“I want Angelina Jolie’s nose. Can you do that?”
As a surgeon, I want as much information as possible to help me understand what a patient is looking for. Often a patient will bring in pictures of people with noses they like, and there is a benefit to that. It does give me an idea of the changes they may be looking for. We understand instinctively what makes a nose attractive. Is it straight, balanced and proportionate? Does it fit into certain ratios of the face? The size of the tip, how far it projects, the width of the nose, are all part of what we find pleasing–or not. You know it looks good, or bad, but why?
My overall goal is to make a patient happy. Listening closely to understand their concerns is part of the consultation. The other part is educating them on what is possible and how we are going to get to their desired goal. Duplicating the same nose as a Hollywood starlet (or Cover Girl or Duchess) may not be the right move. The “perfect nose” must be balanced and in harmony with each individual, and there are nuances. We are not just “swapping parts.” In fact, replacing your nose with Angelina’s may result in a less aesthetically pleasing appearance than the one you had to begin with because the nose must be considered within the context of your unique face.
It is so important to understand the balance between the face and the nose. It is similar to an artist painting a picture. The artist must paint their picture to be in balance with the canvas. The smaller the canvas, the smaller the picture should be while a larger canvas accommodates a larger picture. In rhinoplasty, the canvas is a patient’s face and the surgeon is the painter creating a nose that is better balanced with the face. My evaluation of the nose begins with studying the face overall. This is also a point I stress with plastic surgery residents I teach. Only after assessing facial proportions should the nose itself be evaluated.
Evaluating the face begins with determining the widths and heights of certain parts of the face. As a plastic surgeon I understand how these measurements are important to overall harmony between the nose and face. For example, the distance between the eyes usually determines how wide a nose should be overall. The widest part of the nose is at the base where the nostrils are located. Other proportions of the nose are based off of this measurement. This includes how wide the tip and other areas should be. How we perceive a beautiful nose is related to shadows and light reflections from the nose all related to these delicate ratios.