When analyzing a nose the first step is to listen to the patient’s concerns noting any breathing problems or allergy related symptoms. We then have the patient describe what their appearance related concerns are and then build a conversation with the patient and introduce other related issues affecting the appearance of their particular nose. In our practice we use digital imaging in our rhinoplasty consultations to allow changes to be reviewed with the patient and explain and show the patient changes in pertinent nasal features. In analyzing the nose from the frontal view we look at nasal width and symmetry. A nose can be either too narrow or too wide to be aesthetically pleasing and often a nose will be too wide in one area and too narrow in another. When surgically altering a nose we strive to achieve a natural line from the brow down the side-wall of the nose to the tip which gently tapers outward and is symmetric.
From the side view we first look at the distance the nose is from the face known as projection. Projection should be assessed from the dorsum to the tip and varies from patient to patient based upon facial length, body height and facial width. We also look at the angle the nose forms with the upper lip known as rotation which is closely related to the length of the nose. As the tip of the nose is turned up some length decreases and as the tip is turned down length increases. We also look at the amount of columella that hangs or shows below the nostril margin. This columellar show can be too much known as a hanging columella or too little known as a retracted columella. The nostril margin can also be retraced or hooded and affect this relationship. Lastly from the profile we look at the contour of the dorsum as it relates to the tip. Ideally we want the dorsum to lie on a line just below the nasal tip with a slightly more concave dorsum being well tolerated in females and a slightly more convex dorsum in males.
The last view we assess is the base view or up the nostrils. From this view we can see if the distal part of the septum or columella is in the midline and if the nostrils are symmetric. We can also look to see if the nostrils are too round or to narrow or if the flare of the nostrils needs to be reduced. All of these features can be altered with different techniques.
Rhinoplasty is most complex procedure we do and for that reason we love doing them. We have extensive experience in both primary and revision cases including harvesting and using rib grafts when necessary. Each one of the items mentioned above can have its own blog and we will expand on these topics in future postings. Please take some time to review our photo gallery where all of these terms can be much better explained by photographic examples. We look forward to hearing from you.