In the before and after examples, look for subtle but effective changes in nose and lip angle; the gentle raising of the tip; the slight lowering of the profile; subtle narrowing of the tip.
It has been over a month now since I had my surgery and I just wanted to write to tell you how much I appreciate everything you have done for me. I cannot explain to you (although I'm sure many other people have said that before) how happy I am with the outcome. At first I wasn't sure what to expect, but now that the swelling has gone down, I really can say that I love it. It is very rare to find people that listen to others. You heard exactly what my concerns were and you knew exactly what I wanted. The reason I know this is because you gave me the nose I have always wanted and the very nose that I asked you for. You and your staff made me feel so comfortable about the decision I had made and it made the entire process that much easier. It has been so great to get such extraordinary feedback from my family and friends and to hear them all use the word "natural" in their responses. Some people didn't even notice it when they first saw me, and after I reminded them, they couldn't believe how NATURAL and beautiful it looked which as we all know is exactly what I wanted. Not only do I feel good but I feel freer. My breathing is immaculate and I just feel better. I can't thank you enough for your concern, care and patience. You made this decision one that I will never regret.Thank you, thank you, thank you, -Jaime, college freshman
A generation ago, most surgeons created the identical cookie-cutter, nose at every operation, with little regard for the individual patient's facial features. Invariably, the results were quite artificial looking and certainly unacceptable by current high standards. Today's taste calls for less radical change and a nose that does not appear to have undergone surgery. The surgeon's highest compliment is remaining incognito.
When you can spot an obvious "nose job," two failures took place. The second failure was that of the surgeon: an inability conceptually or technically to create that individualized, unoperated-appearing, natural nose. But the first failure, the primary cause, was that of the patient: poor surgeon selection. Perhaps homework was not done, questions were left unasked, or before and after photos were either ignored or not requested.
An overdone, too-pinched, too-scooped unnatural nose is the product of an inadequately trained doctor working on an unsuspecting patient. Perhaps the patient was content with the sign on the door that said, "Plastic Surgery" or "Cosmetic Surgery" and assumed the doctor behind the door was good at every cosmetic surgery procedure. Now you know better.
Successful nasal cosmetic surgery is brain surgery. You change the way the patient sees himself; you change a life.-Howard Diamond, MD nasal surgeon extraordinaire, New York City
Ideally, a nose should look natural, well proportioned to the face and so pleasing that it calls little attention to itself. Unsatisfactory outcomes tend to be "overdone." Too upturned, too ski-sloped, with overly prominent nostrils, or a "pinched" tip, or an overall unnatural or artificial look.
I want to thank you for the wonderful job you did on my nose. Not only is it tailored to my facial features, but to my personality as well. One of my biggest concerns when I was choosing a doctor was that all of the noses on all of the patients looked exactly the same. It was as if the doctors I had spoken with had found one nose that worked and had simply chosen to reproduce it over and over again without regard to the individual. When I went through all of the photos and watched the video in your office, I thought, "Finally, a doctor who doesn't mass produce his looks."-Heidi, student, California
Let me now share a special little secret: even some of the most sophisticated, cosmetic surgeons shy away from performing some very difficult nasal cases, particularly "redos." They wisely refer such cases to colleagues who major in nasal surgery. Why? Because they are smart enough to recognize that the "nose job" is technically the most difficult procedure in cosmetic surgery. It is both functionally and conceptually complex when compared to other cosmetic procedures of the face and body.
Nasal surgery takes unusual manual dexterity and superior eye/hand coordination.
The operation is usually done entirely through the nostrils (although some surgeons use the "open rhinoplasty" approach combining both internal and external incisions). In either case, nasal surgery is a challenging prospect even for the most sophisticated surgeon. All architectural changes are made inside after tunneling under the skin of the nose. Typically, tissue is removed to make the nose smaller, but sometimes natural tissue or a plastic part is added to strengthen the tip or raise the bridge of the nose. Doing all this through the nostrils is like operating through a keyhole.
Twenty percent of men would like to change the shape or size of their noses.-Men's Health
Custom, miniaturized surgical instruments perform sophisticated techniques and maneuvers. An eighth of an inch, more or less, can make a difference in appearance. Placing and tying stitches is challenging (the good news for you is that those stitches dissolve). As a resident-trainee, at first it took me over two hours to perform a routine nasal surgery. And it was not much fun. Too hard. Today, the same operation takes a mere 45 minutes; now I enjoy it.
In many nasal cases, the surgeon faces the daunting task of not only creating a better looking nose, but also improving nasal airflow, straightening if crooked (very challenging), reducing sinus problems, and improving allergy symptoms. The objective of this total overhaul is a nose that looks good and works well. A big order.
The most popular cosmetic surgical procedure among men was nose reshaping with 150, 185 performed.-American Society of Plastic Surgeons National Statistics, 2001
Why am I providing this additional, technical information on nasal procedures in this chapter? Because if there is such a thing as a super-superspecialist, then a top nose surgeon is it. Even some terrific cosmetic surgeons will deliberate over accepting some nose cases: But that's O.K. As specialized as we may be, we all can't do everything equally well.
After nasal surgery, the best practices make nasal pack removal swift and painless by using old-fashioned decongestant nose drops with an added liquid anesthetic. Nothing exotic. The medicine is dribbled into the nostrils and absorbed into the nasal passages. This "shrink and numb" solution then allows the nasal pads to glide out painlessly. No torture session here.
Likewise, we apply a specially compounded anesthetic ointment to eyelid and facelift incisions prior to stitch removal. Why should you have any pain at all even during stitch removal? For chemical or laser wrinkle removal, there are highly sophisticated and specialized anesthesia formulas available. Pain-killers are started before the patient even goes under general anesthesia, so when they wake up in the recovery room, the pain medicine is already working keeping them comfortable. As appropriate, some patient's home care kits contain Valium.
This tranquilizer, in addition to providing a relaxed, peaceful attitude the first day after surgery, also causes amnesia. As one patient remarked, "I can't remember any pain, so I guess it never happened." Modern medicine has the answers to keep you comfortable and free from pain for the big things and even the little things.
Anesthetic creams, sedatives, tranquilizers, sleeping pills, pain-killers. Superspecialists utilize all of these because they compulsively focus on every detail before, during and after your procedure. They are driven to bring you the best total experience. The less specialized cannot do it because they are too busy pursuing a wider field of interest. Another good reason to insist on the best practices run by superspecialist surgeons.
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