Mar 4

Beauty vs. Breathing: Do I have to choose?

Revision Rhinoplasty pinched tip beforeRevision Rhinoplasty After Base View

This example shows a man who had undergone Rhinoplasty twice in his home country many years previously. His nose changed over time, leaving him with a feminized pinched tip and severe nasal breathing problems. On breathing deeply through his nose, his nostrils collapsed completely into tiny slits. During his Beverly Hills Revision Rhinoplasty, he had multiple grafts placed including batten grafts, spreader grafts, and a tip graft to achieve significant improvement in his breathing and restoration of the nose he had wanted originally, as shown in this 1 year postoperative photo on the right.

We see many patients who had wanted a pretty, small, feminine nose and ended up with a pinched tip, nasal collapse, and breathing problems. We often enter into a lengthy discussion regarding what would need to be done during a revision surgery to correct both their breathing concerns and improve any aesthetic issues. Often, these two overwhelming concerns are aligned. That is, whatever must be done to improve breathing (usually involving grafts) would also tend to make your nose look better. On the other hand, sometimes these concerns may work against each other. For example, improving breathing might involve having to widen or enlarge your nose slightly at the bridge (with spreader grafts) or the tip (with tip or batten grafts), something we need to take into account when we consider nasal aesthetics.

Most people, when we show them how widening their noses slightly would appear on computer imaging, are quite happy with the idea. They feel that the new image looks more natural and returns them closer to the nose they had wanted originally. But, some patients who had rhinoplasty many years ago or when they were very young may have lived with the look and feel of their current noses for so long that it is all they remember. They may not report more than minor breathing problems even though significant nasal obstruction is evident on examination. Their current level of nasal breathing is all that they know.  These patients are often pleasantly surprised after revision rhinoplasty because they never knew they could breathe so well. Likewise, while most patients are horrified with a pinched and shortened nose, a minority of patients may have learned to incorporate this look into their body images. So, they may not be too interested in the idea of widening or lengthening their noses. This is usually not an issue for men who can tolerate a stronger nose.

Our challenge is to find the happy medium here to create a nose that looks good for you and through which you can breathe. It wouldn’t make any sense to give you a narrowed, refined, ultra-feminine nose if you can’t breathe through it. Similarly, when we must reconstruct and widen your nose to improve its function, we need to thin and tailor our grafts so that they also enhance your nasal aesthetics or, at the very least, have no negative impact. Again, it makes no sense to us to have you breathing perfectly through a big, overbearing nose that dominates your other features. Finding balance and restoring harmony is the key that, with careful consideration and planning, can be achieved.

We look forward to any other questions you may have on this topic.

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