The nose is certainly the most prominent feature on the human face. An unattractive nose can make an otherwise beautiful person unappealing. When it is improved, a near miracle can occur. Yet the amazing thing is that when the surgery is done properly, the reason for the new appearance is not at all obvious. When the nose is made to look better, but still appears to be natural, no one knows what has caused the transformation. If you have your nose changed by someone really skillful, no one will ever know.

Unfortunately, the "nose job" has gotten a bad reputation over the years because too many doctors never learn to do it properly. This is evidenced by the unhappy patients whose noses have obviously been "done." Some people think that they can recognize every nose job, but in reality, they can only tell the ones that are bad. No one, not even a plastic surgeon, can tell the good ones.

The surgery demands a high degree of surgical skill. Most plastic surgeons will agree that the rhinoplasty or "nose job" is the most difficult operation of all to do correctly.

The upper third of the support of the nose is made up of bone and does not move. Each side of the lower part is comprised of two pieces of cartilage, a very resilient substance that often has "a mind of its own." The principle of the rhinoplasty is that these internal structures can be altered, and the skin then shrinks to conform to what has been done underneath. Thus, the properties of the nasal skin are important to consider. Thick skin will not shrink as well as thin skin and this can place certain limitations on the result. This cannot always be predicted in advance since thick skin may shrink perfectly well. And thin skin may create additional difficulty, since any little irregularity that is left may show through. One overriding principle is that little changes can make a big difference.

Almost all of the incisions are made inside the nose to prevent noticeable scars (there is a technique called "open rhinoplasty" that is done differently, but that is not addressed here). Through these incisions, the skin is separated from the underlying bone and cartilage. When the procedure is completed, the incisions are closed with stitches that eventually dissolve. Finally, everything is held in position with tape and a thin metal splint that is worn for a week.

There are a number of nasal deformities that can be markedly improved. Usually, a patient will have several different parts of the nose that require correction. Your doctor should explain to you which parts of the nose he or she is going to work on and what will change as a result.