Generally, the outcome of nasal surgery in the hands of the most skilled surgeons still depends on two main factors:

1. The type of patient’s skin in terms of flexibility, thickness and the elasticity
2. The beauty of the rest of the face

Regarding the skin texture, I usually use an example for my patients that is very helpful in understanding the issue, which is the difference between a leather ball and a balloon. Due to having elasticity, a balloon reduces its size by decreasing the air within without losing its form, while a leather ball size will reduce slightly while the air within decrease, and a certain excessive reduced volume would cause its deformation.

However, no skin elasticity is either low-elastic like a leather ball or has a very high elasticity like a balloon. But, this example helps the patients to understand why two different skin reactions are quite different. Nose consists of three major layers:

1. Skin and the muscles affixed to underneath
2. Nasal bone – cartilage structure or skeleton that is more made of bone at the top and more cartilage at the bottom
3. Nasal internal lining or mucous, which covers the nose from inside

In rhinoplasty, skin and its clung muscle layer are lifted from the cartilage and bone layer, and the changes in the cartilages and bones are made. In some points, reduction and sometimes increase and mostly transformation in cartilages and bones are made. Almost nothing is done in the skin layer and muscle, and this layer reacts to changes made in bones and cartilages based on its elasticity. It lies on cartilage and bone layer and gradually acquires the desired form. Here, the skin elasticity determines how much the surgery can be effective. Highly inelastic skin or the so-called fleshy nose hardly responds volume reduction, while it respond relatively good to form change and will respond well to increased volume. Therefore, in case of fleshy noses, if much volume reduction is not to be done, a good surgeon can get very good results.

However, a good, supple and young skin with good elastic properties (or the so-called bony nose), provides an excellent maneuverability for a good surgeon to do different changes. Although even a less experienced surgeon can get modest results in bony noses, but performing surgery on fleshy noses surely needs an accurate and fully-experienced surgeon. After all, even in the hands of a good surgeon, a nose with a good skin (bony nose) would gain a better result than a nose with bad skin (fleshy nose).

The second factor affecting the operation outcome is the beauty rate of the rest of the face. In a beautiful face, even a moderate result in the nose surgery will be satisfying, while an individual that the rest of his/her face is not beautiful will be sensitive to the smallest details after nasal surgery. A person with a small chin or dimple cheeks or who has a long lip back and narrow lips redness, the nose has a protruding nose and reveals projected, which even with a good nose (in case of not correcting the rest of face problems), the nose appears partially protruding. Thus, the small size of the rest of the face components make the nose appears bigger. Sometimes the correction of chin, cheeks and even the lips may indirectly cause the nose looking smaller and more beautiful.