Noseworthy

By the time Tanya turned 30, she had already hated her nose for more than 10 years. "I always wanted a more feminine nose," she says. While her own nose wasn't unusually large, she felt it was out of proportion with her face. "I inherited my dad's nose, which wasn't completely straight and was bulbous on the tip."

In the early '90s, Tanya probably would have lived with her less-than-perfect nose - for life. But after revealing her dissatisfaction to her family doctor, she got a referral to Dr. K. Conrad, founder and chief surgeon at the Nasal and Facial Plastic Cosmetic Surgery Institute and Laser Center - in Toronto and Richmond Hill, Ont. He reassured her that a rhinoplasty could be performed on her safely and effectively, and that her recovery time would be minimal. What's more, he sketched out a nose that he felt would be perfect for her face. "He made me feel completely at ease," she says.

After the surgery, and an overnight stay at the clinic, Tanya left with a small cast on her nose, and purple-blue bruising under her eyes. She wore the cast for one week and noticed just a bit of swelling when it was removed. At two weeks post-surgery, a little concealer easily hid the light bruising left under her eyes. In fact, when she returned to work for a visit (having timed the surgery with an overdue vacation), her co-workers couldn't quite put their finger on what was different about her. One asked if she'd had her teeth cleaned -because her new nose was slightly higher off her lip, her teeth were more visible. Another said she looked great - and well-rested.

"I think it's funny that they don't quite know what I've done," says Tanya. "It tells me that this nose fits my face well, and that my profile is nicer and my nose is more well-defined and feminine. It sounds like a cliche, but I really do feel like a new person."

When it comes to noses, most people aren't willing to settle for almost-perfect, says Dr. Conrad. Even individuals who never would have considered surgery in the past are now making small changes to their noses that make a big difference to their appearance. "They know what is available and that we have the skill to carry it off safely."

Times and procedures sure have changed since the first nose job. Back in the days before Christ, when prisoners in India had their noses amputated for their crimes, it was Indian surgeon Shushruta who reconstructed them. The first intranasal rhinoplasty (nose jobs as we think of them today) didn't take place until 1887. Performed by New York surgeon John Orlando Roe, it was aimed at altering a pug nose - which can be a dead giveaway that the bearer had Irish blood.

Nowadays, being Irish is hardly a badge of dishonor - what woman doesn't have a secret crush on Colin Farrell or U2's Bono? But rhinoplasty continues to help people reach their own standard of perfection. New methods and techniques make the procedure more precise and reduce healing time so you can return to work - and your life - almost immediately. In the past, the procedure usually involved fracturing a patient's nose in the hope that it would break in the right spot. The problem, says Dr. Conrad was this: "If you break a piece of wood, it will not always break where you want it to. You will have to piece together some splinters and it will not be a clean cut." It's now possible to reshape a nose without breaking it. Instead, doctors can now directly cut parts of the nasal bone. The result: traces of bone fragments are less likely to be left behind: the surgeon is able to align the bones more precisely; and trauma, swelling and soreness are minimized, along with healing time.

Within two weeks, rhinoplasty patients can go back to non-physical jobs and in six weeks they can rejoin their spinning class, or take up windsurfing again. Still, if you've got a monumental goal in mind in which you want your new nose to look perfect - your wedding or your child's graduation - Dr. Conrad suggests booking your rhinoplasty at least six months to a year before the event. He says he did, however, recently perform the surgery just six weeks before one patient's wedding. "She sent me a picture," he says, "and she looked wonderful. But I was very nervous."

Another innovation: so-called external or "open" surgery. Rather than operating through the nostrils, doctors make a tiny incision below the nostrils and peel the skin back, enabling them to operate with greater exposure on patients who may have very tiny nostrils, congenital deformities of the nose, or who may have had other rhinoplasties that complicate matters. "Michael Jackson, for instance," says Dr. Conrad, "would have to have the external approach if he decided to restore his original appearance. He has had grafts and all kinds of incisions that resulted in significant scarring, which cannot be dissected safely without damaging the skin," Dr. Conrad adds.

Although Dr. Conrad was one of the pioneers of "open" surgery back in 1971, he says it's best reserved for complicated cases. The slight incision means a small scar will remain between the nostrils under the nose. A skilled surgeon should perform traditional, "closed" surgery - in which a small incision is made on the inside of the nose - on 95 per cent of his or her patients, advises Dr. Conrad. If he or she is not doing traditional surgery, don't be afraid to ask why.

Rhinoplasty may be common, but risks still exist. The slightest slip can affect the functioning of the respiratory system. Cosmetically speaking, imperfections are immediately apparent. Even swelling and bleeding can misplace the nose by a millimeter, creating asymmetry that may need to be touched up later.

In fact, it's those minor touchups that comprise five to 15 per cent of all rhinoplasty patients. For Dr. Conrad, 60 percent of his business is patients looking for revisions to previous rhinoplasties.

"Some patients come with badly mutilated noses because of a past surgeon's lack of skill or technique," he says. "But a lot of them come with noses that are good-looking, but they are unhappy with it." Often a woman thinks her nose is too manly, or a man thinks his results were too delicate.

For the surgeon to create the perfect nose is as fine an art as being a sculptor. A good surgeon should take into account not only the projection of the nose, but the character of the nasal tip, the angles between the nose and the forehead, and between the nose and the upper lip. While a sculptor can chisel away at a piece of wood or stone to create an image that will last thousands of years, a cosmetic surgeon must work under the skin to change "the position, the character, the size and the relationship of bone and cartilage." On top of that, Dr. Conrad adds, "we can never be certain how skin will heal."

A masterpiece, says Dr. Conrad, should be almost undetectable - at least to the unschooled eye. "I can usually tell," he says, "but not always." Dr. Conrad recalls meeting a beautiful woman at a public forum with former talk-show host Dini Petty a few years ago. "I stopped breathing for a moment she was so beautiful," he said. The woman asked him point-blank if he liked her nose. He told her it was beautiful. "It's obvious God gave it to you," he recalls saying. She laughed. "No Dr. Conrad," she said. "You did it two years ago." 

Contact board-certified plastic surgery doctors in your area or read more articles to find out more information about your nose job in the above section of our page. If you live in the Ontario, or are in the Canadian area, you can contact Dr. K. Conrad for more information. 

 

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