There was a time when surgeons performed the same rhinoplasty technique on every patient undergoing the operation. In retrospect it was a one-size-fits-all “conveyor belt” approach that did not work out well for everyone. The obvious “surgical” outcome was the consequence of a significant portion of those patients having nasal surgery.

The change in philosophy came when we realized that nasal surgery must be “individualized” or “customized” based on a patient’s needs, desires and anatomy. Consequently, it is essential to determine by inspection and examination what “type” of nose the patient has. There are sixteen to eighteen different types. All patients fit into one category or another. Some fall into two categories, and a rare patient may fall into three. Recognition or diagnosis is crucial in planning the operation to maximize the outcome not only from a cosmetic perspective, but also from the perspective of function. The goal is and must be an attractive, properly proportioned, non-surgical appearance that is undetectable from a naturally aesthetically pleasing nose.

It is critical that the proper diagnosis be made prior to the surgery. This will determine the plan of what to do and of equal importance what not to do.