Jane E. Brody
Study finds earlier plastic surgery for an enlarged nose seems to produce lasting, beneficial results for teen-agers.
At 15 years old, Diane S. had large flashing eyes, a well-developed body and a razor-sharp mind. But as far as she was concerned, all that anyone noticed was her “enormous” nose.
Throughout high school in the mid 1950’s, she sat in class with her hand and hair over her face and avoided social contacts and events lest her nose be a cause for teasing and rejection. Though she desperately wanted it to be “fixed,” she was told she had to wait for surgery until she was 17 or 18, when her nose was certain to have completed its growth.
Finally, after graduating from high school, Diane had a “nose job,” and within months her long-suppressed gregariousness burst forth like an impatient spring blossom. Her only regret: that she had “missed” high school because she had to wait so long before she felt comfortable about “joining the world.”
Now, some plastic surgeons say, corrections of distressing nasal deformities through plastic surgery need not be delayed until a teen-ager is fully grown. Even when the patient is only 13, the rhinoplasty procedure seems to produce lasting results in most patients, according to a report published recently in the journal Aesthetic Plastic Surgery.
This is not to suggest that a big nose necessarily detracts from ones appearance. Celebrities like Barbra Streisand, Anjelica Huston and Walter Matthau offer proof that a big nose can be an asset.
But for many people, noses that call attention to themselves have long caused social and emotional withdrawal. And rhinoplasty has long been one of the most popular forms of cosmetic surgery.
The author of the new study, Dr. Peter Bela Fodor, a New York plastic surgeon, believes that too many of his colleagues have improperly accepted surgical gospel to delay rhinoplasty without fully examining the outcome of surgery done sooner. In plastic surgery literature, the accepted wisdom is not to operate on girls before age 15 and on boys before age 16.
But for properly selected teenagers, Dr. Fodor and other experts say, there is value in performing surgery on the nose early in adolescence, before the body image solidifies and self-consciouness peaks. In selecting appropriate patients, doctors assess emotional adjustment, tissue development and bodily growth. The early surgery can avert years of distress and perhaps permanent emotional scars.
In Dr. Fodor’s study of 22 teenagers operated on before age 14 and followed for four years or more, the deformity that had been corrected did not reappear as the patients grew.
Still, Dr. Fodor continues to warn young patients that they may need minor corrections later if they under-go rhinoplasty before age 14.
Early surgery can avert years of emotional distress.
Through the years several surgeons have reported that, from a psychological perspective, rhinoplasty tends to be far more successful in young patients operated on before their nose has become an integral part of their persona.
A study by Dr. Alvin I. Glasgold, an otolaryngologist who does plastic surgery in Highland Park, N.J. found that the youngest group of rhinoplasty patients, those 15 to 19, made the greatest improvements in self esteem, social relationships and self-rated physical appearance.
Dr. Glasgold said his findings indicate “the importance of establishing a positive physical self-image during the period of emotional and social maturation.” He now operates on even younger teen-agers, especially girls who tend to mature physically sooner than boys.
This is not to say that every teenager who hates his or her nose is a potential candidate for plastic surgery. Hypercritical attitudes about various parts of the body are extremely common in adolescence, and often these attitudes are not shared by more objective observers.
“A plastic surgeon has to also be something of a psychiatrist,” Dr. Fodor said. “A full assessment must be made, not just of the teen-ager’s nose but also of the youngster’s social, scholastic and emotional adjustment.”
In other words, simply disliking one’s nose is not sufficient justification for surgery, at least not in early adolescence. As teen-agers mature and their faces and bodies fill out and personalities develop, preoccupations about various physical departures from societal ideals often fade.
In assessing young candidates for rhinoplasty, responsible surgeons try to determine whether the deformity and the adverse effects on a child’s development are significant, and whether the child is extremely deter-mined to have the operation. Rhinoplasty, surgeons agree, should never be done because a parent wants it and foists it upon a child.
Plastic surgeons also try to assess the patient’s psychological state. A person with grandiose expectations about the results of surgery is generally considered a poor surgical risk. For teen-agers, however, Dr. Glasgold found that high preoperative expectations typically result in greater postoperative psychogical and social improvement. When youngsters believe strongly in the benefits of surgery, the outcome is often a self-fulfilling prophecy.
Reshaping the Nose
In nose surgery, the incision is usually made in the lining, to avoid an external scar. Skin is then lifted to give access to the bones and cartilage that determine the shape of the nose.
To remove a bump, some cartilage is shaved away. This may widen the nose so that bones must be broken and reset to narrow it. To soften the tip for sculpturing, cartilage at the end can be trimmed. To build up a nose, bone or cartilage can be moved from elsewhere in the body.