I want my nose to look like that

Every so often I am asked by a patient who is requesting rhinoplasty surgery for their nose to look like someone that they had seen in a magazine.  I believe there are several opinions amongst surgeons how to best manage this particular situation.  I have always felt that being honest with the patient is the best way to approach such a request.

The first thing I do is discuss with the patient whether they are interested in the particular shape or characteristics of the nose of the person in the picture they have asked me to look at or are they actually interested in looking like the person they have presented to me.  Assuming that their answer is that they like many of the features of a particular nose, I proceed with a physical exam and take photographs which are standard for rhinoplasty preoperative planning.  During the physical exam, I try to assess the  overall structure and strength of the nasal bones and cartilages and then feel for the thickness of the nasal skin envelope.

These steps are important because if the person presents to me with thick skin and poorly developed structural nasal support (ie. pushing on the tip even slightly causes the tip to collapse), I am obligated to tell them that they are unlikely going to be able to have the same nose as the chiseled, air-brushed model they have presented to me as their rhinoplasty objective.  What I find is that with a good consult and even better explanation, I can show the patient what truly can be achieved and, in an overwhelming majority of the situations, the patient is thrilled with the prospects.  Of course, there are those individuals who do present to my office with pictures of very sculpted noses, and I can, in fact, exceed their desired outcome.