Though rhinoplasty has evolved significantly over the years, it remains a major facial procedure. The skill level and outcome directly impact facial aesthetics, playing a pivotal role in one's appearance. How does one achieve a beautiful nose? What does the surgery entail? What post-operative care is required? With these questions in mind, and with the consent of patient Xiaoxue (pseudonym), I documented her entire surgical journey.
Xiao Xue, a 26-year-old office worker, is a gentle and quiet young woman. However, her naturally flat nasal bridge had cast a shadow of self-doubt over her life since childhood. After experiencing romantic setbacks and repeated job search failures post-graduation, she resolutely sought out a plastic surgery clinic, hoping to eliminate years of regret and distress through surgery.
Candidates for Rhinoplasty
I arrived punctually at the plastic surgery hospital. Xiaoxue chose this facility after multiple careful consultations and thorough comparisons, concluding it was a reputable medical institution with comprehensive equipment, strong technical capabilities, and surgeons possessing extensive experience in cosmetic procedures.Entering the spacious, clean corridor, I saw many patients waiting patiently, some with gauze still on their faces, predominantly young women. Dr. Zhang warmly received us. I asked him about the indications for surgery and Xiaoxue's specific situation. Dr. Zhang explained that among cosmetic procedures, rhinoplasty is the most common.A flat nasal bridge like Xiaoxue's is a primary candidate for rhinoplasty. Medically termed a saddle nose, this condition involves a depressed nasal bridge typically treated with filler materials. Generally, the more pronounced the depression, the better the rhinoplasty outcome. Filler selection depends on the degree of local depression and patient preference. For Xiaoxue, the doctor employed solid silicone for shaping and augmentation.Indications extend beyond saddle nose deformities caused by trauma, yielding particularly favorable outcomes for rounded nasal tips, wide nostrils, low nasal bridges, and lack of nasal projection. Candidates must be over 18 years old, in good health with largely completed physical development, and women should avoid scheduling during menstruation. Xiaoxue had thoroughly discussed surgical outcomes and prognosis with her doctor, explaining her calm and composed demeanor.The doctor emphasized that a positive mindset is crucial for patients. "Beyond those seeking correction for nasal defects, what other types of patients do you encounter?" I asked. Dr. Zhang replied, "Individuals undergoing rhinoplasty arrive with diverse motivations.Some desires are downright bizarre. One patient requested a high, prominent nose, believing it would bring good fortune for career advancement and wealth. I regretfully declined the surgery, as cosmetic procedures are purely corrective—aimed at enhancing appearance by addressing nasal imperfections—and cannot deliver such tangible changes.Some young women bring photos of foreign actresses like Oscar-winning Elizabeth Taylor, requesting European or Greek-style noses. But a Western nose on an Asian face looks extremely unnatural, so we refuse such procedures. A beautiful nose is harmonious. We tailor the shape to complement each patient's facial structure—ensuring it suits them personally and integrates seamlessly with their other features."
The Entire Rhinoplasty Process
Next, the nurse took front and side photos of Xiaoxue for pre- and post-operative comparison. During this time, Dr. Zhang showed me some before-and-after photos of patients. The results were indeed impressive. The most striking transformation was a girl whose bulbous nose tip was reshaped into a sleek, attractive one—a perfect finishing touch that made her look more vibrant and significantly enhanced her appearance.Xiao Xue lay on the operating table while the nurse prepared her for surgery. The instruments laid out resembled those for general surgery rather than typical cosmetic procedures. The most conspicuous item was a white silicone implant mold, resembling rubber, reportedly custom-sculpted to match Xiao Xue's nasal structure. With the announcement "Surgery commencing," anesthetic was slowly injected into both sides of her nostrils.I noticed one injection in each nostril, plus another at the tip of her nose and on her lower lip. As the anesthesia took effect, the surgeon made a small curved incision inside one nostril. He then created a tunnel beneath the nasal skin, carefully inserting the solid implant piece by piece. Finally, he closed the incision with absorbable sutures.I had expected the procedure to take much longer, but it concluded in just 30 minutes. The doctor explained that choosing an intra-nostril incision ensured no visible scars post-surgery. Xiaoxue, deeply concerned about the outcome, stood up and walked to the mirror for a close look. Seeing her nose indeed appear more defined and attractive, she beamed with joy. Standing beside her, I shared her delight, though I noticed her nose was slightly swollen.After sharing my honest observation, Dr. Zhang smiled and explained this was a normal postoperative reaction. He noted the swelling might slightly increase the next day but would typically begin subsiding after three days. He instructed Xiaoxue to keep the surgical area clean and dry, avoid getting water in her nostrils when washing her face, prevent any external impact, get plenty of rest, and consume liquid or semi-liquid foods rich in vitamins. Additionally, she was prescribed five days of antibiotics to prevent infection.Dr. Zhang scheduled Xiaoxue for a follow-up after the swelling subsided, during which he would take close-up and distant photographs for surgical records and hospital archives.The young man explained that his girlfriend had left him after the accident disfigured his face, and he desperately wanted to restore his appearance. Dr. Zhang reassured him not to rush, conducted a thorough nasal examination, and proposed a forehead flap transfer for reconstruction. However, the patient expressed reluctance to leave an unsightly graft scar on his forehead. Ultimately, they decided on a neck flap transplant.The doctor thoroughly explained the surgical steps and expected outcomes, ensuring the young man had sufficient psychological understanding and preparation. After scheduling the surgery, the young man took his leave.I asked Dr. Zhang: "Rhinoplasty is quite common nowadays, and Korean facial plastic surgery is especially popular among young beauty enthusiasts. Yet media reports highlight numerous failed rhinoplasty cases—the well-known American pop star Michael Jackson being a prime example. Is rhinoplasty risky? Are the materials used safe? What precautions should one take before undergoing rhinoplasty?"
Dr. Zhang explained: "All surgeries carry inherent risks, though most procedures are successful. Since the procedure involves the face, it's particularly significant, and it's completely understandable that many people have numerous concerns. Regarding Jackson's nose, three revisions are already pushing the limits, but it's said he underwent six surgeries in total, which is why his nose ended up looking so peculiar."Many lack understanding of the procedure, worrying about post-operative infections, nerve damage, or the nose rotting. First, we must recognize that surgery is performed under sterile conditions. As long as the patient is healthy, has strong immunity, and follows precautions—such as avoiding water in the nostrils when washing the face and refraining from touching the nose for two weeks post-op—infections are extremely rare. Rhinoplasty is a subcutaneous procedure and therefore does not damage nerves.Additionally, rhinoplasty offers various material options: autologous bone tissue, autologous cartilage, or biological substitutes. Common biological substitutes include liquid silicone, ivory, dental materials, solid silicone, artificial bone materials, and expanded polytetrafluoroethylene (ePTFE). Among these, high-molecular-weight silicone-based solid silicone is currently one of the preferred clinical choices for rhinoplasty. Material selection should be based on individual conditions and financial considerations.After over two decades of use, high-molecular-weight silicone-based solid silicone exhibits a complication rate of approximately 5% to 20%. It is inexpensive and free from adverse reactions such as toxicity, carcinogenicity, or allergenicity, making it a safe and reliable material choice.Dr. Zhang reiterates that individuals considering cosmetic surgery must seek treatment at accredited plastic surgery hospitals. Furthermore, the decision to undergo rhinoplasty should be made only after consulting medical aesthetics specialists. Avoid impulsive decisions driven by trends, as they may lead to irreversible consequences.
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