"The most important advance in nasal plastic surgery in the past decade has been an overall significant improvement in the art of diagnosis of small and subtle deviations from normal in the nose," says Dr. Tardy, professor of otolaryngology/head and neck surgery at the University of Illinois, Chicago.
"There certainly have been technical advances as well, but none is as important or as valuable as advances in diagnosis and analysis of very specific deformities in the nose."Educational efforts of the past decade have emphasized a greater appreciation for each patient's unique anatomy, says Dr. Tardy. Undergraduate and post-graduate education has more recently addressed the subtleties, details and nuances of analyzing and diagnosing anatomy.
Improvements have been made in imaging techniques, as well, including a three-dimensional imaging system with which Dr. Tardy and colleagues are currently working at the University of Chicago. In the future, this imaging system will help cosmetic surgeons understand even thetiniest of details of nasal anatomy before beginning any surgical procedure. It also will allow residents in cosmetic surgery training to perform virtual surgery in real time, helping them visualize how to avoid problems during an actual procedure.
Dr. Tardy notes that skillful surgeons understand how each patient's rhinoplasty outcome is influenced by subtleties and anatomical variants that are properly recognized in an exacting diagnosis.
"An intimate knowledge of the variant anatomy encountered in patients, supplemented by accurate, detailed analytic and diagnostic skills, sets the stage for superior surgical outcomes," he says.
Cosmetic surgeons, he says, must possess and execute a wide range of surgical skills.
"No single surgical technique will suffice to refine every nose to an ideal state," he notes. "Avoid the cookie-cutter approach that so often was a hallmark of the past."
He feels that a rhinoplasty outcome that is individualized to each patient should be "the creation of a nose that draws no attention to itself, but enhances the beauty of the eyes, allows for comfortable nasal function, and is in harmony with the other features of the face."
Attaining such success can be easier said than done. However, Dr. Tardy contends that the past decade has brought improvements in how cosmetic surgeons are trained to appreciate facial balance and proportion and to give generous attention to anatomical subtleties and specific diagnoses.
"We now know that even less experienced surgeons, by attention to these details, can produce very nice results," he says.
In some cases, balancing the proportion of the nose to the rest of the face requires enlargement of the nose, rather than reduction. Dr. Tardy says computer imaging and a discussion of the benefits usually alleviates most feelings of reluctance.
He also warns against artificial implants or substances in the nose to achieve enlargement. Instead, the primary source of reconstructive material should be the patient's soft tissue, bone or cartilage from their nasal septum or external ear.