How is facial analysis done, and which proportions are assessed?

The nose is not assessed as an isolated organ separate from the face — it is planned as part of a whole, together with the forehead, lips, chin and cheekbones. The analysis is based on photographs taken from standard angles and on examination.

The first thing I look at is facial symmetry: most people have small, unnoticed facial asymmetries, and the nose usually appears slightly shifted away from the wider side of the face. I look not only at a still photograph but also at how the nose and skin move when you smile and use your facial expressions — skin thickness is another factor that directly affects the surgical plan.

Some classical proportions are used in the assessment: the division of the face into three equal horizontal zones (hairline to brow, brow to base of the nose, base of the nose to chin), the ratio of the nasal base to the width of the face, the relationship between nasal length and midface height, the projection of the tip and the angle between nose and lip. These are flexible guides, not rigid rules — every face can depart from these ideal proportions through ethnic and individual differences, and those departures are usually part of a natural, personal appearance.

In some cases we also use computer simulation or three-dimensional imaging — these improve communication and let us see the bony structure more clearly. But the final decision is shaped not only by these measurements but also by surgical realities such as tissue healing and the true flexibility of the cartilage. The aim is not to reach a mathematical ideal but a balanced result in harmony with your face.

Why are the profile and the front view assessed separately?

Because the two reveal different aspects of the nose, and a problem that is not noticeable in one view can be very clear in the other. From the side, the height of the bridge, any hump, the projection of the tip and the nose–lip angle are assessed — the silhouette of the nose.

From the front a different picture emerges: the width of the nose, the symmetry of the two sides, the ratio of the nostrils to the base and whether the tip sits exactly in the midline. A nose that looks well balanced in profile can show a clear asymmetry or width problem from the front — or the reverse.

The surgical plan therefore rests on both views together, not on a single angle; correcting only the profile and neglecting the front view, or the opposite, can lead to an unbalanced result.

How do the chin and forehead affect decisions about the nose?

The other structures of the face directly affect how large or prominent the nose is perceived to be. With a receding (small) chin, for example, the nose can look larger than it really is — because the eye attributes the imbalance in the face to the nose. In such cases, assessing the chin as well (and supporting it with a separate procedure if needed) sometimes gives a far more balanced and lasting result than reducing the nose alone.

The forehead matters in a similar way: its slope changes the perception of where the nasal root begins. If the forehead–nose angle is very flat or very sharp, the planned height of the nasal root has to be adjusted to it — otherwise the nose may look out of keeping with the rest of the face.

In short, decisions about the nose are never made in isolation; it is planned as a whole with neighbouring structures such as the chin and forehead.

Does planning on photographs guarantee the result?

No. Computer simulation is a useful tool that strengthens communication between us and gives a visual answer to “what are we aiming for?” — but it is not a guarantee of the result.

The shape seen in a simulation cannot fully reflect the real thickness of your skin, the flexibility of your cartilage or how the tissue will behave during healing. Even when the same surgical technique is used in two different patients, the result may have softer lines if the skin is thick and oily, and sharper lines if it is thin and tight. That is why I use simulation as a goal and a communication tool, not as a photograph promised one-to-one.