Nose reshaping surgery, or rhinoplasty, is one of the most popular cosmetic surgical procedures. A combination of art and science, it is also one of the most difficult for surgeons to master. Why would you want to change your nose, and what motivates other people to change theirs? When did you realise you wanted cosmetic surgery on your nose? How old were you when you underwent the procedure? How long did you mull over the decision? You can find the answers to some of these questions in this article. 

Did you know that with noses, as with modern architecture, form follows function? Even the slightest change to the shape of your nose can affect or change its function, improving or causing breathing obstruction and other issues. An undiagnosed issue may become magnified by the slightest surgical changes to the structure of the nose. Conversely, the smallest change in the nose’s internal structures can affect your appearance. A good rhinoplasty technique is a tough skill to master. Its difficulty is one reason for the high incidence of revision rhinoplasty, even when most patients are satisfied with the outcome.

From a surgeon’s point of view

First, let’s find out what surgeons are thinking. Check out this abstract from a paper titled ‘Illusions in Rhinoplasty’ and you’ll see what your rhinoplasty surgeon is trying to achieve:

“A good rhinoplasty surgeon attempts to enhance nasal performance through airway and appearance improvement. The great rhinoplasty surgeon routinely improves not only nasal performance but also endeavours to achieve a higher level of overall facial aesthetic enhancement by manipulating the surgical illusions of the face. This cohesive interplay of science between the eyes, cheeks, nose, lips, and chin is known all too well by the master facial plastic surgeon who defines the art of rhinoplasty.”[1]

The first tip for anyone contemplating rhinoplasty is to find a “great” surgeon, even if you have to pay a higher cost. If not, you may end up spending a lot more in the long run.

What motivates people to have rhinoplasty?

According to a study published in the Aesthetic Plastic Surgery journal in 1998, the factors that motivate people have remained the same over time. Most people who seek rhinoplasty are self-motivated. Their desire comes from inside. Some are motivated to have nose surgery after seeing others who have had their noses changed. These two motivators—independent decisions and the desire to emulate others—accounted for roughly 80% of rhinoplasty requests over time. About 20% were motivated by external influences.

The study which sheds much light on what motivates people to have rhinoplasty, used data from multiple studies done between 1964 and 1997, involving a total of 5,970 rhinoplasty patients.

Your own initiative is a key factor

Interestingly, the first study, which took place between 1964 and 1974, showed that over two thirds (68%) of rhinoplasty patients cited their own initiative as a key motivator. Only 13 percent said the key motivator was seeing the results of another’s nose reshaping surgery. Just over 19% mentioned external influences as key motivators.

By 1997, the number of patients citing their own initiative declined to roughly half of the patients. Seeing results on others became a more prominent reason, with over one third stating it as a motivator. Surprisingly, even by 1997, external factors were mentioned by barely 17 percent of patients.

External influences

External influences include people who pressure others into having surgery. Parents and significant others are mentioned (boyfriend, girlfriend, husband or wife) as exerting pressure. Others, such as friends, colleagues, doctors and hairdressers, are also mentioned as influencing the decision to have rhinoplasty, but with less frequency.

Seeing recent photos or videos of themselves, prospective airway surgery, upcoming festive events like a wedding or party and changes in lifestyle due to divorce are some other external factors that influenced participants to have rhinoplasty. A handful mentioned other lifestyle factors such as widowhood, using contact lenses and retirement as motivators. Weight loss, changes in financial ability that make surgery affordable and midlife crises are also motivators. Some participants—actors and models, for example—seek rhinoplasty for work related reasons. People are also influenced by the attitude of the media towards surgery and media advertisements.

Rhinoplasty has increased in popularity among men

In the first two studies conducted, rhinoplasty patients were predominantly female (94% in each group). By the mid 1990s, male patients accounted for 13 percent of the patients.

This trend has continued unabated, at least in the U.S., the world’s largest cosmetic surgery market. According to the 2011 Plastic Surgery Statistics Report issued by the American Society of Plastic Surgeons, roughly 25 percent of the total rhinoplasty procedures in 2011 were performed on men. Rhinoplasty was also the most popular cosmetic surgical procedure among U.S. men that year.

The Ages and Stages

Rhinoplasty is predominantly performed on young people. Most patients in the studies cited above were below 25, with some in the 25 to 30 age group. Beyond that, the numbers were quite insignificant.

According to 2011 U.S. statistics, rhinoplasty remains by far the most popular cosmetic procedure among the 13 to 19 age group, accounting for over 44 percent of surgical procedures in this age group. It is also the second most popular (behind breast augmentation) in the 20 to 29 age group and the third most popular cosmetic surgery (behind breast augmentation and liposuction) among the 30 to 39 crowd. Rhinoplasty accounts for less than one tenth of all the cosmetic surgeries performed on those above 40.

According to the researchers, most of the younger rhinoplasty patients were self-motivated. Older people appeared to need external influences to push them into the decision.

People in the three studies reported going through three distinct stages before their surgery. The first stage is self-image awareness, followed by planning and performance. People of different ages tend to complete these stages at a different pace.

Analysing the data, the researchers found that the “younger patient group (16–21) recognised the aesthetic disharmony of their noses to their other facial features early in life. They almost universally were self-motivated and were able to go through the three stages to surgery in an average of 2–3 years.”

Although the older patients had also recognised quite early the need for a cosmetic rhinoplasty, external influences often prevented them from planning and going through with surgery. Financial difficulties, not enough vacation time, changes in housing or work situations and military commitments were given as impediments. Older patients had surgery when those reasons no longer applied. On average, older patients tended to complete the three stages between 5 and 6 years.

Over-eager younger patients

From the comparison studies the researchers noted:

“Younger patients very often are overeager to have a cosmetic rhinoplasty. They often have exaggerated expectations and do not consider the possibility of complications or poor results and sometimes have exaggerated expectations. They listen but do not hear when their surgeon explains untoward results or complications. If such complications occur, it can be devastating to the patient and the surgeon.”

Taking this into consideration, the researchers recommended that younger patients should be given well-documented, detailed information concerning nose surgery. It was also important that all aspects of the discussion with the patient and family should be recorded. Older patients were likely to be more “informed about possible complications and are usually less of a risk” than the younger group.

For more information

Here are some valuable resources:

[1] Younger RA. Illusions in rhinoplasty. Otolaryngol Clin North Am. 1999 Aug;32(4):637-51. Accessed on 12 Dec. 2012 at: http://www.ncbi.nlm.nih.gov/pubmed/10433660

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