As a rhinoplasty surgeon, one of the most overlooked aspects of successful outcomes is the role facial symmetry plays in shaping patient satisfaction. While both surgeons and patients often focus on the nose, I have found that underlying facial asymmetry, present in up to three-quarters of those with a significantly crooked nose, is a critical factor. A crooked nose is rarely just a nasal issue; it is frequently linked to broader facial imbalances. Recognising and addressing these asymmetries is key to a successful surgery and a happy patient.
When approached thoughtfully, correcting nasal deformities can significantly enhance perceived facial harmony, even when perfect symmetry remains out of reach. In my practice, this is especially true for aging patients. Aging introduces a host of new challenges: soft tissue changes, bone resorption, and structural weakening can exaggerate asymmetries and complicate traditional rhinoplasty techniques. The nasal tip loses its support over time, causing tip ptosis and the characteristic hanging columella. At the same time, brittle nasal bones and thinner skin make surgical manipulation more delicate.
In younger patients, rhinoplasty is often primarily an aesthetic pursuit. For my older patients, however, functional concerns like nasal obstruction frequently drive their decision to seek surgery. These cases require not only a clear understanding of the aesthetic goals but also careful attention to preserving and improving nasal function. I have learned that the techniques used for younger patients do not always translate well for the aging nose, which requires more structural grafting and a nuanced approach to restoration.
For me, the consultation phase is critical. A detailed history is essential—not just to explore their nasal concerns but of the broader facial context. Past trauma, surgeries, or congenital conditions can influence the nose and the face as a whole. Often, patients are unaware of their own facial asymmetries. To avoid unrealistic expectations, I take great care to explain how these asymmetries can influence the outcome of their rhinoplasty. Photographs and digital imaging help guide these conversations, enabling patients to visualise the interplay between their nose and facial proportions.
For aging patients, particularly, managing expectations is paramount. The soft tissue and skeletal changes that accompany aging mean that perfect symmetry is rarely achievable. That said, I have found that correcting nasal deviations, even partially, can significantly enhance perceived facial symmetry. Structural grafting with robust materials, such as irradiated cadaveric costal cartilage, has become my go-to technique for these cases.
One of the most rewarding aspects of my work is seeing the transformative impact rhinoplasty can have on my patients. I have seen firsthand how improving nasal alignment not only enhances facial harmony but also boosts confidence and satisfaction. Even subtle corrections can make a world of difference, especially in the context of an aging face. In the end, rhinoplasty is as much about managing expectations as it is about surgical technique. By combining a meticulous assessment with open communication and a tailored approach, we can achieve results that respect the individuality of every patient, no matter their age.
