Consultant Facial Plastic Surgeon Julian Rowe-Jones — a leading expert in nasal plastic surgery — reveals how empathy, hard work and passion lies at the heart of his work in the most difficult of all aesthetic facial plastic procedures — rhinoplasty
Body dysmorphic disorder and personality disorders have a high incidence in patients seeking cosmetic surgery, particularly rhinoplasty. The greatest challenge when looking after patients requesting rhinoplasty is determining which patients can be helped by and will benefit from surgery. Understanding patient expectations and hopes and trying to predict whether rhinoplasty can meet these expectations is, at times, very difficult. Unfortunately, despite good surgical results some patients may still not find surgery makes them happier. This may not be easy to determine before surgery even after lengthy consultation.
The anatomy of the nose is very complicated underneath the skin and there are very many features of the outside surface of the nose that need to be considered. There are limitations in what can be achieved, particularly when one considers that unintended effects may accompany the intended effects of surgery. This must be factored into any surgical plan. The skin of the nose needs to shrink in most cases and, unlike the case following major weight loss surgery, we cannot cut away skin from the outside of the nose as scars would be visible. The nose cannot be covered up with clothes. We are human flesh and blood and there is unpredictability in how we heal, which can affect the results of surgery.
I must be certain when I recommend surgery that my patient has understood what can be achieved and has agreed on what we are trying to achieve together. I must be certain they have understood and accepted that unpredictability and that risk cannot be eliminated — even in the best surgical hands. They must also accept that revision surgery cannot always correct a complication.
The psychological management of patients with appearance concerns is every bit as important as surgical excellence. I am greatly rewarded when I am happy with the technical results of surgery but more so, when a patient says that surgery has ‘been the best thing they ever did’ and allows me to use their results and pictures for teaching. This is part of what a great doctor-patient relationship is about.
We emphasise a team approach to patient education and care. Patient communication of all the factors of rhinoplasty is extremely important and we all have areas of special expertise and responsibility to help patients.
I chose rhinoplasty because it provides me with never-ending intellectual challenge and infinite opportunities for aesthetic creativity. I also chose rhinoplasty simply because it is the most difficult of all the facial plastic surgery procedures.
I am proud of having established a clinic with a team specialising in rhinoplasty. I am proud of having achieved international recognition for my rhinoplasty surgery. I am proud of our patient-centred approach to rhinoplasty.
Fact box — nose jobs
- According to figures for 2015 from the British Association of Aesthetic and Plastic Surgeons (BAAPS), the number of nose jobs increased by 14% from the previous year with 4,205 cases (men and women)
- Last year, rhinoplasty was the sixth most popular procedure for women and the second most popular for men
- Rhinoplasty is widely considered to be a difficult procedure and this is reflected in a relatively higher rate of revision compared to other cosmetic surgery