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Adjusting Facial Balance

Rhinoplasty is a very popular procedure. Many people are dissatisfied with their nose and feel it is their most prominent feature. While there are different techniques for correcting non-aesthetic noses, other cosmetic procedures can reduce the appearance of a large or prominent nose by balancing the patient’s facial features, such as the chin or cheeks.


There are two commonly performed approaches to rhinoplasty – external (open) and internal (closed). With the internal technique all incisions are made inside the nose and therefore are not visible. Due to the “closed” technique, it can be difficult to work on the cartilage. It must be pulled out and then worked on. The internal technique of rhinoplasty is suitable for minimal work on the nose tip, or if there is a slight hump.

During a procedure using the external technique most incisions are also made inside the nose. However, one small incision is made under the tip of the nose. This enables the skin to be lifted over the nose framework to see where and how the cartilage is lying and what needs to be corrected. “You get one hundred times more exposure with the open technique than you get with the closed technique, “said Dr Sherman. “I like to use the external technique because it gives wonderful, permanent results. With external surgery, revisions are extremely rare.” The scar under the nose is very aesthetic and heals well.

Sometimes the nose may need to be rebuilt, either as the result of an injury or to correct a previous procedure. In difficult cases there may be a loss of tissue and the surgeon will have to augment the nasal tissue. In the case of correcting earlier surgery, cartilage may need to be harvested from the septum, ear, or occasionally ribs, to help correct distortions such as crookedness, asymmetry and depressions. Cartilage grafts strengthen the skeletal framework of the nose and help prevent twisting and warping during recovery, and drooping during the natural aging process.


Rhinoplasty is a relatively painless procedure. “Because of the techniques we use, very little pain is experienced,” explained Dr Sherman. A small, flesh-colored cast is worn for 10 day to help stabilize the nose. After the cast is removed 80% of the swelling has usually subsided. Any residual swelling takes between 6-12 months to modify itself. With the techniques now used, bruising is also very limited. “Fifty percent of my patients don’t get any bruising.” said Dr Sherman. Some patients experience minimal swelling and bruising around the inner Adjusting Facial Balanceeyes. “Techniques that cause massive swelling, where the eyes are closed up for two or three days, are antiquated.”


Dissatisfaction with your nose does not automatically make someone a good candidate for cosmetic surgery. A prospective candidate must have realistic expectations. “Sometimes someone over-focuses on some aspect of their nose,” explained Dr Sherman. “There are also some patients who put too much emphasis on their look as determining their success or failure in life. These are situations where I won’t be able to correct the problem significantly enough to make them happy.” Dr Sherman proclaimed computer imaging a “godsend” in helping show people what they might realistically expect to look like after rhinoplasty.

Often it may not be a case of a person needing rhinoplasty. In this circumstance it is the doctor’s obligation to explain how proportion works within the face.

Facial Balance

The face can be divided into thirds – consisting of the forehead; the nose and cheeks; the mouth and chin. A weak chin accentuates the mid-third of the face. “It is very, very common for patients to come in and feel their nose is too large. When we do an evaluation of their face we find their chin is in less proportion, making the nose look bigger.” In this instance Dr Sherman may recommend chin augmentation to balance the face after rhinoplasty. Inserting a chin implant means the size of the nose may not need to be reduced as much. This makes it a better procedure, both aesthetically and functionally, as over-shortening the nose looks less natural and can affect the airway.Adjusting Facial Balance

Another procedure performed in conjunction with rhinoplasty is cheek implants, as small or sunken cheeks can highlight the nose. “By giving the cheeks more fullness, we are balancing the mid-third of the face and taking away attention directed at the nose,” he explained.

The key to good rhinoplasty, as with the majority of cosmetic surgery procedures, is achieving a natural-looking result. Though it is the central feature of the face, it is surprising how little we notice other people’s noses. If a natural-looking nose is the result of rhinoplasty, friends and acquaintances are more likely to ask if you have had your hair cut or lost weight, not if you’ve just undergone cosmetic surgery. As Dr Sherman explained: “Nobody usually memorizes someone else’s nose. They just see the whole person.”

To view Before and After photos of Rhinoplasty surgery, Click Here.

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