Among all plastic surgery procedures of the face, nose surgery is one of the more frequently requested. Due to the nose’s prominent position on the face, its size, shape and symmetry are sources of concern for many patients.

Surgically altering the nose, known as a rhinoplasty, can reduce or increase the size of the nose, modify the shape of the tip or the bridge, reduce or increase the width of the nostrils, or correct the position of the nose.

In addition to providing these cosmetic benefits, a rhinoplasty can also be performed to relieve breathing problems caused by narrow or partially obstructed nostrils or a deviated septum.

There are many different aspects of the nose that a person might be concerned with. Some feel that their noses are too large in relation to the surrounding features.

Others are annoyed by a tip that is too blunt, too bulbous or too “pointy,” or nostrils that are too wide or too visible from the front. Still others have noses that are crooked, due to either injuries or genetic traits.

To understand the aspects of the nose, it can be divided into the bony vault, the upper two-thirds of the nose, the lower one third, and the tip. Each of these can further be divided into width, length, height and projection.

For instance, a common patient complaint is the presence of a hump on the bony part of the nose. The nose might be too wide, the tip too bulbous, and the tip might lack enough projection. This can cause the tip to point downward.

But all noses are unique and must be treated individually. Since each part can cause a change in another area, a rhinoplasty is considered as one of the more difficult procedures to perform well.

Rhinoplasty incisions are generally concealed inside the nostrils or in the natural creases beneath the nose. Depending on the desired result, the surgery might involve the removal of bone or cartilage, repositioning of soft tissues, or the addition of cartilage (usually from the septum) to build up areas that are too small or that sink in.

The goal is a result that looks completely natural for each individual face, and when desired still maintain the ethnic characteristics of the patient. Additionally, men’s noses do not look like women’s, an important distinction.

When the septum, the partition that separates one nostril from the other, is too large or deviates to one side or the other, the airway can become blocked, resulting in a decreased ability to breathe, often during sleep.

One of the most common causes of this problem is a deviated septum from a previous fracture in which the septum is crooked, resulting in one side of the airway being significantly smaller than the other.

Symptoms of this condition include loud snoring, nasal congestion, headaches, and frequent sinus infections. Interestingly, some people don’t even remember an injury to the nose; however, many have a vivid memory of being hit in the nose at some point in their lives.

Rhinoplasty surgery is performed under general anesthesia, and recovery time is approximately 7 to 14 days. A splint, if used, is removed at seven days.

E. Ronald Finger, MD, FACS is a board certified plastic surgeon with offices in Savannah and Bluffton. www.fingerand