How do you determine the most pleasing nasal proportions?
As a board-certified facial plastic surgeon, I have in-depth knowledge of what are considered to be the ideal proportions of the face (have you read my post about the golden ratio?). To supplement my training and expertise, I have done extensive research on how someone’s face is perceived based on their features (read my blog here). Cosmetic surgery will undoubtedly impact the way you’re perceived, so it’s important to entrust your surgery with a skilled specialist who understands the real-life implications of making a change to your appearance.
During every rhinoplasty consultation, I capture images of my patients from frontal, profile, base, and oblique (3/4 turn, which is the most common angle others see you) views. I then modify the photos together with the patient as a way to guide the discussion about desired and realistic outcomes, and we discuss how changes to different areas of the nose may affect the nasal and facial appearance from each of these perspectives.
From the frontal view, the most concerning thing for most patients is whether their nose appears widened (either at the base or the tip). Historically, nasal aesthetic ideals dictate that the widest part of the nose should be no wider than the distance between the eyes. The tip of the nose should be approximately half of the overall width of the nasal base.
From the side view (profile), the root (top) of the nose should ideally start at the upper eyelashes for women and the upper eyelid crease for men. The tip should project away from the face approximately 55-60% of the total nasal length (from the root to the tip). The angle between the nose and the upper lip should be maintained between 95-105 degrees for women and 90-100 degrees for men; too large of an angle results in an unnaturally upturned appearance.
Viewing the nose from underneath (base view), the nostrils are ideally close to symmetrical. However, base asymmetry is not uncommon and is usually due to an underlying asymmetry in the maxilla/upper jaw; I use the analogy of putting a tent up on the side of a hill when trying to explain this relationship. Asymmetry in facial projection isn’t addressed by rhinoplasty surgery, but I do work to minimize and disguise its impact on the overall nasal harmony.
The oblique (or ¾ turn) view is often where a crooked nose will be quite evident. For a patient with a nose that is curved, the dorsal hump (bump) of the nose will often look most obvious when viewed obliquely from the opposite side, which can highlight this particular irregularity.
The above considerations are a sampling of what goes into planning and executing a superb rhinoplasty surgery. With proper analysis, realistic patient expectations, and the skills of a qualified facial plastic surgeon, rhinoplasty is a very rewarding procedure for both patient and surgeon alike.
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