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Rhinoplasty — Open vs. Closed San Francisco Nose Surgery

Deciding on a rhinoplasty technique can be a confusing task if the patient has no understanding of their choices. Here is a brief description between two of the major choices patients will be faced with: the open and closed techniques.

When using the open rhinoplasty approach, your plastic surgeon will make a tiny incision on the external skin that separates the nostrils. The nasal skin can then be lifted, offering a great deal of surgical access to the underlying architecture of the nose. This technique involves an incision that is more visible after surgery. Hiding the incision is preferable for many patients.

Just Breathe

Before you read any further, stop for a second. Close your eyes, take a deep breath. How did that feel? Was your mouth open or did you just breathe through your nose? In your nose, was there any resistance, on one side or both? Now what if you were jogging? Or sleeping? I’m sure that this isn’t something you think about all the time, but it’s hard to say that breathing is overrated. In fact, there is a type of mindfulness meditation based in part on what you just did – pranayama. In this practice attention is focused on the simple act of breathing as a way of calming the spirit, and medical studies have shown positive effects on stress-related diseases.

Pranayama: the importance of breathing in mindfulness meditation

It’s hard to imagine that breathing could be underrated (I mean, without breathing, where would we be?), but it really is.  The simple act of airflow through the nose and mouth is not only necessary for life, but also can be an integral part of a feeling of calm, centeredness, and well-being. Pranayama is a Sanskrit word meaning “breath or breathing” and, in some contexts, “controlled breathing.”  It is a combination of Prana (“life force”) and ayama (“to draw out”).  Numerous forms and practices exist, involving the timing, manner, and rhythm of the breath.  This can include alternating nostrils, adding pauses or specific sounds and phrases, shaping the mouth in a particular way, etc.

A nose is just a nose, except when it isn’t

rhinoplasty_sanfranciscoOver the years, plastic surgeons and other physicians and scientists interested in aesthetics have explored the “ideal proportions” of the human face and its features. This has led to myriad schemes for classifying facial types, suggesting courses of treatment, and even planning surgical modifications. More recently, we have begun to focus on facial recognition – using experimental psychology techniques to find out exactly how people recognize each other or assign certain faces to particular groups (e.g., age groups, ethnicities, etc.). Out of this inquiry has come an interesting body of literature regarding facial features that the brain uses as shorthand for gender – how a person can decide on the gender of a face after seeing a single image flashed on a screen for less than a second. This work has determined that the ridge of the brow plays an important role, as well as the prominence of the jaw.


The Princess’s Nose

Of all the obsessive publicity and incessant attention surrounding Prince William and Kate Middleton, the most interesting item I’ve seen recently was about the Duchess of Cambridge’s nose. Apparently, according to the Transform Cosmetic Surgery Group, her nose was the most popular celebrity lookalike feature in the United Kingdom for 2012 ( The timing is curious since only a few weeks later the unveiling of the official portrait of Kate was met with widespread disappointment ( To my eye, the portrait looks quite accurate in terms of facial proportions, coloring, and even expression . . . yet somehow it is not beautiful. Much more could be said on this topic, but we’ll leave that for another day.