What people don’t like about their noses (according to a plastic surgeon) [Shannon O'Brien, MD, Portland]

Eva Sheie (00:00):
You're listening to Where Before Meets After. How long do rhinoplasty patients think about getting rhinoplasty before they come in to actually talk to you?

Dr. O'Brien (00:09):
It's a good question. Most of them have researched it extensively and there may be varying amount of time, but oftentimes it's a year plus that they have really been looking at it, thinking about it, and then they want some information about it. Many come in with pictures and those kinds of things and ready to really talk about their thoughts. It's definitely not a thing that people come in on a whim and want to talk about their nose.

Eva Sheie (00:35):
Do you ever hear people say they've been thinking about it since they were like little kids or teenagers?

Dr. O'Brien (00:41):
Teenagers is probably when it really starts coming to mind. Kids start looking at themselves in the mirror more and their mid-face has finished growing and their nose is starting to grow or finished growing. And so that's when they start seeing traits that maybe they're not happy with or that at least they want to talk about. And also sometimes as teens, that's when sports injuries, other things happen where sometimes they may have an injury or something.

Eva Sheie (01:06):
What kinds of things do they complain about? Do they use the same words when they are talking about what they don't like?

Dr. O'Brien (01:13):
A lot of people come in complaining that something on their nose is too big. Often there's a bump on the nose, the tip is bigger than they would like it to be. The nose is wider than they would like it to be. And so a lot of rhinoplasty surgery is a reduction kind of effort making things smaller.

Eva Sheie (01:31):
Does anyone ever say their nose is too small?

Dr. O'Brien (01:33):
Occasionally it's sometimes more of an ethnic thing, such as an Asian nose may have a flatter dorsum, so the back of their nose may be a little flatter than they would like it. And so sometimes you're building things like that up. Sometimes the tip of the nose is a little flatter from a number of ethnicities. They want just a little more projection on their profile. But for the most part, it's a reduction kind of procedure.

Eva Sheie (01:58):
What can't you fix with rhinoplasty or correct?

Dr. O'Brien (02:02):
There are some things about how the nose is attached on the face that you can't really change. So if one nostril is literally attached higher than the other, you can make things smaller, but you can't really attach certain or change certain things as to where their origin is on the face. Other than that, you can change a lot of things and correct a lot of things.

Eva Sheie (02:27):
Is there such a thing as a perfect nose?

Dr. O'Brien (02:30):
I mean, I think a lot of noses look perfect, but it's not necessarily a specific shape or what have you, because I think when you're looking at noses, they fit the whole ... It's part of the whole face. And a nose on one person may be perfect, but you take that exact nose and try to put it on someone else. And it changes the balance of the face, the facial structures, the harmony between the eyes, the nose, the mouth, the cheeks, the length of the face, the width of the face, all of those things. And so I think there are a lot of perfect noses out there, but they're not necessarily the same nose.

Eva Sheie (03:06):
How do we perceive our own nose? And I think where I'm going with this is, is it possible that when we look in the mirror, we see things that may not actually be there?

Dr. O'Brien (03:17):
People often see things that are not really there because either a child made a comment about their nose at a vulnerable time and they carry that with them even when it's not real or true. It doesn't mean that there aren't things that can be changed, but it may mean that there's not really anything wrong with what they're looking at.

Eva Sheie (03:37):
Do you use any tools or are there any specific ways that you show people what you see so that you're all on the same page and really so that you know that you're thinking about it the same way when you're talking about having surgery?

Dr. O'Brien (03:54):
Yeah. I think with rhinoplasty surgery, because it is such a specific procedure in the middle of your face, it's important that you really sit down and talk and sort out what it is that the patient is interested in changing, as well as what anatomically is there and can be changed. So I spend a lot of time talking to people. I use TouchMD and look at graphics that include diagrams of where the cartilages are, where the shape is. I show photos in the office, and then I also utilize Vectra, so 3D imaging in order to help try to shape the nose the way I think is a realistic outcome for the patient and make sure that we're on the same page. And then I always encourage people to bring in photos of what they're hoping to see in order to see if it's something that is even feasible or reachable goal.

Eva Sheie (04:49):
When you take those photos, I think you're able to draw on them. Can your patients who come for consults take the photos with them?

Dr. O'Brien (04:58):
We use a system that electronically will send the pictures or give them access to the photos that are saved in their chart. And so through TouchMD, they're able to look at their own photos and anything that we've saved along the way, they can evaluate at home or look with their family or friends or whoever they're using at home for support.

Eva Sheie (05:20):
Thanks for listening. I'm your host, Eva Sheie. Follow the show and submit questions for our experts at wherebeforemeetsafter.com. Where Before Meets After is a production of The Axis.