What Makes a Rhinoplasty Look Natural?

As most of you guys know, my posts are always about teaching. We're always trying to make a point, whether it's anatomy, consultation, surgery, whatever. So let me tell you about my day and I'll conclude with what the teaching lesson is.

So I started the day with three cases, three surgeries in the hospital. The first two were noses and the last one was a lower eyelid fat pad lift, lower blepharoplasty. Then I drove back to my office and I saw several patients.

One of them was this beautiful, gorgeous 16-year-old cute girl who wanted a cutesy nose, Barbie doll nose, beautiful, natural, fits her. That nose that I created for her, on my face would look very unnatural. On her face, she looked like she's born with it. So a natural nose or natural result is not the actual result. It's basically what fits that face. So for her face, what I created was beautiful, natural, cutesy. She wanted a little bit of slope, a little bit more lift, beautiful tip. Loves it. Happy.

Then I saw another lovely, beautiful young lady. She wants the opposite. She does not want any slopes. She does not want any lift. In fact, she has a heavier, droopier tip and she has a very small bump. All she wants is that bump addressed.

My recommendation is against that, because I think overall she needs to treat everything: put the tip in the right place, get a very natural nose, very straight bridge, no slopes, no upturn. But it's droopy right now. It's heavy right now. So I've met with her three times, with her parents three times. She's very smart. She's on her way to medical school. So I want to make sure she understands what she's asking, because once it's done, it's done, right?

So against my better judgment, I'm like, sure, I can do a very conservative closed endonasal rhinoplasty where all I'm doing is addressing your bump. Do I think she's going to look beautiful with it? No, she's leaving things on the table. The things that need to be done are truly the tip changes, the tip position changes, the tip structure changes. But what makes her happy, what makes her parents happy, is the bump.

And I'm like, as long as you get it, as long as you understand it, reluctantly, I'm willing to do that for you, because it's about you. It's about making you happy. You're not asking for something unreasonable. You're not asking for something dangerous. You're not asking for something crazy. You're not asking to be Michael Jackson. So yes, I'll do it for you.

There's actually a friend of mine that does that all the time. Pretty much most of the noses he creates are very, very, very subtle changes. And this will be that. My personal taste is not very, very, very subtle change. My personal taste in rhinoplasty is the right change that looks subtle.

Sometimes it's a dramatic change, but it can look super subtle. If it fits the face, 99% of the time it'll trick their friends, family, uncles, cousins, even parents, even spouses. They get tricked. The change was not subtle, but the result looks subtle. Anyway.