Rhinoplasty (Greek: Rhinos, "Nose" + Plassein, "to shape") is a cosmetic surgical procedure performed by an Otolaryngologist--Head and Neck Surgeon (Ear, Nose, and Throat Surgeon) or a Plastic Surgeon, in order to improve the function (reconstructive surgery) and/or the appearance (cosmetic surgery) of a person's nose. Rhinoplasty is also commonly called a "nose job". Rhinoplasty can be performed to meet aesthetic goals or for reconstructive purposes to correct birth defects or breathing problems. It can be combined with other surgical procedures such as chin augmentation to enhance the aesthetic results.
Rhinoplasty was first developed by Sushruta, an important physician (often regarded as the "father of plastic surgery") who lived in ancient India circa 500 BC, which he first described in his text Susrutha Samhita. He and his later students and disciples used rhinoplasty to reconstruct noses that were amputated as a punishment for crimes. The techniques of forehead flap rhinoplasty he developed are practiced almost unchanged to this day. This knowledge of plastic surgery existed in India up to the late 18th century as can be seen from the reports published in Gentleman's Magazine (October 1794).
The first intranasal rhinoplasty in the West was performed by John Orlando Roe in 1887. It was later used for cosmetic purposes by Jacques Joseph (b. Jakob Lewin Joseph) in 1898 to help those who felt that the shape or size of their nose caused them embarrassment and social discomfort. His first rhinoplasty patient was a young man whose large nose caused him such embarrassment that he felt unable to appear in public. He approached Joseph because he had heard of a previous successful otoplasty, or "ear job," which the surgeon had performed.
How rhinoplasty is performed
It can be performed under a general anesthetic or with local anesthetic, depending on patient or doctor preference. Incisions are made inside the nostrils (closed rhinoplasty). Sometimes, tiny, inconspicuous incisions are also made on the columella, the bit of skin that separates the nostrils (open rhinoplasty). The surgeon first separates soft tissues of the nose from the underlying structures, then reshapes the cartilage and bone causing the deformity.
In some cases, the surgeon may shape a small piece of the patient's own cartilage or bone to strengthen or increase the structure of the nose. Sometimes this is done for cosmetic reasons (to improve the shape of the nasal tip, for example), or it may be done to improve breathing and function of the nose.
In rarer cases, a synthetic implant may be used to reconstruct the nose if the normal structure of bone and cartilage is badly damaged or weakened. Alloplastic synthetic materials are often associated with long-term complications such as migration and extrusion. Alternatively, cartilage from the septum, ear or rib may be used.
To improve nasal breathing function, a septoplasty may be performed, with or without cosmetic changes. The cartilage that is removed may be used as a graft to improve the appearance and structure of the nose.
In the entertainment industry
The Los Angeles Examiner of May 5, 1930, stated that:
"Having one's nose shaped to fit the talkies is the most popular thing in Hollywood now. Hollywood plastic surgeons agree that more than 2000 facial beautification operations have been performed among film players within the past few years."
Siblings Michael, Janet and La Toya Jackson's are among the most prominent rhinoplasties in show business with a dramatic reduction of nose size and change of shape. Like many starlets, a young Marilyn Monroe had work carried out on her nose before her first film roles at the advice of her mentor Johnny Hyde. Jennifer Grey is another famous movie star whose looks transformed completely after a nose job.
Ethnic Nose Rhinoplasty
Many African-Americans or Asian-Americans, and others with non-European looking noses, choose to have an aesthetic rhinoplasty.
Although techniques and methods employed during rhinoplasty surgeries are the same regardless of race, there are some trends that apply to patients of certain ethnic backgrounds.
Asian-American Rhinoplasty: Asian patients often want their noses to appear narrower. This can be done through the use of infractures, where the nasal bones are broken and moved in or reset to thin out the nasal area and add projection in the process. (Outfractures, where the nasal bones are broken and moved outwards, are used to widen a too-narrow dorsum.)
African-American Rhinoplasty: One common trend in African American Rhinoplasty is to narrow wide nostrils. This procedure may include removing sections of the base of the nostrils or sections of the nose where it meets the face. The tip of the nose can be restructured by removing tiny sections of cartilage.
Revision rhinoplasty is a nose operation carried out to correct or revise an unsatisfactory outcome from a previous rhinoplasty. It is also known as secondary rhinoplasty or tertiary rhinoplasty. There are two main reasons for performing secondary or tertiary rhinoplasty. The first is purely cosmetic. A patient may be unsatisfied with all or part of a previous nose “job,” because of the way their nose appears after rhinoplasty surgery. A nasal hump may not have been reduced enough, or too much. A prominent or bulbous nasal tip may have not been addressed appropriately, or over-aggressively. The nose may looked pinched, it may look like a parrot’s beak, or like a boxer’s nose. There are many ways in which previous nose surgery may have left a nose aesthetically unappealing to a patient. The second reason is functional. The original nasal surgery may have been carried out to help with difficulties in breathing, and the outcome may have been unsatisfactory. Alternatively, the original surgery may have been performed for cosmetic reasons, but may have disrupted a normal physiologic mechanism involving the inspiration or expiration of air, making it difficult to breathe. Secondary rhinoplasty, and especially tertiary rhinoplasty, are extremely complicated procedures. This is self-evident because it is clear that even when the patient was operated upon for the first time, even when the tissues were “virginal,” and untouched the desired result could not be obtained.