This cannot be completely boiled down to lines and numbers—there is always an indescribable "artistic" element. However, by studying beauty, and faces that are universally felt to be beautiful, artists and plastic surgeons can arrive at some guidelines or proportions that represent the "aesthetic ideal." Leonardo da Vinci was among the first to make such studies of beauty and aesthetic proportions. He and other artists have been joined in this pursuit by facial plastic surgeons, whose profession entails understanding beauty and then making changes that enhance the beauty of their patients.

The figures that follow show diagrammatically the ideal dimensions of the nose (Table 1, Figs. 9-17). This aesthetic "ideal" is simply a goal or a frame of reference that must be modified to reflect the realities of a particular patient's facial features.

The lines and measurements outlined here are a general guideline for facial plastic surgeons that is applied to each patient individually. When a patient presents for a rhinoplasty consultation, the experienced surgeon makes mental note of a "firstimpression"—e.g., too big, twisted, large hump, an overoperated or revision nose. This first impression is important, because the odds are that this is what is bothersome to the patient as well. Often the surgeon will also ask the patient early on what it is that bothers the patient about his or her nose.

The surgeon considers the nose from the front. He determines whether the nose is twisted or straight, narrow, normal, or of excessive width, whether the nasal tip is bulbous, asymmetric, or otherwise abnor­mal. He also makes note of the skin quality—thin, medium, or thick.

The surgeon considers the nose from the side and determines whether the nose in profile is too long or too short, whether the profile has a hump, if it is too scooped, or if it is a pleasant and desirable outline that fits the patient's face. The surgeon determines if the tip of the nose sticks out too far from the face ("overpro­jected"), if the nose is too small ("underprojected"), or if it is just right. The surgeon also examines the nose to see if there is too much nostril showing.

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Ask Dr. Becker a question about revision rhinoplasty or make an appointment for a consultation, by calling 856-589-NOSE (6673) or emailing us at info@revisionrhinoplasty.com.