What is the lower age limit — must growth be complete?

As a general rule I wait for the facial skeleton to finish developing before rhinoplasty — usually around the age of 18. In exceptional situations — a congenital anomaly causing severe breathing difficulty, a serious injury, or an obstruction that seriously impairs quality of life — patients under 18 can be assessed on medical grounds. There is no upper age limit; if general health is suitable, rhinoplasty can be performed safely at older ages too. (See the Rhinoplasty page for more.)

Which health conditions postpone surgery?

An active cold sore (herpes) or an open wound on the skin, or a current upper respiratory tract infection, are among the conditions that make us postpone surgery. If you take medication that increases bleeding (aspirin, anticoagulants), it needs to be stopped for a period before surgery in coordination with your doctor. Chronic conditions that affect general health, such as uncontrolled diabetes or high blood pressure, must also be brought under control first — as with any operation.

What does a realistic expectation mean, and when is surgery not advised?

A realistic expectation means setting a goal that fits what the existing structure of your nose allows. Expecting a “very small” result from a very large nose, for example, is often not possible because the thickness of the skin does not allow it to contract that far. Similarly, in patients who want to raise a very low nasal root considerably, the anatomy of the forehead bone (the frontal sinus) and the skull base sets a natural limit — pushing past it does not give a safe or natural result.

When the expectation falls outside the range your nasal structure allows, I prefer to talk about that openly rather than recommend surgery.

Do smoking and medication affect the decision?

Yes, smoking especially. I ask you to stop smoking at least 1 day before surgery and to stay away from it for at least 1 month afterwards — smoking seriously impairs healing of the lining of the nose. Medication that increases bleeding (aspirin, anticoagulants and similar) likewise needs to be paused before surgery under your doctor’s guidance.

How are concerns about body image approached?

In deciding on rhinoplasty, the patient’s psychological state is as important a criterion as the anatomy of the nose. Research shows that even an anatomically successful operation can end in dissatisfaction if there is an underlying body-image problem — so at the consultation I pay attention not only to your nose but also to your expectations and your level of concern.

What I look for is proportion between an objectively small flaw and the distress the patient feels about it. If there is a clear anatomical problem and your expectations are realistic, you are a suitable candidate. A mild degree of concern about body image is not a barrier to rhinoplasty either — on the contrary, surgery often brings relief and satisfaction for these patients; what matters is close follow-up. Where I am most careful is when the level of concern is disproportionately high for the visible flaw and has become an intense, persistent preoccupation — in that situation surgery generally does not bring the expected relief and can sometimes lead to requests for further revisions. In such cases I recommend an assessment together with a mental health professional, and sometimes not recommending surgery for the time being is what best serves the patient’s real need.

In short: mild concern does not rule out surgery, and often eases with it. The real limit begins where concern loses proportion to the flaw and becomes an intense preoccupation.