Rhinoplasty is one of the most fascinating plastic cosmetic surgery procedures, not only because of its surgical complexity but also because of its profound impact on a patient's psychological well-being.
Surgeons specialized in this operation must be prepared to satisfy the patient's specific concerns and requests for a particular anatomical change. Aesthetic design of a nasal alteration must take place with significant participation of the patient. Almost without exception, everybody wishes a natural and unoperated looking nose. In general, females prefer a feminine, not excessively large nose, whereas males want to preserve their masculine appearance, and yet, benefit from a refinement which should correct exaggerated attention drawing features.
I have observed in the large numbers of revision surgeries that I am asked to perform, a tendency among some surgeons to create a nasal appearance which is not in harmony with other facial features. In many instances I find that not enough attention is paid to satisfying the patient's gender expectations.
The following exact drawings of my actual patients' profiles will help to demonstrate characteristics of aesthetically pleasing results in a male and female rhinoplasty, taking gender preferences under consideration. In this male rhinoplasty, attention was focused on minimal reduction in size with preservation of strong masculine features.
This female who had 3 previous unsuccessful rhinoplasties requested a revision to enhance her feminine appearance.
The example below shows a well performed nasal correction in a female by another surgeon with a well balanced and natural looking result, but lacking in femininity. The post operative nasal features could suit a man's face. In my over 25 years of rhinoplasty surgery experience, this particular problem has given a reason for many patients to request further correction.
As much as preserving and emphasizing femininity in female patients is important, it is even more crucial in the majority of males to avoid profound adverse psychological effects which can be caused by creating a feminine, delicate looking nose. A thorough preoperative discussion will help to discover the patient's psychological needs. In general, patient satisfaction depends on achieving a better shaped nose and preserving or emphasizing his or her gender identity. It is well recognized, however, that such an identity may at times be different then from the patient's apparent sexual characteristics, and under these circumstances the patient’s gender identity particularly will play a main role in planning the final outcome.
Some individuals have abnormal anatomy of the nasal passages causing mild or, at times, severe difficulties with nasal breathing needed for normal body function. The surgeon must be able to diagnose the problem and have the dexterity to correct it. The rhinoplasty operation, unlike other procedures, demands from the surgeon awareness of pleasing aesthetic proportions of the face combined with the understanding of gender differences, self identity and related psychological issues.
All this will help to meet the challenges inherent with nasal plastic surgery.