Lisa Shapiro
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