Rhinoplasty Ladder – Step ladder principle
At times I get patients with ugly and horrible looking nose who comes with unrealistic expectations and ask me to create a nose like of a bolly wood actor and actresses. Sometimes they bring a picture of their idol stars and they ask for the impossible.
In Nose Job-Rhinoplasty-Surgery there is ladder principle.
Let me Explain- One cannot climb more than one or twoÂ step in a ladder at a time. One cannot make an ugly nose to a very beautiful Nose. The nose ladder is ugly, bad, normal, and pretty, very pretty. One cannot make an ugly nose to very pretty. Often patient has some cine star type nose in their mind and if they don\’t achieve that they get depressed.
I tell my patients that they should be realistic in what to expect and that sometimes only a slight improvement can be made.
There is a rhinoplasty “ladder” which is discussed here, where any nose on a scale of 1-10 can only be improved 2 to at most 3 steps. So a 7 has a potential to become a 10, but a 4 at most will can only be a 7 but will never be a 10.
Asking for the impossible
Certain features on the nose make it anatomically impossible to improve the person’s nose beyond a certain point. If the person has very thick skin and a very amorphous tip of the nose which looks like a ball, it would be next to impossible to create a perfectly refined and defined narrow tip for this patient. It can become more refined tip, but it may not even be as refined as someone who may be a natural 7, who may not have a refined tip, but their skin is relatively thin, and sculpting the nasal cartilages will make a remarkable improvement.
Pre op selection important
It is important to have several views of preoperative digital images of face and nose views. This will be useful after surgery to evaluate the result.
Preventing patient dissatisfaction depends upon proper patient selection. Any patient that makes the surgeon uncomfortable should at the minimum have surgery delayed, and perhaps referred for psychiatric evaluation. The most commonly diagnosed psychological conditions which should make the surgeon concerned include: neurotic disorders, personality disorders, psychotic disorders, and depression/mania.
Cosmetic surgery is not a game. It should be taken seriously by both patient and surgeon alike.