Orange County Nose and Sinus Center

Some common ways of reaching an aesthetic diagnosis range from using mea surement contraptions to trusting one's instincts. Unfortunately, neither of these meth ods is very reliable not useful. It has been my experience that an aesthetic diagnosis can be simplified using two processes: observation and visualization. Observa tion can be described as a methodical, visual inspection. During the process of observation, the surgeon objectively tests each observed characteristic against an ideal standard. Visualization is a more challenging concept, yet no less essential. Visualization is the process by which a mental image is formed by anticipating the effects of structural changes prior to technical implementation. In rhinoplas ty, the statement “This is how the nose would look if” best captures the essence of visualization. Considering anatomical restrictions, the plastic surgeon considers the options and visualizes the effects forming a clear mental image of the result. A rhinoplasty is planned from the physical equivalent of that mental image.

THE PATIENT'S CONSIDERATION OF AESTHETICS
As noses vary from patient to patient, so does the definition of beauty. It is neither possible nor desirable to impose a predetermined ideal nose to every face. Aesthetic surgery should not neutralize the face by denying it of individual characteristics such as familial or ethnic qualities. The cat egorical imposition of an "ideal" appearance does not allow for those attributes that define particular individuals. In order to preserve these identities, it is paramount to actually listen to preoperative patients for their concerns about identifiable characteristics. These characteristics can be described as a dorsal convexity or rounded nasal tip. With revision rhinoplasty patients, surgeons may plan to restore certain identity-bound characteristics that were lost in the first operation. Success is defined from the patient’s perspective as well as the surgeon’s technique. However, it is important for the patient to accept that, like the architect, the surgeon is an expert in medicine and will ultimately decide what is best.
Paradoxically, technique may bow to the physical limitations of structure and might be to the patient's advantage, preserving natural traits by the surgeon working within the patient’s genetic context. Thus, these physical restrictions act a safeguard against aesthetic uniformity.

Consider, then, a patient whose aesthetic is severely monolithic: she wants only "to be beautiful." During consultation, this type of patient should be made aware of the aforementioned identity-bound characteristics of her nose—traits that can and should be changed and those that cannot. Beauty may carry more clarity when viewed from a more critical and realistic perspective. Similarly, the surgeon plans the operation in a manner that is not idealized and renders that which is feasible and specific from the fantastical.
What if a surgeon’s aesthetic judgment differs from that of the patient? If, after full discussion using photographs, the doctor is satisfied the patient understands but disagrees with his viewpoint and is reasonable, many plastic surgeons will defer to the patient's judgment. After all, at the end of the day, the patient must live with her new nose—not the doctor. Thus, a plan emerges from an appreciation of the patient's desires and a well-defined aesthetic concept based on normal nasofacial and intranasal relationships.