Parents, teens must weigh many factors in deciding on rhinoplasty

Many teens are unhappy with their appearance and ask their parents for a "nose job," or rhinoplasty. But there are a lot of factors to consider, such as the limits of surgery, the long-term effects and possible complications, according to Dr. Patrick J. Byrne, a facial plastic surgery specialist who practices at the Johns Hopkins Cosmetic Center at Green Spring Station. Byrne, also an assistant professor at Hopkins School of Medicine, says there are better techniques to make the surgery successful, but this is still a big decision.

At what age is it appropriate to consider rhinoplasty, and how common is the procedure among teens and adults?


In Baltimore, rhinoplasty is the second most common plastic surgery procedure, and it is the most common with teens. Our belief is that for most patients, it is best for the face to completely develop prior to performing such a delicate and important operation; therefore, a good rule of thumb for girls is 15 years of age or older, and for boys 17 years of age or older.

Can the teens choose the kind of nose they want, or are there limitations based on facial features?


It is very important to spend a good deal of time with the teen, and their parents, to discuss what their hopes are with regards to the surgery. At the Cosmetic Surgery Center of Maryland, we strive for natural results in all of our procedures. We educate the teen about features that can look great for their own particular face in order to strive for harmony and balance. It is true that each patient's features and the type of skin they have differ to a certain degree, and it is important to take these unique features into account with surgical planning.

Are there factors that make teens, or adults, bad candidates for rhinoplasty, such as allergies, mental health issues or other physical considerations?

We consider a number of factors when considering anyone for rhinoplasty. Previous surgery or injuries, medical conditions, and mental health are all very important to carefully evaluate. Surgery is not appropriate for everyone. This is an important decision, and one not to be taken lightly, so we try to do our best to help families make wise decisions.

What does such surgery commonly entail, and what qualifications should your doctor have?

People should only consider surgery with board-certified plastic, or facial plastic, surgeons to ensure they have the proper education, training and experience. Rhinoplasty is considered by many the most difficult operation in all of plastic surgery. I would recommend that anyone interested in rhinoplasty investigate how many such operations their surgeon performs annually. In my opinion, there is no other procedure in plastic surgery than rhinoplasty in which experience is more important. The procedure is one in which we reshape and reposition the structural components of the nose. The cartilage and bone are refashioned — as naturally and safely as possible — into a more harmonious structure. It involves a lot of art, and science.

Are there any potential complications or issues over time to consider such as infections, breathing difficulties, sagging or regrowth?

Yes, there can be complications or issues over time, but new techniques are improving the results and their longevity. The techniques have evolved in recent years through the recognition that the traditional rhinoplasty techniques often caused a lot of problems — months or even years later, people would develop breathing problems, or a collapsed abnormal appearance. Today, most of us who truly specialize in this area now use a "structural approach" to rhinoplasty, which means we pay particular attention to preserving the important structures of the nose. The result appears more natural, and lasts a lifetime. This is a profound change in how the procedure is performed. As one who teaches other surgeons about rhinoplasty all around the country, I can tell you that it is my hope that more and more surgeons will master these enhanced techniques.

What are the costs, and who generally pays?


Rhinoplasty is generally considered a cosmetic procedure, therefore not covered by insurance. However, if the patient has breathing issues, the portion of their surgery to fix those concerns will be covered by insurance. Many of my patients have some breathing problems, or a history of trauma to the nose, and end up being diagnosed with correctable structural abnormalities that can be corrected through insurance. Typically, this is done at the same time as the cosmetic rhinoplasty.

Dr. Byrne will be hosting a free seminar from 6 p.m.-7 p.m. May 17 for families who are considering rhinoplasty for their teen. For information or make a reservation call 410-296-0414.