Rhinoplasty is a permanent surgical procedure, so the results should last your lifetime. The most important aspect of your rhinoplasty is choosing an experienced and skilled rhinoplasty specialist whom you can trust with your nose. Rhinoplasty is considered the most difficult of all facial plastic surgical procedures.

Everything about your proposed surgery should be explained to you by your surgeon at your consultation and again at your pre-operative appointment. You should have pre-operative lab work and surgical clearance from an internist if indicated.
On the day of surgery at our office, your anesthesiologist and nurse will ask you a few questions before taking you into the operating room suite. Once you lay down on the bed, you are made comfortable by the nursing staff with pillows and warm blankets. Once the monitors for your heart, blood pressure, and oxygen level are in place, the only uncomfortable thing that you feel is the small amount of numbing medicine that the anesthesiologist injects next to a vein in you hand. The I.V. is then placed painlessly. At this point the anesthesiologist gives a little medicine in the IV that makes you feel very good ("Just Say NO to Drugs, except in the operating room), then we ask that you think of your favorite place with your favorite person, and you are off to pleasant dreams and a restful sleep. Our anesthetists usually use a medication called Diprovin (made famous by Michael Jackson, but in our center only board certified anesthesiologists administer the medication with proper monitoring) and once you are asleep they then place a laryngeal mask (LMA) to facilitate administraton of oxygen. The LMA also protects the airway and stomach from any fluid. Depending on what needed to be done to your nose, your operation may last anywhere from 1 to 3 1/2 hours. I prefer to not use post-operative "packing" into the nose. If you ask patients who have had rhinoplasty,"What was the worst thing about your rhinoplasty?", if they had packing in their nose for a few days, they will say, "The packing!"

Next thing you know, you are waking up in the recovery room with tape and splint on your nose. After about one hour, once you are fully awake, you are allowed to go home. Once you are home, we recommend that patients get into bed with there head elevated up on 3 to 4 pillows so that their nose is elevated well above their heart. Baggies of frozen peas are kept on the bridge of the nose as tolerated. Surprisingly, our patients seldom complain of pain, but rather a stuffy nose or sinus headache type of pressure that is usually relieved with Tylenol.

Patients return to the office two days after surgery to have their nose cleaned of any mucus or dried blood, the nasal passages are suctioned so that breathing is a little better. The nose will become congested again for a few days. On the fifth day, my favorite, the tape and splint are removed and the new nose is unveiled. Swelling and bruising continue to resolve over the next few days so that patients are quite presentable between 7 to 14 days after surgery. Physical activity is limited for the first two to three weeks after surgery. The appearance of the nose should continue to improve over the next 6 to 12 months. We then see our patients at one week, one month, three months, six months, one year, and then once a year as needed.

All patients should be aware that there is usually between a 3% to 10% chance of revision surgery after initial rhinoplasty.

Good luck and be well.

Dr. P

It is surprising that there aren't more fractured noses given the number of times our noses are traumatized, especially our active children. The most common question and cause for concern after nasal trauma is, "Doc, is the nose broken?" Here are 10 tips on broken or fractured noses :

1. Don't panic. All bleeding eventually stops. Apply pressure with your fingers to the upper 1/3 of the nose, and hold a little pressure on the nostrils while squeezing them, holding a few Kleenex under the nostrils.

2. Put some ice on the bridge of the nose, and avoid blowing the nose.

3. It is seldom necessary to rush into surgery to correct the nasal fracture, as it is best to wait at least 5 days for the swelling to resolve, especially in children. Unfortunately, unsuspecting parents may be exposed to an unethical surgeon who will immediately operate on the child's nose even before the swelling has resolved. Many of these children do not need surgery, and are exposed to the unnecessary risks of anesthesia and surgical complications such as severe hemorrhage.

4. The nose should be checked by a facial plastic or ENT (ear, nose, throat) surgeon within 12 to 24 hours of the injury to make sure that there is not internal nasal septal bleeding (a septal hematoma, a very rare condition that is the only reason for immediate surgery). The child should then return for re-examination 5 days later.

5. Apply "baggies" of frozen peas to the bridge of the nose during the first 48 hours after the trauma. The cold packs can be kept on for 10 to 15 minutes and then off for 10 to 15 minutes.

6. Have your child keep his/her nose above the level of their heart when lying down, and when sleeping (sleep up on 2-3 pillows). This will help keep the swelling down, as well as help with breathing.

7. X-rays of the nose usually don't mean a thing other than for insurance companies and medical-legal reasons. Once the swelling has resolved, the nose will either be visibly crooked or not. The decision to treat the nose is made by clinical examination. If the bones feel and look straight, surgery is not necessary. I have seen fractures where the X-ray showed broken bones, but the nose was straight. These noses heal well by themselves. On the other hand, there have been noses where the X-ray appeared normal, but the nose was quite crooked.

8. The only surgery that should be performed on a child's crooked, recently fractured nose is a "closed" nasal reduction which involves manipulating the nose with an instrument inside the nostril. No incisions need to be made. The closed reduction should be performed between 5 to 14 days after the injury. By 18 days, the nasal bones may have healed and are difficult to shift back.

9. If "open" surgical correction is necessary, it should be delayed at least 6 months to allow for full healing from the trauma. It should also be delayed until your child is past puberty, and their growth has slowed down. If they have a deviated septum with difficulty breathing, sometimes the surgery can be performed earlier.

10. When in doubt, always get a second opinion, and choose your physician carefully. Be well!

Questions recently asked, and is more common than you would think: "I'm 13 and I hate my nose. I want it smaller. Everyone calls me names. Is there anything that I can do at my age to make my nose look a little more normal? I have a big bump at the bridge of my nose. By the way I am a 13 year old girl".

My answer: Kids can be very mean, I am sorry that you have to hear the mean words from those "bitter hearts". I would advise you to consult with a few rhinoplasty surgeons and see if they think that a little bit of Juvederm, Restylane, or Radiesse might be able to make your bump appear smoother until you are ready for rhinoplasty.

13 is a little young for the surgery. For best results, your bone growth should be mature. There are radiologists who can look at your X-rays and let you (and your parents) know when your bones will be mature enough for rhinoplasty.

Please try to not let their words bother you. They are immature and probably jealous of you in so many other ways. Don't stoop to their level. Treat others kindly and you will maintain your class and dignity (something that will take a lot more that a simple surgery for those insensitve kids to attain).

Be patient, and before you know it, that big nose of yours will be smaller.

Hi Doctor Persky, well I want to have rhinoplasty. I'm 20 years old, but there's a problem - my mom is scared that something might go wrong. How can I convince them that I'm not confident with myself and need the procedure?
Thank you Doc.


Hi Kat,

Please email a photo of your face from the front and profile, and from below as well. I will then get back to you. With any surgery there is the possibility of risks and complications, but we must weigh the risks versus the benefits. If the benefits far out weigh the risks, then by choosing the surgeon whom you feel most comfortable with (one with an excellent reputation, with results that appear beautiful to you, who understands what troubles you, and feels confident that your surgery would be successful), you have the best chance of achieving your goals with the lowest chance of something "going wrong."

In the meantime, the best thing that you can do is to let your mother know how you truly feel, what it is that bothers you, what you would be satisfied with, and let her know how it affects your confidence. Let your mom know how long you have felt badly about your nose, if you have been teased about your nose or if there have been incidents where you have been hurt, share these with her.

If you have an ethnic nose, your mother may be concerned about you losing your ethnicity, not "fitting in at family get-togethers". Let her know that it is possible to change your nose without losing your familial appearance. You may also volunteer to help defray the costs of surgery by getting a part time job, etc.

You must know that rhinoplasty is not answer to "changing" one's life. It won't get you "that job","that guy", make you more popular or anything like that.

I hope that everything turns out for the best for you. If it does not work out for you now, know that you will eventually be able to have your surgery later in life.

While you are waiting to have your rhinoplasty, I hope that you can smile when you remember the old saying about noses, “you can pick your friends, and you can pick your nose, but you can't pick your friend's nose."

Good luck and be well.

Dr. Persky was interviewed online by The Orange County Register's "In Your Face Chat" today. The complete transcript of the chat, along with interesting before and after rhinoplasty photographs can be found by copying and pasting the following link:

http://www.ocregister.com/articles/chat-face-noon-2532299-questions-href

Highlights included discussions about teenage rhinoplasty, Marilyn Monroe, Angelina Jolie, Halle Berry, the Olsen twins, Jennifer Grey, Ashley Tisdale, Sharron Stone, Madonna, Meg Ryan, Barbara Streisand, and Cher. The last segment of the chat included discussion about restoring lost facial volume with fillers, "The Liquid Lift".

You do not necessarily have to look like you lost an Ultimate Fighting Championship fight after having rhinoplasty. Every surgeon is different, and as you can tell from the variety of answers to this question on www.RealSelf.com, some create more bruising and swelling than others.

I have found that when the proper techniques are used, my patients have a small amount of bruising around their eyes that looks like a bit of bluish-purple eye shadow for two to four days. Most of their swelling (80%) has gone down by the fifth day after surgery when the cast or splint is removed. Swelling continues to dissipate over the next few weeks; the final nasal result evolves over months to years.

I have found that injecting local anesthesia with epinephrine (adrenaline) in key locations, performing the surgery meticulously in the proper plane of dissection, and NOT using intra-nasal packing for days following the surgery are the most important points to minimize bruising and swelling.

Not using nasal packing allows for the nose to drain onto the moustache bandage and not accumulate in the soft tissues of the nose, eyes, and cheeks. Not to mention the fact that if polled, rhinoplasty patients consistently will tell you that “the worst part of having a rhinoplasty was having the packing in the nose, and having it removed days later”.

Ask to see some of your prospective surgeons post operative patients to get an idea of what you can expect from her or him. If they look like they lost that bar room fight, visit another surgeon who may pack less of a punch.

Do choose your rhinoplasty surgeon most carefully.

Good luck and be well.

You must be very truthful and not tell any lies like our friend Pinocchio. It is important to know that the great majority of your growth has been completed before having a rhinoplasty. There are bone studies that can be carried out to assess the growth maturity of a teen. If a patient has passed through puberty, their shoe size has stabilized (as well as their overall growth), and their skin is not overly thick and oily, then they are a candidate for rhinoplasty (though on the very early end of the age range). It is important that the patient really wants the surgery, and has thought about it for some time. They should not have it done unless they want it from deep in their heart. They should not have it done to "please" their parents. It will not "change one's life" and expectations must be real. Most importantly, choose a well trained, experienced, rhinoplasty surgeon whom you trust. Be well, and remember, no more lies.

Patients often ask, "I have somewhat a large hump on my nose, I want it reduced but only by a millimeter or less because I don't want it removed, just a slight reduction so I can keep my ethnic feature. Is this possible to do where only a millimeter or less is shaved?" It is possible to perform minimal hump removal in an ethnic nose. I find that computer imaging helps both my patients and me as a surgeon in being able to predict if the Subtle Rhinoplasty will fit the individual. The key to the computer imaging is creating a profile that the surgeon can realistically replicate in the operating room. The patient and surgeon must then be happy and satisfied with the predicted result. The Subtle Rhinoplasty has become very popular in my practice. Patients have very little bruising or swelling, packing is usually unnecessary, and the results are most satisfying for both patient and surgeon. There are many people who have thought about a subtle change in their nose for many years, but have not considered rhinoplasty as a reality because they have been petrified that they will have too much of a change, and ruin their appearance. They don't want to look like "everyone else who has had a nose job"; they still want to look like themselves, just without the bump (of less of it). They want to look natural after surgery; they want a nose that looks like they were "born with", not like every other patient in the surgeon's waiting room. They don't want to have to re-introduce themselves when they bump into old friends after their surgery (as Jennifer Grey found herself doing). With a conservative, Subtle Rhinoplasty the risks are low, and the benefits are high. It is always much easier to go back and remove more in the rare case than it is to go back and add tissue to a nose where too much has been removed. The Subtle Rhinoplasty will become very popular in the future as more patients achieve their desired results in the hands of properly selected experienced surgeons. Select your surgeon most carefully.

Maybe you have been unhappy with your nose for as long as you can remember, or perhaps you are having difficulty breathing; either way, a rhinoplasty or nose reshaping may be an option for you. A rhinoplasty can change many things about your nose, including your nose size (in relation to your face), nose width at the bridge, the size and position of the nostrils, and nose profile (by downsizing visible humps, bumps or depressions on the bridge). A rhinoplasty can also reshape the nasal tip, improve the appearance of large, wide or upturned nostrils and correct nasal asymmetry. From a functional standpoint, a rhinoplasty can correct certain breathing difficulties such as those due to a deviated septum. Rhinoplasty is also an option for certain birth defects or noses that have been injured in car or sports accidents Here's what you need to know now about rhinoplasty. Rhinoplasty Defined A rhinoplasty or nose job is a surgical procedure designed to reshape the nose. It can be done to correct a structural deformity (such as a bump or hook), provide subtle changes to nose size and shape to improve your appearance or to correct a functional problem (such as difficulty breathing due to a deviated septum). The septum is the wall between the two nostrils. Composed of cartilage and bone, it divides the nasal cavity into halves. The ideal nasal septum is straight, separating the left and right sides of the nose into passageways of equal size. In contrast, a deviated septum occurs when the septum is severely shifted away from the midline. In severe cases, a deviated septum may cause difficulty breathing through the nose. Are you a candidate for rhinoplasty? Preparing for Rhinoplasty Your surgeon will likely give you a list of instructions before you undergo a rhinoplasty. In general, there is no eating or drinking after midnight on the evening before. Smoking cessation should occur before rhinoplasty. Your surgeon may be able to provide tools to help you quit. In addition to all the other negative health affects associated with smoking, it severely compromises blood flow to the skin. This means there is less oxygen to aid in wound-healing, and necrosis (death) of skin can occur. Drinking alcohol in the week before rhinoplasty is also discouraged, as alcohol can also impair the healing process. Your surgeon may also discuss discontinuing certain medications in the days or weeks leading up to your rhinoplasty. For example, non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can increase the risk of bleeding. While considered natural, certain vitamins and herbal preparations such as Vitamin E, gingko biloba, omega-3 fatty acids and green tea can also increase bleeding risk. Tell your surgeon about everything that you are taking, even if it seems harmless. Never stop taking any medications without first discussing it with your doctor. Some surgeons may prescribe homeopathic therapies before your rhinoplasty, such as arnica (an herb that can minimize bruising). In addition, mega-doses of vitamin C may also help aid clotting and wound healing. Some surgeons also prescribe steroids before a rhinoplasty to decrease the initial swelling. Key Rhinoplasty Statistics In 2007 there were 285,000 rhinoplasty operations performed in the United States, down 7 percent from 2006, according to statistics compiled by the American Society of Plastic Surgeons. Rhinoplasty is one of the top five cosmetic plastic surgery procedures performed each year. Rhinoplasty Risks Infection Bleeding Breathing issues (nasal obstruction) Dissatisfaction with cosmetic results Additional touch-up surgeries Septal perforation. In these cases, there is a small whole in the septum, causing turbulence that results in a whistle when a person speaks or sings. Anesthesia complications Death Types of Rhinoplasty Primary rhinoplasty is a nose-reshaping plastic surgery. Two types of primary rhinoplasty include "open" and "closed": Open Rhinoplasty. For major nose reshaping, the incisions are made in the vertical strip of skin separating the nostrils. This is called the columella. The skin and soft tissue are then elevated off the underlying structures of the nose so the surgeon can see the nasal anatomy. Closed Rhinoplasty. For minor reshaping, many surgeons make incisions within the nose. The skin of the nose is then separated from the bone and cartilage, which form its supporting framework. Once exposed, bone and cartilage can be removed, reshaped, augmented or rearranged to achieve the desired new shape. Secondary Rhinoplasty. Also called revision rhinoplasty, this is performed to correct problems that persist or develop after a previous rhinoplasty. Although the problems may be minor and easily corrected, often the problems are major, which makes the secondary rhinoplasty more difficult. Secondary rhinoplasty can also be done as an open or closed procedure. Filler Rhinoplasty. This involves the use of injectable fillers to fill depressions, smooth out sharp angles or change the angle of the tip of the nose, restoring symmetry and making your nose appear smaller and more attractive. Instead of removing a bump, a surgeon would use an injectable filler to even it out. The results are not permanent. CDC Warns Against Cosmetic Charlatans ATLANTA, May 2008 — The federal Centers for Disease Control and Prevention is warning consumers against undergoing cosmetic surgery by unlicensed providers. Three women in North Carolina developed kidney failure after they received soft-tissue filler injections in their buttocks. The women received the injections from an unlicensed provider, who was arrested and charged with practicing medicine without a license. Click here to read the complete story. Evaluating Your Nose An evaluation with a surgeon is the first step in your decision to undergo rhinoplasty. During this meeting, your chosen surgeon will likely take photographs of your nose at varying angles. He or she will also talk to you about your expectations to make sure that yours are realistic. It may be a good idea to bring photographs of noses that appeal to you, to aid in the dialogue about expectations as well as give the surgeon a better idea of what you want out of your rhinoplasty. In addition, your surgeon can show you photos of other rhinoplasty patients with similar nose shapes, which can help you better understand the likely results. Computer imaging can be used to show how your nose wil look after rhinoplasty. If you are having rhinoplasty, you may also need to consider other facial procedures to achieve balance and proportion. For example, chin augmentation is often performed with rhinoplasty. The Rhinoplasty Procedure Most rhinoplasties are performed on an outpatient basis in a hospital or surgical suite. Exactly how long the procedure takes depends on the type of rhinoplasty that is performed. For example, a primary rhinoplasty normally requires one to three hours in surgery, while a secondary rhinoplasty can take much longer. A filler rhinoplasty can take just 15 minutes. Anesthesia. Your surgeon will likely recommend local anesthesia with some sedation or general anesthesia for your primary rhinoplasty. A secondary rhinoplasty will often involve general anesthesia due to the complexity of the procedure. A filler rhinoplasty requires just local anesthesia. The Incision. Surgery of the nose is performed either using a closed procedure (where incisions are hidden inside the nose), or an open procedure (where an incision is made across the columella). The surgeon then raises the soft tissues that cover the nose through these incisions. This provides access to reshape the structure of the nose. The reshaping. Your surgeon can reduce or augment nasal structures with cartilage grafted from other areas of your body. These pieces of cartilage can come from the septum or occasionally from the ear or the rib cartilage. If the septum is deviated, it is now straightened, and the projections inside the nose are reduced to improve breathing. Closing the incision. Once the underlying structure of the nose is sculpted, the nasal skin and tissue are redraped and the incisions closed. Recovering from Rhinoplasty You will probably be excited, if not anxious, to see your new nose, but patience is key after rhinoplasty. Complete results are not immediate and can take up to one year to be fully evident. You will be unable to breathe through your nose for the first 24 hours, due to nasal packing, which is stuffed up your nose to help reduce swelling and bleeding.There will be some pain that can typically be controlled with pain medicine. Most people who undergo rhinoplasty can stop pain medication after 48 hours. Some people feel nauseated after the surgery. You may experience limited bleeding during the first few days. Your surgeon may also tell you to apply a cold compress to your nose to reduce swelling and to elevate your head for the first 24 hours. It is important to avoid any trauma to the nose during the first week after surgery. Blowing your nose is not permitted after rhinoplasty. This can be tough, as you may feel stuffy. Decongestants may help. You will likely be asked to return in three days so the surgeon can remove the stitches. On day seven, the cast is removed. Your nose will still be swollen, but after two weeks much of the swelling will have decreased. At this point, all nasal packing, splints and other post-surgical dressings should be removed. A splint may be placed over the outer part of your nose to protect your nose as well as help it hold its new shape during the healing process. The surgeon may also place a softer splint inside your nose to prevent scarring inside the nose. By one month, 85 percent of the swelling will have gone down. The remaining swelling may take up to one year. For these reasons, you should wait at least one year before undergoing revision rhinoplasty. Rhinoplasty Cost The cost of cosmetic surgery tends to comprise the surgeon's fee, anesthesia fee and operating room fee. The anesthesia fee ranges from $600 to $1,000, the facility fee ranges from $700 to $1,100 and the rest of the cost is the surgeon's fee. According to the American Society for Aesthetic Plastic Surgery, the national average for plastic surgeon fees for rhinoplasty is $4,277. Secondary rhinoplasty can cost up to three times as much, due to its complexity. A filler rhinoplasty costs a few hundred dollars, but results are not permanent. If you decide you need an additional facial procedure later (such as chin augmentation), the two procedures may be more expensive than if you have them at the same time. [Read more about comprehensive treatment plans.] Insurance does not typically cover the cost of cosmetic procedures, but if the purpose of your rhinoplasty is to improve breathing, it is considered reconstructive and may be covered by insurance. It is a good idea to contact your insurance company beforehand and find out their exact policy. Consult a Qualified Plastic Surgeon Before deciding on rhinoplasty, be sure to discuss treatment options with a board-certified plastic surgeon or a board-certified facial plastic surgeon. Most facial plastic surgeons do their residency training in otolaryngology-head-and-neck surgery, followed by fellowships in facial plastic surgery. Plastic surgeons do their residency training in general surgery followed by a fellowship in plastic surgery, Plastic surgeons should be certified by the American Board of Plastic Surgery. Facial plastic surgeons should be certified by the American Board of Facial Plastic and Reconstructive Surgery. Board certification assures you that your surgeon has had extensive training and is up to date on new technology and techniques. Source: American Society of Plastic Surgery website article on nose surgery. American Academy of Facial Plastic and Reconstructive Surgery website article on rhinoplasty. [page updated October 2008]

I was recently asked about a "quick fix" rhinoplasty on the plastic surgery patient chat line RealSelf.com. This is another case of "if it sounds too good to be true....then it usually isn't". The question involved a quick fix to narrow the bottom part of the nose. Rhinoplasty has been described as the most difficult of all facial plastic surgical procedures by the greatest plastic surgeons in the world. Sculpting the nose to blend in with the other surrounding facial features is the goal. A beautiful nose "gets out of the way" of attractive eyes, cheeks, jaw line, and mouth. Narrowing the base of the nose can be one step in a rhinoplasty, very rarely the only step. When one area of the nose is altered, the rest of nose is usually sculpted to fit the change. The most essential aspect of rhinoplasty is the proper diagnosis of what is causing the perceived problem. Once the diagnosis is made, then a properly qualified rhinoplastic surgeon can carry out the necessary maneuvers to accomplish the desired results. It is essential to choose your rhinoplasty surgeon most carefully. Everyone's nose is different, and surgeon’s skills and aesthetic senses of beauty differ. Take your time and make sure that you and your surgeon are "on the same page" with regard to your expectations and the surgeons ability to meet those expectations. By all means avoid the "quick fix". The first rhinoplasty operation is your best chance at getting the excellent result that you desire. Revision rhinoplasty is more difficult because of what has been removed as well as scar tissue.

In the early years of rhinoplasty, having a nose that looked operated on was somewhat of a status symbol, so much so that a few surgeons had characteristic noses that they created consistently on their patients. In New York City there was the "Diamond" nose, and in Los Angeles the "Parkes" nose. Today, the goal of any good cosmetic surgery is a natural look. Recently in my practice I have come to realize that there are thousands of people who have a minor bump, hump, or tip disproportion that has bothered them for a long time, but feared having it repaired because they did not want the rest of their nose and appearance changed. They didn't want to end up with the Dr. "you fill in the name" nose job. Now those slight nasal "offending parties" can be corrected with a subtle rhinoplasty. The procedure is quicker and easier for the patient as the nasal bones are not broken, the nasal septum (center divider of the nose) is not operated upon, and there is no packing placed into the nose. There is no to minimal bruising, swelling, or pain. Nasal breathing can be improved at the same time. The downtime is only 4 to 5 days, and full normal activities can be resumed in 14 days. Patients need no longer fear that their entire look will change. Call our office to find out if that little thing that bothers you about your nose can be taken care of with the subtle, finesse rhinoplasty.

There is no recipe for an excellent rhinoplasty. Everyone is different. A beautiful nose gets out of the way of the eyes and mouth. The nose then "fits" the face. Choose your surgeon most carefully. They should have experience, they should be Board Certified in plastic surgery, facial plastic surgery, or otolaryngology (ENT), but most importantly they must have an artist's aesthetic sense.

Christina Ricci stars in the recently released motion picture, Penelope. In the "fairy tale" film, she is born with a pig's nose (as well as pig's ears) because of a witch's curse. The curse can only be reversed if she is accepted and loved by someone of her same "blue blood" society. Penelope's nose is short, turned up with a "ski slope", has enormous nostril show, a retracted columella, is very wide at it's base, and has many horizontal deep lines across the dorsum. Repairing her nose would require an open rhinoplasty. Cartilage grafts would be needed to lengthen and support her tip. Nostril reduction and lower nasal cartilage narrowing along with the injection of fillers along her dorsum would likely improve the porcine appearance. In the movie, Penelope finally accepts and loves herself for what she is (not a bad idea for all of us), and it is she that reverses the curse, giving herself a "normal" nose. In real life, the best way to avoid a "pig's" nose deformity after a rhinoplasty is to choose your surgeon most carefully before the first operation. It always amazes me that many patients will spend more time picking out the color of their new car than they will spend on choosing their nasal surgeon. Carefully look at many before and after pictures. Ask to speak with, and preferably see patients whom the surgeon has operated upon. Otherwise, you may end up like Penelope with a "pig's" nose, and be forced to select your revision surgeon more carefully.

Ashley Tisdale, a young teen star from the popular High School Musical, unveiled her new nose a few weeks ago in New York City during a holiday performance. According to reports she had difficulty breathing through her nose, visited another Ashely's (Simpson) surgeon, and underwent the procedure to correct her breathing. "Oh, by the way, while you're in there, can you straighten out my nose and take off that bump from when my nose was broken?" "Hope that she didn't Jennifer Grey her career with that nosejob" is what I've heard from some Hollywood agents and actresses. The key to any facial plastic surgery is that it should look natural, nearly undetectable. Some ethnic and celebrity noses have the potential to change the entire look of the face when they undergo rhinoplasty. After a rhinoplasty, it should not be necessary for the patient to have to greet friends, family, and aquaintances with " Hi, I'm (fill in the name of the nose job patient)". I empathize with Ashley and her surgeon( a world class rhinoplastic surgeon) as they are being scrutinized under the world media magnifying glass. It takes about 6-12 months for the nose to settle as it heals. Hopefully her burgeoning career will not be affected and she will be able to breath well through her newly reconstructed nose.