KEY POINTS:
Is it long? Fat? Straight and angular? It seems there are as many different "perfect" noses as there are different faces.
And it is for that reason New Zealanders seeking nose jobs should avoid the country's "cowboy" operators, Auckland plastic surgeon and rhinoplasty specialist Glenn Bartlett told the Weekend Herald at the annual conference of the Australasian Aesthetic Plastic Surgeons conference in Arrowtown this week.
World-leading plastic surgeon Bahman Guyuron told the conference the key with noses was that they must be matched to their owners.
"If you do 10 different noses, each will be different. Because each face is different. And you have to match the nose to the face."
That could mean lengthening, shortening, widening, narrowing, removing bone, cartilage, soft tissue or myriad other procedures.
The outcomes are as varied as the procedures. Widening the top of a patient's nose can make the eyes look further apart. Lengthening a wide tip can make it look narrower.
But while the changes may seem superficial to some, the surgery is anything but.
Bone is removed by rasping _ a similar process to grating cheese. Cartilage is sliced with a scalpel and yanked free. Soft tissue is chopped out with scissors. Stitches are threaded through cartilage and flesh.
Almost every option is available in New Zealand and those practices were best done by appropriately trained plastic surgeons, Mr Bartlett said.
While most rhinoplasty (the fancy name for nose jobs) operations were done by the appropriate surgeons _ plastic surgeons or ear, nose and throat surgeons _ every country had its cowboy operators, and New Zealand was no different, he said.
Some dermatologists, general surgeons, and even GPs offered rhinoplasty. Their prices were usually on a par with the appropriate surgeons _ about $10,000 to $14,000 _ although their aggressive advertising often set them apart, he said.
And their results were invariably less likely to impress patients, Mr Bartlett said.
Rhinoplasty was particularly vulnerable to inexperienced operators because of the immense experience needed to be good at it, he said. The surgery itself was not particularly difficult, but the ability to know what to do in a given situation was.
"Usually their results are not as good. And once the damage is done it becomes increasingly difficult to undo it. And if [secondary operations] are done by someone who's not experienced, it can be an ever-spiralling downhill battle."
Even the best plastic surgeons had to "touch up" about 5 to 10 per cent of their patients, he said, although the horror stories of nose jobs gone shockingly wrong were all but extinct among plastic surgeons.
The other common misconception, that every person getting a nose job was trying to look like Barbie or Ken, was also false, Mr Bartlett said. There were between 100 and 200 rhinoplasty operations each year in New Zealand, and the vast majority were on people who just wanted to fit in.
"The people who usually turn up for rhinoplasty have been embarrassed about their nose for years. They will often have their heads down, or avoid photographs. And usually it's a really transforming operation for those people.
"They want a nose that fits in their face. They don't want to stand out in a crowd, they want to blend in to the crowd. Most people aren't after Hollywood starlet transformations."
FACE FACTS
Do you have a perfect nose?
Vertical fit: Draw a line from the area between your eyebrows to the bottom of your nose. This should be the middle third of your face (your hairline to the eyebrows is the top third and the bottom of your nose to your chin is the bottom third).
Horizontal fit: Check the width of your nose. It should take up the middle 20 per cent of your face (the other 80 per cent is divided evenly between the width of both eyes and the distance from eyes to ear-tips).
Side-on check: Can you draw a straight line between the centre of your eyebrows and your chin, which passes through the base of your nose?
Reality check: If everyone looked exactly symmetrical, life would be boring. Allow for some variation.
