Is a Nose Operation the Right Decision for You?

What are you actually buying?

There is a version of this decision that clinics prefer, in which the question is which technique and which surgeon. There is a more useful version, in which the question is what you are buying. A nose operation is a trade: you give up the nose you have, several weeks of ordinary life, a sum of money, and the certainty of never having been operated on. In return you get one structural change, delivered slowly and judged late. Whether that is a good trade depends entirely on which change, and on what you were expecting it to do besides change a nose.

It buys a specific structural change: a bridge line altered, a tip reshaped, a nostril base narrowed, an obstruction improved. It does not buy a different face, a different reception from other people, or relief from distress about appearance in general. Knowing which of those you are shopping for is most of the decision.

Separate the physical change from the life change

Write down two lists. On the first, put the physical change you want, in plain words: the hump gone, the tip less bulbous, the nostrils less wide, the breathing improved. On the second, put what you expect to be different in your life afterwards. The first list is a surgical plan and a surgeon can discuss it honestly. The second list is usually about how other people see you, how you see yourself in photographs, or how a particular comment lodged itself years ago. Those are real concerns, but an operation is a poor instrument for them, and mixing the two lists is how patients end up with a result that is technically fine and personally disappointing.

One test sorts the two lists. Ask what happens to the underlying problem if the nose turns out well. If the answer is that the problem is unchanged, then the nose was never its cause. That does not make the operation wrong, but it changes what it can be expected to deliver, and it is worth knowing before you consent rather than after.

What does the trade cost besides money?

Not only money. It costs the first week, which is uncomfortable and visible, and the second, which is socially awkward. It costs the months in which you cannot judge the result, which for many patients is the hardest part, harder than the bruising, because there is nothing to do but wait. It costs a small, lasting change in how your nose feels and sometimes how it breathes. And it costs the option of a first operation, because whatever happens later happens to a nose that has already been altered.

The photograph test

Take a clear photograph of your face from the front and the side, and look at it for a week without deciding anything. Then ask which feature you notice first, and whether it is the nose. Patients frequently find that the feature they dislike most is the chin, the mouth or the eyes, and that the nose has been carrying the blame because it sits in the middle of the face and is easiest to name.

When is the decision not ready?

• You are comparing your nose to a specific other person's, or asking for a named celebrity result.
• You want the operation before an event that is weeks away, and the date is driving the plan rather than the anatomy.
• You have not yet asked what the surgeon would advise if you decided not to operate at all.

Is deciding not to operate a failure?

It is the outcome of a substantial number of assessments, and it is a legitimate result rather than a failed consultation. Doing nothing keeps every option open. An operation removes the nose you have and cannot put it back, so the burden of proof sits with operating, not with waiting.

What a confident decision is not

A good decision is not the same as a confident one. Most patients who do well can still describe their doubts on the morning of the operation. What distinguishes them is that the doubt was about the risks, which are real and which they had accepted, rather than about the goal, which was not settled and never got settled.