Rhinoplasty – why the problem is not always right in front of your face


The art of cosmetic surgery is as much to do with being in tune with a patient as it is enhancing function and aesthetics so they work in harmony.

That’s according to cosmetic surgeon and Comparethetreatment expert, Julian Rowe-Jones, who specialises in rhinoplasty, or ‘nose jobs’ as they are more commonly known.

With a wealth of experience – and internationally recognised for his skills, he runs two clinics in Guildford and London’s Harley Street that treat those of us who have thought long and hard about the decision to go under the knife to alter what is, essentially, a problem right in front of our face.

With 2,703 Brits undergoing the procedure in 2016 – rhinoplasty was the most popular cosmetic procedure for men and the seventh most requested by women – there is evidently a demand for the surgery.

However, as with all procedures, there is an expectation upon the clinician to offer us not only feasible alternatives but also the option to not go ahead with surgery.

And should he be in any doubt as to whether he can meet a patient’s expectations with his much-honed skills, Dr Rowe-Jones has no compunction in refusing to operate.

In fact, he is rather sanguine about any criticism he may face as a result of turning patients away at his surgery door.

So keen is he to uphold the principles of excellence with his own cosmetic treatments, he turns away prospective patients frequently – despite being under no illusion that this may upset some.

Indeed, social media now offers disgruntled consumers a fast route to airing grievances, but Dr Rowe-Jones is adamant that honesty is the best policy and that, in some cases, no treatment can offer the best results.

He explains: ‘There are some major misconceptions about having a nose job and one of the biggest is the belief that I will not turn down patients wanting treatment. But sometimes, during consultation, it will become obvious that there are deeper psychological issues – and, in such cases, surgery is not the answer. It’s a complex process trying to understand motivation and expectations, partly because patients themselves find it difficult to express exactly what they wish to achieve. It is therefore important we get to know somebody well.

‘Formal psychological questionnaires help to an extent but these are not foolproof. Therefore, to offer the appropriate support and care, we need to take time to get to know each other.’

He says: ‘Many people believe that rhinoplasty is minor surgery. They think that, with twilight anaesthesia and a little bit of a tweak, it’s like playing with plasticine and easy to do. This is not the case.

‘Others fail to realise the limitations when it comes to size reduction. They do not understand the complexities of the nose tissue or that the skin has a finite ability to shrink. If we liken it to someone who undergoes enormous weight loss, they very often require surgery to remove the layers of excess skin. This cannot be achieved with the nose without excessive scarring.’

He believes that face surgeons should not only have been trained in either ENT – head and neck/facial plastic surgery, plastic surgery or maxillofacial surgery – but that ‘we should also ensure that a patient’s psychosocial and aesthetic goals can be met’.

He says: ‘A clinician needs to be aware of people’s cultural sensitivities as well as understand their aesthetic taste and what it means to them. It is important to recognise – and take into account – your own personal preferences to avoid surgery that may look incongruous.

‘Rhinoplasty is technically one of the most difficult procedures when it comes to achieving a patient’s desired results. The nose is obviously a difficult part of our body to hide and the tissue hard to manipulate. We can disguise others lumps and bumps with clothes, but not the nose. It is also a transformative procedure rather than rejuvenative, which means sculpting a new shape rather than restoring something a patient was once happy with and this is challenging.’

Dr Rowe-Jones also feels that modern-day society now sets ideals of perfection and has raised the bar for our expectations. This is thanks largely to the plethora of images on the internet that put forward these beauty ideals that are not attainable for the large majority of us – even if they may be desirable.

He says: ‘The norm has been completely distorted and society now leads people to believe in high levels of entitlement – it feeds Narcissism. Selfies and the like on social media links self worth to appearance and online popularity. Some prospective patients may oscillate between Narcissism and low self-worth and today’s society helps neither. It is important that we realise we should not try to help resolve these issues with surgery.’

With image manipulation software to hand at his clinics, Dr Rowe-Jones believes this can go some way towards helping patients. It is important to have this visual insight into what is – and, just as importantly, what is not – possible.

He says: ‘The 3D imaging software in my clinics helps communication and can aid understanding on both sides – for the treating clinician and the patient, although it does have its limitations. The important thing is to really listen to them – what patients say can very often be illuminating. In my clinics, everyone is treated on their own merit.’

With the prospects of being back to work two weeks after surgery – mostly due to the need to avoid infections – rhinoplasty can certainly boost confidence once all the implications have been seriously considered and talked through with loved ones as well as in the clinical setting.

In Dr Rowe-Jones’s own surgery, reconstruction of the nose is with the patient’s own cartilage and tissue – ‘I would never use anything artificial,’ he says – and he suggests post-surgery care is as key to a patient’s long-term happiness as is taking the time to talk through the procedure, the desired results and what can (and cannot) be achieved.

He says: ‘We have looked at our Centre for Appearance Research Questionnaire scores – before and after surgery – and found we achieved statistically significant improvement in all the questions. These questions relate to questions, such as:

  • How self-confident do you feel?
  • How noticeable is your problem?
  • How much do you think about your nose?
  • How much do you avoid activities? And so on.

‘Cosmetic rhinoplasty, in well-selected patients and performed well can – in the words of some of my patients – “be the best thing I ever did” and can “change my life”.’

He believes that once in the comfort of our own home, however, we should always ask ourselves one question – ‘When I left, was I clear as to what was being proposed?’

He concludes: ‘If, cosmetically, you do not know exactly what the surgeon’s aims are for you, then you may wish to reconsider your choices.’
book a consultation with Dr Julian Rowe Jones

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