An artistic approach to the new nose
Cosmetic surgeons use new tools to refine, not revamp
Twelve years ago, a young woman named Elina met with a number of plastic surgeons about her nose, which she described as having a pronounced bump and bulbous tip, traits she had inherited from her father. Each surgeon showed Elina, then 18 years old, an “after” rendition of herself that she described as jarring.
“I remember telling my mom: ‘This doesn’t look like me. This doesn’t feel right,’ ” she said. “I thought, ‘I’m going to have to live with my nose,’ and I put it on the back burner.”
But then, while scrolling through Instagram, Elina, now 30 and a creative director in Manhattan, New York, who asked to be identified only by her first name, stumbled upon Dr. Dara Liotta, a facial plastic surgeon who specializes in natural-looking nose jobs. After a consultation, she plunked down $15,000 for a rhinoplasty with Liotta and is thrilled with her new, slightly altered profile.
“She left me this bump,” Elina said. “It looks so natural. I saw a bunch of friends, and they didn’t notice.”
Gone is the era of the cookie-cutter ski jump nose. Today’s cosmetic doctors are approaching rhinoplasties with a more artistic, individualized approach, using new surgical and nonsurgical techniques to refine rather than revamp one of the most prominent features of the face.
“You are taught to do rhinoplasty a certain way, but now it’s much less mathematical,” said Dr. Matthew White, a facial plastic surgeon in New York. “It’s about really spending time talking to the patient and figuring out what they are looking for.”
Wendy Lewis, an aesthetics industry consultant, remembers when a particular New York surgeon — Dr. Howard Diamond — was so well known for creating a specific nose, one with a scooped-out bridge and pinched tip, that it was called “a Dr. Diamond” nose.
“That was the standard, and by today’s standards that would be unacceptable,” Lewis said.
Rhinoplasty, which typically costs between $5,000 and $15,000, remained the most popular facial plastic surgery in 2019, according to the American Academy of Facial Plastic and Reconstructive Surgery. The group surveyed 774 of its members, and from the information they provided, the academy estimated that 55,000 surgeries were performed in the United States last year.
“The data shows that rhinoplasties are as popular as ever,” said Dr. Patrick Byrne, a plastic surgeon at the Cleveland Clinic, pointing to “the ubiquitous nature of social media” and use of smartphone cameras — he says they distort the proportions of the face, making the nose look larger — as key drivers of the demand.
For Nikki Kanter, 36, a digital marketing consultant in Chicago, wanting to look better in pictures was a factor in her decision to get a nose job. “In pictures, if I didn’t angle my face right, I looked like a boxer,” said Kanter, who had broken her nose in college when she was hit in the face by a bag of beads thrown from a float at a Mardi Gras parade. Her rhinoplasty fixed the damage that had been done internally, straightened the bridge of her nose and fixed the “droopiness” of the tip.
“Honestly, it’s one of the best things I’ve done for myself,” said Kanter, who added that she doesn’t look drastically different but is more confident.
In the last decade, doctors have abandoned socalled reduction rhinoplasty techniques in favor of a new “structural” approach. Instead of breaking the nose and then cutting away and removing cartilage and bone to reshape the nose and make it smaller, surgeons now rework (but don’t remove) the cartilage in an effort to build a more structurally sound nose that isn’t going to collapse with the passing of years.
“That’s why the tip of noses pinch with time, because there’s not enough cartilage to support it,”
Liotta said.
Aside from being more structurally sound, the new, subtle nose job also reflects evolving social norms and standards of beauty. Laurie Essig, a professor and director of gender, sexuality and feminist studies at Middlebury College in Vermont, pointed out that the first nose jobs were performed in the 1800s, mostly on
Irish men who wanted to look more “white.”
“It is a racialized and gendered project,” said Essig, author of “American Plastic: Boob Jobs, Credit Cards, and Our Quest for Perfection.”
To make noses look more youthful, Dr. Babak Azizzadeh, a plastic surgeon in Beverly Hills, California, grafts fascia — that is, connective tissue — taken from above a patient’s ear on to the bridge of the nose. The fascia provides a layer of tissue that mimics the look of thicker, more supple skin. “It’s a game changer,” Azizzadeh said of the technique.
The same results can come from injectable fillers, say some dermatologists, who use hyaluronic acid fillers not only to soften angles on the nose but to more dramatically contour it. These are often referred to as liquid rhinoplasties, in which aesthetic doctors use filler and neurotoxins to camouflage a bump or lift the tip of the nose by injecting the muscle beneath the nose with Botox.
Dr. Dendy Engelman, a dermatologist in New York, said she has seen an increase in patients asking about liquid rhinoplasties and attributes the rise to social media, where the procedure is often touted by doctors because of the dramatic before-and-after photos that appear to be tricks of the eye.
“With noses, you think about tiny tweaks, almost airbrushing of the nose,” Engelman said. “It’s what we do with makeup tricks, using how light reflects to make the nose look less prominent.”
But some doctors caution that injecting filler into the nose is riskier than in other parts of the face because of the number of arteries at the midline of the face. If filler gets into an artery, it can cause skin necrosis (dying) and possibly blindness, as Engelman acknowledged. She emphasized that patients should make sure their doctor has plenty of experience and training in liquid rhinoplasty.
Dr. Paul Frank, a dermatologist in New York and the author of “The ProAging Playbook,” said he is concerned about the longer-term effects of injecting filler into cartilage.
“We just don’t know what kind of damage this could be doing to the nose,” Frank said. “In the right hands, a rhinoplasty is safe and long-lasting.”