Male Rhinoplasty
Una publicación compartida de Anil Shah MD (@shahaesthetics) el
“A rhinoplasty should look something created from nature. Abnormal curves, contours, overly narrow or wide will give a subtle but evident hint to observers that something just is not right.”
A man’s nose should look a man’s nose. This is a seemingly easy concept but probably not followed by many plastic surgeons. Whereas a female nose can be slightly rotated on a small figure or have a slightly narrower appearance, both normal and natural variations, a man’s nose will look odd if his tip overly rotated, pinched, or concave.
A straight nose is paramount on a female face, but on a male face slight deviation can be acceptable. On profile view, a straight profile or a slight convexity to the bridge can make it difficult for outside observers to tell if there has been a rhinoplasty.
The osteotomies (narrowing of the nasal bones) are completely different in a male rhinoplasty and a female rhinoplasty. Females can and often seek slight narrowing of the nose on frontal view. A male nose must be narrowed with caution. A dead give away of a male rhinoplasty are two indentations on the sides of the nose, signs that the surgeon has been too aggressive with the osteotomies.
Are more and more men getting rhinoplasty?
I think more and more men are getting rhinoplasty for several reasons. First of all, rhinoplasty techniques have changed over the last several years. Historically, rhinoplasty has been thought of as a reductive operation. Many men and men considered handsome have masculine features. Some noses actually benefited from augmentation and projection. Techniques to augment the dorsum have improved so that graft visibility is less noticeable and nasal tip projection is more predictable. In addition, plastic surgery has grown rapidly over the last several years. More and more men are seeking plastic surgery to improve esteem and looks.
How should a men’s nose look different from a women’s nose?
A man’s nose should fit the face. Often times that calls for stronger dorsums, more projected nasal tips. While many women seek a narrower nose, most men seek wider noses.
Are men more or less particular than women?
As with female patients, there are a wide variety of personalities and needs for every patient. It is your right as a patient to be know what you like. However, historically, men were thought to be “trouble” patients. A neumonic was devised called SIMON (self centered/ immature/ male/ obsessive/ narcissistic) to describe the typical male patient.
My experience has been far from that. In fact 50% of my rhinoplasties are men (national average around 15%). I find if a thorough consultation with photoimaging usually helps facilitate communication and lead to better understanding.
Who are the most sought after male celebrity noses in your office?
Patients who bring in a celebrity photograph are usually do not have realistic expectations. certain noses may “work” on that face but would not work on another face. For example, Brad Pitt’s nose would not look right on Hugh Jackman’s face and vice versa. With that preface aside, the most common nose requested is Colin Farrell closely followed by George Clooney in the year 2007.
The first example is of a male model who had traumatic assault and subsequent nasal obstruction. Looking at his nose on the frontal view, a few things standout. His nasal bones are deviated to the left. On his base view you can see the footplate is pushed out to the patient’s left side. Often times when you see that there is an underlying septal deviation as the cause of that. He did not want significant downtime and basically wanted to look similar except for the cartilaginous knuckle on his right side of the nose.
Due to the fact that the patient wanted a quicker recovery and minimal change to the outside of the nose, I decided to do an endonasal approach to provide the patient with a quicker recovery and minimal change to the outside of the nose. Many surgeons would chose to do this case with an external approach, which would be fine, but it does have a prolonged recovery.
As you can see with the intraoperative photos, he had a natural overlap of the cartilage creating a knuckle. Much has been written about knuckles and bossae. It is tempting to shave a bossae down and let it heal. I think this is a dangerous thing for the patient to shave down the bossae, making it weaker than expecting it to improve. I feel a safer approach is to overlap the cartilage and place a small cartilagnous graft underneath to fortify the lower lateral cartilages. This allows the lower lateral cartilage to actually become stronger than it was preoperatively.
The septum was deviated off to the left side of the airway. A modified swinging door was used to repositon the septum in the midline. The nasal bones were repositioned to allow for improved position.
At two years after the initial surgery, you can see that the bossae has been corrected and that his nose is now better aligned. His breathing has improved as a result.
