Nasal surgery represents the ultimate challenge to a plastic surgeon. Many plastic surgeons do not know or will not fix a dysfunctional airway. Conversely, many NT doctors will not alter nasal appearance. To date, I have done more than 8000 nasal cases with almost half of these re-does from other doctors. In fact 1 patient had 12 failures. Despite having one of the largest experiences in the world, superb nasal surgery is still difficult for me; but transformative for the patient. One of the tragedies of the new insurance revolution is that patients are forced to choose a surgeon from their list in lieu of the best surgeon available.
This can result in airway collapse, disfigurement, obstruction and renewed and repeated difficult surgery. When I left my plastic residency training program, I had done more rhinoplasties than any previous resident. I had patients flying from as far as England for surgery and paying my department. Starting practice, my backlog was over 200 patients.
Within two years of practice, I began to hear sundry complaints, from my own patients. Fortuitously, I personally took them to John Hopkins Hospital where an entirely different philosophy related to the nose. I effectively closed my practice and became a post-doctoral fellow relearning nasal surgery from an ENT perspective.
The nose (upper airway) is unique in that it must be narrow enough (like the nozzle on a hose) to blast air into the lungs effortlessly without turbulence, for life, providing filtration, warming and humidification. It should look normal; that is unoperated and should be ethnically appropriate. It should also be career appropriate – small, short, scooped noses are anathema. Men in particular (one third of my practice) want strong straight noses. Men need functioning airways to preclude sleep apnoea leading to heart disease. To the on-looker, the nose should be straight, emphasising the emotive quality of the eyes and not collapse or invade the lip while smiling.
The aim of the nasal surgery is to produce a great looking nose that works wonderfully!!