Each passing day, nose job (rhinoplasty) candidates are getting a little more information about the procedures and the process. Until almost a decade ago, virtually no one asked their doctor about the technique the latter would use. As a result of the transition to today’s information society, surgical techniques began to make their way first into the media and then into our minds.
I decided to write a blog post about it because it is a question that I get frequently asked on social media, and it is not possible to answer it in a jiffy.
We aim to achieve a natural, beautiful and safe result in rhinoplasty. Here, the same words are usually employed, but what everyone understands from these words varies from one patient or doctor to another.
For example, what a beautiful nose should look like is still not clear as of 2019. A nose that one finds beautiful may be considered unnatural or incompatible with the face by another. For some patients, for instance, a curved nasal ridge is an absolute expectation from surgery, while for others, a curved nose may be unacceptable.
Therefore, in my philosophy, rather than just my liking, an individualized evaluation tailored for my patient together with my patient is guiding.
I ask my patients one question: What is your favorite part of your nose?
(Most of the time, patients are ready to list the parts they dislike the most)
If the answer is “I don't like any part of it”, our work is demanding and tends towards psychotherapy. Every nose has beautiful and not so beautiful features. These should be analyzed and listed before the operation. This is because we will keep the features that are beautiful or unique and fix the ones that are not. It is not possible to plan a natural outcome without perceiving what is already beautiful.
From my point of view, the criterion of naturalness is key. It is even more important than the surgical result being “exactly as the patient wants”. The reason I am telling this is because wants and tastes vary and change. The nose you desperately want to have at age 25 may start to seem unnatural to you after a couple of years. For instance, it will take just one single inopportune simile by a friend for you to lose your deep affection for that curved, upturned, tiny nose you always wanted. A tactless person comes up and says, “Oh, you’ve got yourself a snout!”, and you cannot get over that psychological trauma.
Therefore, although the wishes of our patients are the most important criteria for us, it is essential not to get caught up in the same enthusiasm or popular trends as the patients and to stay on the scientific path.
Let's go back to the concept of naturalness.
Natural means "as it exists in nature". What is meant here is that an operated nose is not easily picked out and defined as “done” by not only the friends and acquaintances of the patient but also anybody they will meet for the first time.
However, when you look at the nature surrounding you, you see an infinite number of varying nose shapes. Natural noses can be arched, curved, long, thick-skinned, drooping or wide-tipped. The presence of any of these features, which are not generally perceived as beautiful, sometimes adds a character and naturalness to the nose. So naturalness actually originates from minor imperfections that deviate from the ideal. You can see such nuances (such as slightly arched nasal ridge, slightly long nose, slightly wide nasal tip) in the noses of women idolized for their beauty such as Blake Lively, Gal Gadot, Scarlet Johansson and Penelope Cruz.
Therefore, in cases where the nose is generally beautiful, but the patient complains of minor problems that add naturalness to their nose, I do not perform surgery.
Another key point is that a more beautiful nose alone will not always make the face more beautiful in a holistic way. For instance, you can make the noses of handsome men like Tom Cruise and Kenan İmirzalıoğlu more beautiful, but this change in the nose will spoil the character of their face.
In a nutshell, naturalness is important.
If you think “It’s OK if my nose does not ultimately look natural”, I am not the doctor you should see.
Another principle that determines my surgical philosophy and technique is "consistency". Good results can be achieved with any surgical technique. The key point is to achieve good results in every surgery. Therefore, a surgical technique that gives good results in 8 out of 10 patients, but not in the remaining 2, is poor in my view and needs to be replaced. Over the years, I left behind inconsistent surgical techniques to make progress. To evaluate techniques, you need to be able to analyze their long-term consequences.
Unfortunately, patients do not know which technique is more consistent. This is because every doctor shares their best results. But what is the percentage of achieving good results? This is the question that should matter to you, because the answer to this question will determine the percentage of your satisfaction with rhinoplasty.
The most important variable that determines my surgical technique is this principle of "consistency".
I prefer to perform surgical operations by seeing, measuring and structurally testing each step of it. This is why I use the open structural ultrasonic rhinoplasty technique. The open approach allows you to see anatomical details. Asymmetries, individual differences, and more importantly, the work you do.
Structural rhinoplasty means building a reliable support while establishing the basic proportions of the nose, as well as reinforcing and supporting the nasal skeleton and shaping the nose. In structural rhinoplasty, the tip of the nose becomes a little harder, but remains in place after the surgery. Its height and angle are more resistant to post-operative changes.
The ultrasonic rhinoplasty technique (piezo rhinoplasty) allows us to see them perfectly before cutting and shaping bones very precisely and measuredly. Breaking bones with a chisel and hammer leads to unexpected and undesirable fracture lines. Therefore, I only employ the ultrasonic bone shaping technique. There is a dedicated article on this technique. If you wonder, I recommend you take a look at it.
Finally, I make original contributions to these techniques. As of today, I have authored 6 different scientific articles that entered the medical literature in the field of rhinoplasty.
The take-home message from this article is that planning and implementation must be "individualized".
Please feel free to contact me for more detailed information about rhinoplasty or to learn how surgical planning can be tailored to your needs.
Take good care...
... of yourself and your beauty.
OB