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Seconds before I enter the room to see a new consult, I always envision what the patient may be thinking as they are waiting for what is always a very personal journey to be fulfilled. A female Iranian name on the chart always brings a smile to my face and is not unlike the feeling I had in medical school when I went home for Nowrooz. An instantaneous connection and warmth now fills the office walls because a mutual understanding between patient and doctor is almost certain. An “Iranian Rhinoplasty” should be any plastic surgeon’s dream because usually a very attractive, elegant, young woman with eyes that dazzle, a smile that enchants, and perfectly projecting cheek bones now just needs the right nose (sometimes a chin augmentation also) to center everything into a beautiful and harmonious state. It should be noted that rhinoplasty (“nose job”) is the number one most challenging plastic surgery procedure that we do. This is why many can recall seeing noses that do not look right.
Iranian women have been altering their noses for generations. While body contouring, facelifts, and breast augmentation are gaining popularity here and in the motherland, rhinoplasty remains embedded within our culture as much as the “haft-seen” has been. This is not unique to our culture. Dr. Jacques Joseph, a German Jewish surgeon in the 1920s and '30s is considered to be the “father of rhinoplasty,” made his career from “ethnic rhinoplasty.” However, only the wealthiest could seek out his expertise. To add to the intrigue, the earliest recorded Plastic Surgery procedure was a nasal reconstruction performed in 500 B.C. India by Sustruta! What has evolved since those times in the mind of our beautiful, young Iranian lady sitting in my office? A lot!
For one thing, very rarely does she want a completely different nose or a less ethnic nose. I would never even allow myself do that; to erase our past and our ancestry. The key today in all of Cosmetic Surgery is to retain the distinctive features that make you who you are. This is most crucial in rhinoplasty as the nose is the center of the face and must blend with other facial features. Iranian noses are very distinct and are not necessarily similar to other noses in the region. What makes Iran unique is that it is the first non-Arab country as you move east in a straight geographic line. Iran is poised in a location where southern noses may have Arab or even some African characteristics (thicker skin, flatter bridge, flared/ short nostrils), northern noses may show European or Russian influence (narrow and high upper bridge, thinner skin, pointy or droopy tip), while eastern Iran may have East Asian features (short nostrils, very flat bridge). Most often it is a combination of the above---elongated nostrils, “bulbous” (poorly defined) tip, large obvious lower (nostril rim) cartilage with a large hump to top it all off. It is of utmost importance that the surgeon is armed with the most advanced surgical techniques and knowledge. In Dallas, for example, there is a conference given every year just on Rhinoplasty to teach these techniques to surgeons around the world. In 2009 it will be in its 26th year, which speaks volumes to the importance of this ancient Plastic Surgery operation.
Back to our lady who is still waiting. I imagine what she might be thinking, hopefully it is not, “doctor kojast, ba yeh mareezeh degeh hast?” As an aside, I always try to discuss the specific concerns and issues each patient has with the patient alone for at least part of the visit. Having the parent (often Mom) not in the room at all times honors this as the very personal decision that it must be. If I sense hesitation from the patient, or any signs of concern on my part I will suggest a return visit in a month or two (just as the patient should feel right about the interaction, so should the surgeon). While this sometimes means that another surgeon may perform what is undoubtedly one of my favorite operations, I will know that I made a decision that is right for both patient and doctor.
I now enter the room and a warm familiar smile instantaneously becomes mutual and I am once again thankful that I have woken up today to do what I am most passionate about. The rhinoplasty is a success and after the swelling is down (sometimes 6 months to a year), the nose has truly unveiled itself. All the “Persian” beauty is now realized and, when done well, it can be a hidden secret.
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