There has been a lot of discussion in the media regarding teen actress and singer Ashley Tisdale's decision to have here nose fixed for a functional breathing problem early in December. When she emerged approximately 3 weeks later, it was difficult to recognize her, similar to the way Jennifer Grey of Dirty Dancing fame emerged after her nasal surgery. It is clear that both of these actresses underwent not just breathing surgery, but an operation called a rhinoplasty (nose job) to alter their appearance. Interestingly, both of these young women were attractive in their own right, and likely wanted only to have minor changes in their nasal shape to better enhance or define their beauty. Interestingly, the extremely small and pinched look of the tip of Ashley Tisdale's nose indicates that a lot of cartilage was removed from it, and this usually causes difficulty breathing; this is the very reason why she embarked on her surgery in the first place.
The unfortunate truth about rhinoplasty is that approximately 7 to 10% of rhinoplasties performed in the United States require revision surgery because the person undergoing the surgery is not satisfied with its look, or because of post-surgery breathing problems. So yes, there is a way to restore Ashley Tisdale's nose to a more natural appearance that does not erase her identity. In her case where the nasal cartilages and bones were overresected (too much removed) this would involve replacing the removed cartilage with cartilage borrowed from other portions of the nose or body like the nasal septum (a piece of cartilage inside the nose) the ears or in very severe cases, unlike Ashley's nose, the rib cartilage. This requires the expertise of a facial plastic and reconstructive surgeon that specializes in both revision cosmetic surgery and reconstructive surgery, and these doctors can be found both through the American Board of Facial Plastic and Reconstructive Surgery or the American Academy of Facial Plastic and Reconstructive Surgery.
So how does the actress or everyday prospective patient prevent this problem when choosing a surgeon? The first step is ensuring your doctor is board certified and specializes only in facial plastic surgery and not a generalist also performing other cosmetic surgery procedures like breast augmentation, liposuction and tummy tucks. Avoid the "jack of all trades." One way of ensuring this is by choosing a doctor board certified by the American Board of Facial Plastic and Reconstructive Surgery as noted above. But this is only the beginning.
When interviewing a doctor for surgery during a consultation, you should be allowed to see hundreds of examples of their work. During your review of these photos, make sure that all the noses do not look the same because that indicates that the doctor has a "cookie cutter" approach to surgery and that your nose will look just like all the others. This is important as each rhinoplasty surgery should be sculpted to balance with other facial features and stature. For example the 6 foot runway model with a long face should not have an overly small and upturned nose because it will look ridiculous.
Additionally, their needs to be an extensive discussion with each patient to arrive at what their concept of beauty is and what their desire is for surgery. If you were Ashley Tisdale and only wanted your bridge slightly refined and wound up with a nose half it's originally size that would be horrible. The best way for a surgeon to arrive at this conclusion is by taking digital pictures of the patient and using digital morphing technology to manipulate the photos so that there is a clear understanding of what a patient wants their nose to look like. This becomes the road map for surgery. This is not a gimmick, and I and a minority of surgeons across the country use this to make sure we are going to deliver what each person wants. Many plastic surgeons will not use this technology as they cannot tailor their operation but give you the "Doctor Smith Nose."
Their needs to be a merging of good techniques, the aesthetic understanding of the surgeon, and the desire of the patient defined by digital morphing to prevent unwanted results. But who knows, maybe Ashley wanted her nose to look that way!
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