Making Changes to your Nose

Dr. Nicholas Nikolov, MD

by Dr. Nicholas Nikolov, MD | August 16, 2010 @ 02:00PM

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Beverly Hills plastic surgeon Nicholas Nikolov, M.D. explains to Jodi Thiessen effective ways to communicate to gain the result you want."I don't have a preferred procedure – everything depends on the patient and what the exact problem is they are trying to correct," said Beverly Hills plastic surgeon Dr. Nikolov, who uses several rhinoplasty techniques to gain a patient's desired result. And he says treating men is very different. "The most important thing is that the cosmetic expectation of males is very different from that of women. Men are trying to achieve a lot of refinement but not necessarily a small nose or a perfect nose.

"It's not uncommon for me to leave a small hump on a man's nose intentionally," said Dr. Nikolov. Often, a man doesn't want a small, cute nose – a more common request is for a more refined look with natural idiosyncrasies and masculinity to be preserved. "I may leave a little imperfection that is characteristic of the nose. For someone who has an extremely large nose, giving him a very small nose takes away his identity," said Dr. Nikolov.

There are set ratios, measurements and angles for an optimal male nose, which are different than those of a female. However following these guidelines of what is aesthetically pleasing isn't always optimal. Dr. Nikolov explained: "It's not just making a perfect nose geometrically but leaving the person with a personality as well. So you feel like you're talking to the same human being, just with a much nicer nose."

So how do patients decide on the best surgery and look for them? Dr. Nikolov has several techniques to communicate both visually and verbally with patients to not only find out what they don't like about their nose, but also what they find attractive. "There are several ways I approach communication,"said Dr. Nikolov. "You have to talk with the patient enough to know about them and their life and work and what they find attractive. It can take some time to get in their head and get a feel for what they find attractive; sometimes they can't verbalize it."

The first step is for the patients to tell the surgeon what it is they don't like about their nose and what they would like changed. This should be done before anything the surgeons says influences them and their desires. Dr. Nikolov suggests the patients bring in photographs of noses they like. "These are not for me to try and duplicate but a lot of times I will find certain consistencies where the nose is a little thinner, or smaller or bigger. Sometimes a patient can't tell me in words but I can see what they are leaning towards.

"After this, a photo can be taken of the patient.This can be blown up to life-size so that it can be drawn on. In the mirror, for whatever reason, we don't see a lot of the faults we see in ourselves in a photograph. When you look at a photograph and say I hate my nose, you can find out exactly why," said Dr. Nikolov. "Drawing on the photo you can find out exactly what needs to be done, what looks attractive and the actual changes can be measured. I know how much I have to lower the tip or flatten the bump and the patient can see it upfront before surgery."

The surgery is usually performed under general anesthesia as a day case. After the surgery, a splint is put on to minimize the swelling and help keep the nasal bones in position until they've healed enough. The inside of the nose is not packed unless the patient has had a previous nasal fracture and the bones have been shattered, in this case they will need support from the inside.

There is usually some slight bruising and swellin most people can return to work in a week unless they have a very physically strenuous job. While women easily cover bruising with makeup, some men prefer to take longer from work until it has completely cleared.

"Patients are not allowed to exercise, lift or exert themselves for three weeks. Basically anything that increases pressure in the head should be avoided, said Dr. Nikolov.

Patients should not wear glasses during the post-operative healing period; contacts are fine, but the weight of glasses could affect the healing bones. "I suggest they tape glasses to their foreheads for seven weeks," said Dr. Nikolov. "Also, I recommend they don't blow their nose for seven weeks; breathing in and sniffing is fine, but blowing the nose can also affect the healing structure."

While the changes can be seen immediately following nose surgery, it isn't for over a year that the final result will be apparent. It takes time for the swelling (although not noticeable after a week or so) to subside.

This article provided by Dr. Nicholas Nikolov, MD.

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