They say the nose defines a person’s character. However, when it is disproportionate, it can disrupt the balance and harmony of the rest of the facial features. Rhinoplasty—one of the most meticulous and precise cosmetic procedures, and also one of the most rewarding—makes it possible to achieve a nose that is well balanced with the rest of the face while maintaining a completely natural appearance.
Among all aesthetic surgeries, rhinoplasty is the most meticulous and demands a high level of precision. “Just one millimeter more of filing on the nasal dorsum can completely change the result,” explains Dr. Jorge Planas, Medical Director of Clínica Planas in Barcelona and one of the leading rhinoplasty specialists. The plastic surgeon performing the procedure must have a well-developed artistic sense, as they must consider features such as the nasal root, dorsum, tip, alae, and angles.
And when asked what the ideal nose is, the answer comes quickly: it doesn’t exist. “A nose has to be seen on a face. A nose, no matter how beautiful it may be, can be a disaster on the wrong face. And besides, there are many beautiful noses,” explains Dr. Jorge Planas. “You cannot create the same nose on different faces. A slim face is not the same as a wide face or a long face… You have to take into account the patient’s facial angles (the nasofrontal angle or nasal root, the nasolabial angle, and the mentolabial angle), as well as height and body build (whether the person is tall or short, robust or slender). For example, a short, very slim person with a small face and fine hair does not require the same approach as a tall person with a solid build, broad facial features, a prominent bone structure in the cheekbones, chin, and nasal tip, and voluminous hair. There are many factors that contribute to choosing the right nose,” he adds. To all of this, he includes one more key factor: skin thickness. If the skin is thick and not very elastic, it can conceal small imperfections, but the surgical result will be less visible and the degree of reduction more limited. On the other hand, if the skin is thin and elastic, a well-executed rhinoplasty will look flawless, allow for a greater definition, and adapt better to the new underlying bone and cartilage structure.
Ideal profiles
Lengthening a short nose, shortening a long one, increasing the size of a small nose, reducing a large nose by eliminating the well-known dorsal hump, narrowing a wide bridge, or lifting a drooping nasal tip—today, rhinoplasty can modify virtually any type of nose. However, great care must be taken when planning the procedure. The nose is a central facial feature, and its balance can either enhance or detract from the harmony and attractiveness of the rest of the face.
As Dr. Jorge Planas states in his book Cirugía estética sin trampa ni cartón, “The nose should go unnoticed and allow the eyes and the smile to take center stage. However, if it is disproportionate to the rest of the face, it will draw excessive attention. That is why the surgeon must aim for a natural result and achieve a size that is proportional to the rest of the facial features—in other words, harmonious with the face as a whole. This means avoiding upturned noses, pinched noses, noses that show the nostrils, or noses that are too small… in short, noses that clearly carry the label of ‘operated nose.’”
Should I have surgery?
Two main reasons can lead someone to want to change the shape of their nose. One is purely aesthetic—to make it “more attractive”—but it can also be due to breathing difficulties. The nose is an organ with an essential function: breathing. However, many people experience breathing problems, either due to congenital causes (such as a deviated septum or enlarged turbinates) or as a result of nasal trauma (a childhood fall or an accident). In these cases, patients often take advantage of surgery not only to improve breathing (septoplasty) but also to make aesthetic changes (rhinoplasty).
“In any case, what is clear is that while in the past patients did not dare to admit aesthetic reasons for undergoing rhinoplasty, nowadays neither men nor women feel the need to use that pretext. They have surgery simply because they want a different nose shape,” explains Dr. Planas.
Rhinomentoplasty and grafts
When someone undergoes nose surgery, they may also have the option—if recommended by the surgeon—to modify certain aspects of their face. Rhinomentoplasty combines nose surgery with chin augmentation. “The face must be considered as a whole. You cannot operate on the nose and ignore the rest of the face. For everything to be harmonious, sometimes it is necessary to move the chin backward or forward (using fat grafting or osteotomy), since the forehead and chin lie on the same facial plane,” explains Dr. Jorge Planas.
In addition to chin treatment, there are also cases of nasal augmentation, whether in Asian or African noses, or in post-traumatic noses following accidents. In these situations, it may be necessary to use bone grafts taken from another area of the patient’s own body (such as the iliac crest, ulna, or cranial vault). “Another contribution of mine is a paste made from bone bank powder combined with the patient’s own growth factors (from the blood). This paste is injected over the bone, which is prepared to allow it to integrate and form new bone,” explains Dr. Planas.
