The Human Nose Between Artistry and Medicine

Press Release
January 2008

San Francisco, CA, January 2008 - Building on an impressive track record of 25 years of rhinoplasty experience, San Francisco plastic surgeon Dr. David Kahn has reached a career milestone few surgeons can take pride in — his 3,000th rhinoplasty procedure. By combining a strong sense for aesthetics and balance in the human face with an intimate understanding of the nasal anatomy, Dr. Kahn's rhinoplasty procedures have earned him several television appearances and numerous lectures to other plastic surgeons. On the occasion of his 3,000th nasal surgery, Dr. Kahn is sharing some of his insights culled from two decades of dedication to perfecting the human nose.

Reflecting on the surgical changes associated with rhinoplasty over the past 25 years, Dr. Kahn points out that the most dramatic development was probably the introduction of the open rhinoplasty technique about two decades ago. Though he prefers to conduct the traditional, more challenging closed rhinoplasty - mainly because of the lack of external scars - he recommends the open technique when extra cartilage is required to enhance the patient's nasal bridge or increase projection of the nasal tip, as is the case with Asian nose lift surgery.

According to Dr. Kahn, "the aesthetic of the ideal nose has not changed over the 25 years, but people have definitely become more open towards rhinoplasty as well as plastic surgery in general". A look at the number of rhinoplasty surgeries performed in 1997 versus 2005 reveals an increase of almost fifty percent. Rhinoplasty has historically been one of the most requested facial surgery procedures (along with eyelid surgery) and is currently the second most popular cosmetic surgery procedure among male patients (after liposuction). Interestingly, the procedure is not necessarily more affordable today than it was before. In fact, quite the opposite is true - prices for rhinoplasty have increased substantially over the past 25 years, as rhinoplasty procedures have become more advanced and specialized.

So how challenging is rhinoplasty compared to other plastic surgery procedures? "Rhinoplasty demands a very unique combination of technical and artistic skills" says Dr. Kahn. "Unlike a procedure like liposuction, which is about removing fat and skin, rhinoplasty is not just about reducing proportions, it's about modeling them by sculpting bones, skin and cartilages." Getting this process right requires not just technical skills, but real artistry on the part of the surgeon - a very demanding combination, which makes rhinoplasty one of the most challenging and difficult to learn cosmetic procedures.

It takes a lot of practice and training for a surgeon to develop his or her aesthetics and learn to create a natural-looking nose, that's both beautiful, functional and in harmony with the patient's facial features. Even when following precise rules of facial symmetry, the technical expertise and innate artistic abilities of a surgeon will greatly influence the final rhinoplasty results. Dr. Kahn cites the example of the nasofrontal angle (the angle where the nose meets the forehead, visible from the profile), which may be too sharp in certain patients and create a nose that starts too high and looks heavy. Since modifying this angle is highly challenging, a significant number of surgeons shy away from making this particular change. However, a surgeon with strong technical skills and a fine artistic eye will be able to create a subtle depression in the nasofrontal area, which results in a youthful-looking nose and a delicate profile in women.

If done right, rhinoplasty can be a highly rewarding procedure, since it enhances the attractiveness of not only the nose, but of the entire face, which can dramatically increase a patient's self-esteem. To a doctor, the great feedback received from his or her rhinoplasty patients can be very satisfying. Dr. Kahn recalls a particularly fulfilling experience: "I had this patient who told me he was so embarrassed with his nose, that every time he approached an intersection or group of people, he would put his hand to his face, so that nobody could see his profile. After his rhinoplasty surgery, his embarrassment disappeared and he said he was able to walk down the street with a confidence he never thought possible."

Dr. Kahn points out that, similarly to any other cosmetic surgery procedure, rhinoplasty has certain limitations related to a person's anatomy. One of the factors is the thickness of a person's nasal skin, which determines how small and delicate a nose can look. A surgeon cannot change a thick nasal skin - he or she can only change the underlying bone and cartilage framework, to which the nasal skin needs to adjust over time. Another limitation consists in a person's facial features - while a great nose job can produce amazing results on a person with overall attractive features, the same nose job would have a more toned down effect on a person with less appealing features.

Encouraged to share one of his rhinoplasty secrets, Dr. Kahn indicates that the key to a good-looking nose is the strength of the tip. "If the nasal cartilage is not strong enough, I usually use the septum to reinforce the tip and give it a better definition", says Dr. Kahn. "This helps achieve a refined nasal tip - characterized by the so-called "double-break appearance" - which can dramatically enhance the overall look of a nose." At the same time, tip reshaping represents one of the most intricate and challenging parts of a rhinoplasty procedure, both technically and artistically. "I've definitely spent a lot of time practicing and perfecting my tip refinement technique" says Dr. Kahn, "and I will continue to challenge and grow my skills in pursuit of rhinoplasty results that bring most joy and happiness to my patients."

About Dr. Kahn: Dr. Kahn is board certified in head and neck surgery and facial plastic surgery and is licensed in the State of California. Dr. Kahn's practice - The Kahn Center for Cosmetic Surgery - is based in San Francisco, CA, and has been devoted exclusively to plastic surgery since 1978. Dr. Kahn has developed new techniques for closed rhinoplasty and has helped introduce a revolutionary new facelift procedure known as the Weekend Facelift. To learn more about Dr. Kahn and the Kahn Center for Cosmetic Surgery, visit www.sf-plastic-surgery.com.


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