Joan always had a big nose. The kind that would make Barbra Streisand stop and say, “Oy!” But even though Joan knew men adored women with perky, petite noses, she sniffed at the thought of getting hers fixed, opting instead for a less conventional way of minimizing the problem.
Joan’s first day as curator of the Pinocchio Museum was everything she had hoped for, as neither tourist nor docent so much as glanced at her nose (now dwarfed by the super-sized schnozzes protruding from the faces of hundreds of wooden marionettes). Then an overnight termite infestation destroyed the entire puppet collection, leaving Joan a “sitting nose,” so to speak, with nowhere to hide. All attention was focused again on Joan’s protruding proboscis. As Japanese tourists clamored to pose for pictures with “The Rady Pinocchio,” Joan decided to stop lying to herself and discreetly dialed a nose doctor to discuss her options. She then called Donna Karan, Céline Dion, Annie Leibovitz, and Barbra herself for moral support.
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Everyone knows the nose is the centerpiece of their face. It is literally front and center, an attention hog. And that’s why Hollywood has had a long, strong tradition of stars getting rhinoplasty. Two hundred and eighty-five thousand people got a nose job in 2007, making it the third most popular plastic surgery of the year, right behind breast augmentation and liposuction.
Just about anything can be done (and has been) to the proboscis: a bump flattened, a tip tweaked, the nostrils narrowed, the sides slenderized. As Leonardo da Vinci explained to me once over Campari, “The nose sets the character for the whole face.”
Sigmund Freud, that odd little Austrian, was as obsessed with the nose as he was with the penis. He had two operations on his own nose, both to fix the giant hole in his septum he got from snorting massive amounts of cocaine. Mucus ran from his nose continually. In his drug-induced haze, he likened it to vaginal fluid. Then, after observing that his lady patients reported nosebleeds during menstruation, he clapped his hands together and said, “Ah-ha! The nose is a tiny vagina.” In one of his famous dreams, he examined the nasal cavity of Irma, a patient, and felt a strong desire to inject into it, with a “needle,” the milky “solution” that she craved.
In Siggy’s world, a nose wasn’t always a nose.
As we’ve come to understand, Freud was a misogynist and a homophobe—as well as a downer at parties. Physiologically speaking, however, his theory of linking the nose and the vagina has some validity. The nasal septum is made of erectile tissue, like the clitoris and penis. As I’ve learned from my gentleman friends, Viagra makes their noses swell. Nosebleeds are common when women get their periods. Freud believed that, inside the nasal cavity, there are small spots that, when fingered, can turn you on.*
The first nose job in history was performed by a doctor named Sushruta in ancient India, circa 500 B.c. That’s a 2,500-year-long tradition of nose fixing! Why does its shape and size matter so much? The small, pretty nose is a long-standing archetypal symbol of truth and goodness. We all know—and this is a proven fact—that when you lie, your nose grows and sprouts branches, complete with a bird’s nest and eggs. The plucky down-on-her-luck princess always has a button nose. Her evil stepmother has a crooked, pointy, mangled, green-tinted snout. It’s a hardwired-in-the-brain instinct to trust a balanced, well-proportioned face and associate it with honesty and loyalty. When a baby sees a face that’s out of proportion—a nose that’s too long or too wide—he’ll cry. Shrinks have done studies.
Aristotle, the Greek father of philosophy, believed a hooked nose was a sign of intelligence. How did he reach this conclusion? He himself had a hooked nose. He was smart, ergo, ibid, ipso facto, everyone with a hooked nose was smart. Here’s a theory of mine: men will twist any flaw to their own advantage. I bet Aristotle would’ve said a small penis was a sign of virility—if he had a small one, which I can’t confirm.
I’m not that old.
Nose jobs are the ultimate balancing act of plastic surgery. A tiny tilt of the tip—which I had done—made a tremendous positive impact on my face. Do too much, and a woman can lose her unique character.
Jennifer Grey, star of Dirty Dancing, is an oft-cited example of a star whose dramatic nose job sandbagged her acting career. She used to have a distinctive nose, but her new bland one got Baby put in the corner for good.
There was a lot of chatter about Ashley Tisdale, a Disney star with a formerly distinctive nose, when she had her “deviated septum” fixed. (Funny and ironic, isn’t it, that people so often lie about nose jobs, and, historically, lying is what makes the thing grow bigger!) Anyway, her quirky bump got chiseled away, and her look went from bold to blah. It’s too early to tell if her new face will have her exiled from the Magic Kingdom.
Ann Miller, the dancing star of Hollywood’s golden age, had her nose fixed, and it was way too small. Rumor had it that she had a prosthetic nose piece made for the movies. Her boyfriend, Louis B. Mayer, would take the piece with him when he went out of town so Ann couldn’t leave the house.
Thank God the stigma about rhinoplasty is gone. People look at a teenage girl with a funny nose, and they ask, “Why hasn’t she had that fixed?” Nose jobs are almost as standard as braces now. It’s a rite of passage, and I’m all for it. Never mind throwing a big sweet sixteen party for your daughter. Put the money where it’ll do lasting good: the best time to get your daughter’s nose done is the summer before college. At a new school, she starts fresh. No one will register the change. They’ll see only the beauty.
But, as with all plastic surgery, bad outcomes do happen when you tell the surgeon you want a certain star’s nose. That celebrity might have a gorgeous one, but the shape of her nose might not look right on your face. Fortunately, most doctors have computer programs to show how different noses will look on you. I think there’s a general perception that nose jobs are minor surgery, and that, since teenage girls get them, they aren’t dangerous.
Wrong!
It’s a big operation, under general anesthesia (usually). It’s risky, and a bad nose job can ruin your looks, possibly, forever.
On the other hand, a good nose job can turn a jolie laide into Angelina Jolie.
A rhinoplasty requires tremendous surgical skill. For this procedure more than just about any other (except for face lifts), you must screen your doctor like your future happiness depends on it (FYI: it does). Pore over his before-and-after photos. Do you like what you see? Find out how many nose jobs he’s done. There’s an old expression that you have to hit 3,000 golf balls before you have a swing.
“Rhinoplasty is the most complicated and artistic of all plastic surgery,” said Michigan-based surgeon Anthony Youn, M.D., author of the highly entertaining blog Celebrity Cosmetic Surgery (which mentioned me only twice). “Some surgeons with twenty years’ experience say they feel like they’re still only beginning to feel comfortable with rhinoplasty. I’d say a surgeon should have done fifty to one hundred in his lifetime. So he’s not rusty, he should do a rhinoplasty at least every two weeks. Even then, some surgeons are only comfortable doing relatively simple operations, taking off a bump, for example. He’d have to be very experienced and brave to take on a complicated case, like Michael Jackson.”
One more reason to count your blessings: you do not have Michael Jackson’s nose. What’s left of it.
The nose is divided into twin chambers on either side of the septum. The septum is the wall of cartilage inside the nose (translucent white bendy matter; you’ve seen stuff like it many times when splitting chicken breasts). The septum serves both form (the tent pole that gives the nose shape and structure) and function (creating clear passageways for breathing). Remember the Hollywood scourge of the “deviated septum,” the dread condition starlets like Ashlee Simpson, Jennifer Aniston, and Ashley Tisdale have suffered and had to have “corrected”? A deviated septum means you have holes in the cartilage (aggressive picking? Cocaine use? Afrin addiction?) or the septum has fallen to one side and can’t get up (injury, bad genes). Aesthetics-wise, a deviated septum might mean a crooked nose, à la Owen Wilson. Health-wise, air passage could be blocked. What’s a starlet to do? Nose job to the rescue. If she’s not going to eat, at least she has to breathe! Might as well get her nose straightened, too.
Nostrils, we know all about. Nasal cavities are where the air goes in. The outward or lateral sides of the nose consist of cartilage (from the end to about halfway up) and bone (from the middle of the nose to where it meets the skull). The strip of skin between the nostrils that runs from the tip to where the nose meets your face is called the columella. Your nostrils are attached to the face by the alae.
Let’s not forget the parts that give your nose “character,” as da Vinci put it—the tip and the dorsal hump. The tip (aka, the greater alar cartilage) is the mass at the end of the nose. On the tip, you have the meaty substance called the alar fibro-fatty tissue. When a nose is called “bulbous,” the bulb in question is ample alar tissue.
The dorsal hump is the bump on the bridge of the nose.
Every year in the summer camp play, you were always cast as the witch. Or you’ve been described as having “strong” features or as a “handsome” woman. The hooked nose, otherwise known as “Roman” or aquiline, as well as the Grecian nose, a straight, strong line from forehead to nasal tip, might look good on “strong” and “handsome” men. On women? Of course, it’s a matter of personal preference. Meryl Streep never had her dorsal hump shaved, yet her placement in the pantheon of “beauty” is secure.
But if you decide that the hump has got to go, you’ll undergo either an “open rhinoplasty” or a “closed rhinoplasty.”
An open rhinoplasty is what it sounds like. The skin of the nose is pulled back, so the doctor can operate on your open, exposed nasal bones and cartilage.
A closed rhinoplasty does not involve the removal of the skin on the nose. All the work is done through holes made in the nostril cartilage.
The closed technique was pretty much the gold standard until about twenty-five years ago when the open method became popular. Some doctors still prefer to do it the old-fashioned way, even though they’re operating “blind.” To shave a dorsal hump with a closed rhinoplasty, the doctor will cut holes in the nostril cartilage, into which he’ll insert a tiny scalpel to shave away the excess cartilage on the septum. If need be, he’ll insert a hammer into the holes to chisel away excess nasal bone by tapping the hammer with a mallet. He’ll smooth down the chiseled bones with a “rasp,” also inserted through the same holes. All excess cartilage and bone are removed with a forceps. A “closed” operation is fast, causes little bleeding, and the patient won’t have any scars. Also, the patient can opt for local anesthesia. Your nose will be numb, but sorry, you’ll be awake to the sounds and smells of your surgery.
Nowadays, most doctors use an open rhinoplasty to shave down a dorsal hump because they have better control over what they’re doing. You’ll have general anesthesia and be asleep for the length of the operation, some one to two hours—or possibly longer. The first step is to lift the nose skin. To do so, the doctor makes incisions inside your nostrils, at twelve o’clock, and a zigzag-shaped incision across the columella, the strip of skin between the nostrils. Next, he liberates the skin on your nose from the underlying cartilage and bone by cutting and pulling it back with a retractor. Your nose will be peeled like a grape. Your face will be normal, except for a skeleton nose in the middle. The process of pulling back the skin is called “skeletonizing”* the nose.
The bunched-up nasal skin is secured. On to getting rid of that dorsal hump. The surgeon has to remove excess cartilage on the septum and the lateral sides of the nose to give it a less Roman profile. To cut the soft cartilage, he’ll use a scalpel. But when he gets to the bone on top, your doctor will use a chisel and a mallet to hammer away nasal bone. “The nasal bones aren’t that hard,” said Dr. Youn. “The other bones of the skull are much harder. In fact, when I’m working on a nose, I know I’ve gone too high when the bones become harder. To break the nasal bones, you only need to tap softly on the mallet. I like to make several small perforations, and then use my fingers to make the break.” Like breaking a piece of matzoh? “Exactly. It can make a bone-crunching sound. This is one of the reasons I like general anesthesia. The sound can upset the patient.*
Once the excess cartilage and bone that comprise the hump have been cut away, your surgeon will use a rasp—a surgical file—to soften the sharp edges of the newly chiseled bone. Then, since the cutting has left your nose de-roofed, your doctor will break the nasal bones on the sides, where they meet the face, and pinch them together over the septum to close the structure. (Incidentally, this is also how to thin a wide nose, with or without first shaving off a hump.)
Finally, the surgeon lowers the skin and sews the nostril cartilage and the columella back together. He’ll put some bandages on to minimize swelling and protect the fragile structure during the healing process. Post-op, you’ll look like you’ve been hit in the face with a hammer. Maybe because you have been hit in the face with a hammer.
If all your problems are to the point, meaning, on the tip of your nose, the doctor might not have to break bones! That’s the good news. The bad news? He’s still going to slice. Most tip-centric nose jobs are via the “open” method. It’s easier to correct the bumps and bulges when they’re exposed in their naked villainy. Once the doctor makes the appropriate cuts along the columella and inside the nostrils, he’ll pull back the skin to expose the tip.
Grab the end of your nose and wiggle it around. The seemingly moveable bits are the alar cartilage and the alar tissue. Depending on what you need done, the doctor will use a scalpel to cut excess alar cartilage, thereby making the tip smaller, shorter, less pointy, whatever you desire. I had my nose tip lifted, just turned up a bit, and it made a world of difference! In some cases, to narrow a too-wide tip, the doctor will use sutures—surgical thread—to pull the two sides of the alar cartilage together. By sewing you up tight, he might not have to cut cartilage.
A word on cutting through cartilage: back to the raw chicken breasts we’ve all slapped around. When making, say, coq au vin, you use the whole breast sliced into manageable portions. To section a breast, one must cut through a band of cartilage—white, translucent, bendy matter. You can do so easily with a sharp knife. You could probably hack through it with a butter knife, but you’d mangle it in the process. On your nose, the surgeon will use a sharp scalpel and cut slowly and carefully.
I’ve seen pictures of bad cutting jobs: jagged, ripped cartilage. Not pretty.
“Even if you do cut cleanly, there’s the potential problem of scar tissue formation,” said Dr. Youn. “In order to heal, the nose forms scar tissue. Surgeons can’t control how it grows. This is one reason to get rhinoplasty right the first time. With each successive surgery, you have more scar tissue and greater risk of not getting the outcome you want. Rhinoplasty is a surgery of millimeters. You can shave one millimeter off the tip, for example, and two millimeters of scar tissue might form. I tell patients, each time they have their nose done their expectations have to decrease.”
Sarah Jessica Parker has, allegedly, had her formerly rather large tip tweaked in as many as three different nose jobs. She must have a lot of scar tissue, because her nose shape is still not small. But as they say, “She looks a lot better.” Besides, a too-cute nose on her face could have doomed her to Jennifer Grey-ville.
When Beyoncé allegedly got her nose slenderized, she probably had her lateral (side) nasal bones broken and pushed inward to bring the bridge of her nose to a more defined point. This can be done without having to cut cartilage (as with shaving a dorsal hump). Beyoncé might also have had a certain procedure to narrow wide-set nostrils, too. It’s called a Weir excision. The surgeon makes snips at the nasal base (not to be confused with a naval base), where the outside of the nostril connects with your face. He removes a bit of extra flesh and then stitches what’s left together, narrowing the nostril opening. Imagine a circle (the nostril opening). Cut part of the circle away, and then re-close the ends. What do you get? Smaller circle.
The scars are small and hidden in a natural crease. Undetectable. If you also have an extra-long nasal tip shortened, you’ll need a Weir excision, too, to prevent a bunch-up of extra skin.
Go find a mathematical compass. I suggest checking your kid’s backpack or an old desk. You can also find one in any antique shop, right next to that genuine Louis XIV iPod.
Got it? Now measure the angle created between the upper lip and the columella—the strip of skin between the nostril openings. This is called the nasolabial angle. The perfect nasolabial angle, for men, is 90 degrees. For the ladies, it’s 100 degrees. If your nose is long and bends downward, the nasolabial angle is too small and your nose is too long. The only good thing with this is you can stop and smell the flowers without having to bend over.
Your surgeon has many options here, including nipping the tip and shortening the septum/lateral nasal cartilage in an open rhino-plasty.
Paging Cameron Diaz! Reportedly, the blond actress’s nose was broken a few times over the course of her young life, which gave her a deviated septum (!), which caused breathing problems. Cameron Diaz, snorer? Too sad and tragic. She got a nose job to have her right-leaning septum pushed back to the center of her face. Good for her. She had a crooked nose, and now it looks nicer. Why couldn’t she just say she didn’t like how it looked and wanted it fixed? Why insist that she had it done only for health reasons? Why not say, “I was getting the septum fixed, so I had them straighten me out, too.”
If you have a crooked nose, then you most likely have a bent septum. The procedure to straighten it out is called a septoplasty. Using an open or closed rhinoplasty, the doctor will cut away the part of the septum that’s bending into one of your nasal cavities and blocking airflow. If a lot of septum is removed, the doctor might harvest extra cartilage from your ear or another part. In some cases, you’ll have little baby-sized splints inserted to support your new septum. They’ll come out a week or so after the surgery. Through the nostrils.
“Several months after surgery, straightened cartilage might warp and change shape,” said Dr. Youn. Even if your nose looks perfect a month later, it can always bend again, from warping or the buildup of scar tissue.
A nose that’s too delicate for your face can be pumped up. Only way to do it, obviously, is to add to what’s already there, and that means implants. Little silicone implants can work well. “In Asian cultures, to make noses more Caucasian-looking, they use an L-shaped implant,* from the root of the nose between the eyes to the tip,” said Dr. Youn.
It’s preferable to use cartilage from the patient’s own body. If someone else’s cartilage is used, the body will reject it coldly. Your nose welcomes with open nostrils the cartilage from your own ear or bone from your rib, which the surgeon will graft onto your current structure, like adding a sun room to your house.
Say, back in the seventies, you got a nose job in the then-trendy “ski-jump” style, and now you want more volume along the bridge of the nose. A procedure that’s gaining in popularity is using fillers, in this case, Restylane, to add volume to the nose. It’s a valid non-invasive procedure for someone who doesn’t want surgery. People think of it as a lunchtime nose job: get a shot of filler for a minor touch-up or to fix a small defect.
But it isn’t risk-free. You might have lumpiness, unevenness, tissue rejection of the filler. It’s temporary, too. At some point, getting Restylane shots in the nose every six months might not be cost-effective. If you do the math, it might be worth it to get the permanent solution of rhinoplasty.
You can’t change the snout of a pig into the beak of a sparrow, no matter how much money you spend. Have a frank talk with your doctor about what he can and can’t do.
Remember, a plastic surgeon’s favorite words are “realistic” and “expectations.”
According to the American Society of Plastic Surgeons, the national average fee for a rhinoplasty is $4,000. But since each nose is unique, with its own humps and hooks, you can pay less, or a lot more, up to $7,500, depending on your nose needs. A closed rhinoplasty to simply narrow a wide nose would be less expensive than an open rhinoplasty with a tip reduction, dorsal hump removal, and re-roofing. Basically, if you need to fix a nose like Barry Manilow’s—the man who from New York can smell the smog in Los Angeles—you’ll be on the high end of the range.
The rewards:
No one will ever call you Hawk Face again. I say this for the teenage girls who dream of a cuter nose. Kids can be cruel. We all want to fit in with the community of our peers, while standing out for our individuality. No one wants to stand out for having a beak.
Parents: When your kid hits sixteen—the youngest age doctors will perform a rhinoplasty—let her (or him) have the nose job she’s been begging for. It’s an act of kindness, which she’ll appreciate for the rest of her life.
You have eyes now. The thing about a prominent nose: It’s an attention hog. It’s the first thing you look at in the mirror. It’s the first part of you to enter a room. In conversation, no one makes eye contact with you because they’re staring at your nose. Once you’ve been fixed, suddenly mascara, liner, and shadow have a purpose! People will start to say things like, “Have you always had such beautiful blue eyes?”
Photos of you from more than one angle. People who’ve had a lifetime of being self-conscious about their noses have figured out their best angle and presented it for the camera compulsively. Grab a stack of old pix. There’s you, three-quarter view, in front of the Grand Canyon. There’s you, three-quarter view, in front of the Eiffel Tower. Well, now you can pose with your profile in front of the Statue of Liberty.
Confidence! Self-Esteem! Win by a nose! Having a nose job is like getting over a hump, literally and figuratively. Once you’ve gotten rid of what’s been holding you back, the rush of confidence will astonish you. Look what it does for women who divorce their dead-beat husbands.
The risks:
Death. I always start big and go down from there. Any time you have general anesthesia, there is a chance something could go wrong, and you won’t wake up. I don’t like to say it; I have to.
Complications. Bleeding through the N-holes. If this happens, you’ll get civilized packing from your doctor until the leaky vessels heal. You might get an infection, also, but probably not if your doctor gives you pre-operative antibiotics.
Scarring. Rarely are the columella and Weir excision scars more noticeable than you might like. Although you won’t enjoy it, your doctor can cut away bad scars and try again to stitch seamlessly.
Pain. Degree of “discomfort?” High. Remember what I said about being hit in the face with a hammer? Nose jobs are uncomfortable. You can be relieved of the worst of it with painkillers. They’ll keep you numb and relaxed for the first few days. Most likely, your nose will be stuffed like a turkey with gauze.
Fortunately, it’ll be immediately relieved the blessed moment the packing comes out a few days later. Give it two or three weeks before all tenderness and twinges go away.
Swelling. You’ve just spent $5,000 for a smaller nose. You look in the mirror, post-op, and your nose appears to have been inflated with helium. It could be a float in the Macy’s Thanksgiving Day parade, right behind the one of my thighs. Swelling is part of recovery. Fortunately, it’ll go down and quickly. By the end of the first week—if you’re vigilant with the ice pack—you’ll have a pretty good idea of what your new nose looks like. By the end of the month, eighty percent of the swelling is gone. You’ll have to wait six months, though, to see your new nose in a pristine state of healing.
Bruising. Expect shiners—Rocky Balbo-style. Big black-and-blue beauties under your eyes. Go outside before the week’s out, and your neighbor might call a domestic violence hotline on your behalf. Until the bruising disappears in a couple of weeks, makeup helps.
Disappointment. Have I mentioned that disappointment is a severely underestimated emotion? Never more so than fantasizing for decades about a new nose, only to look in the mirror and think, “Eh.” Or worse, “Feh.” I won’t lie to you. Rhinoplasty has a high rate of repeat surgeries. There’s cartilage warping to worry about. And scar tissue formation.
Michael Jackson
Marilyn Monroe: A little thinning changed her from a pretty farm girl into the World’s Sexiest Woman.
Beyoncé: A slight narrowing took her from pretty to booty-licious.
Winona Ryder: By thinning her tip, she looked more feminine, delicate, and sexy. A small change for dramatic effect. *
Cher: Does anyone remember her nose from “The Sonny and Cher Show”? It was big and made her look cross-eyed. A total revamp turned her into a goddess.
Gwyneth Paltrow: Her alleged reduction made her new nose fit with her fine features. Now if they could just do the same with her gigantic ego.
Angelina Jolie: Her puffy nose allegedly narrowed, Mrs. Brad Pitt went from weird to wow.
Katie Holmes: An apparent tiny slenderizing of the nose, rumored to be via rhinoplasty, gave her a more mature look. Or maybe she’s aged years since becoming a Stepford Wife.
Jennifer Grey: Who knew that her nose was her mojo? After she got it fixed, Baby got fewer parts.
Ashlee Simpson: She lost the bump and her “edge.”
Tori Spelling: Her nose is mangled with scar tissue and just looks bad.†
Courtney Love: Train wreck. And it collided with the middle of her face.
Jennifer Aniston: A nose job denier until she was forced to admit to it. And then she used the deviated septum line. It’s like pleading the Fifth!
Ashley Tisdale: Thanks to her “deviated septum” surgery, she’s gone from bold to blah.
Cameron Diaz: She got her crooked septum straightened and looks better than ever.