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| Do people come in wanting work that is totally unrealistic? "Sure. I will discourage up to 10% from having surgery. Either their aspirations are unrealistic, or esthetically, their nose is already complementary enough so that no improvement is likely." "Technically, the patient also could have extremely thick skin, or lack certain supporting tissues, thereby preventing me from achieving what they are looking for. Though I could get a partial success, I'm going to make it very clear they should not count on anything more." "For example, if a patient has severe allergy problems, we are not going to cure their allergies, and it may be that we are not going to satisfy all their breathing needs. But if they get 50% improvement, and that's what they're hoping for, they will be very satisfied." The surgery takes about one hour, and patients are asleep during the procedure. "They feel no discomfort whatsoever. At the end of the day they go home. By that time, their breathing should be open, and within "five days, as much as 90% of the swelling and discoloration will go away. So by the following week they usually go back to work." Within a month, most patients even return to their sports activities. We look at pictures, and the doctor comments on the 'before' and 'after' shots. "Here is a natural result that doesnt look surgical. This is an attractive, dignified look which will complement one's features. But remember, it has to fit each individual's case. "The same technique is not used on everyone. The approach varies from individual to individual, depending on the facial features, the jaws, the chin, the cheeks, the size of the eyes, the forehead. He shows me a photo of a woman with a bump in her nose. "But the tip looked very good, so I left most of it in place. By magically making the bump go away, it's a perfect nose." This approach reflects the doctor's surgical philosophy. "If it's not broken," he says, "don't fix it. I like a minimalistic approach," he adds. "Here's a moderate sized bump, which pointed down to the upper lip. This woman was 50 years old, and her new nose still reflects the character of the face, whereas before it was just thick and wide, especially at the tip." The new balance with her face is very attractive, and gives her a more youthful appearance. "That's why the nose is such a key determinant of facial anatomy. It sets the tone for the rest of the face." Throughout, he strives to maintain the person's character in his work. "Character is crucial," he acknowledges. "Creating an amorphous, thinned-out nose takes away from a person's appearance "But so often, the patient's character is diminished by a surgeon who creates an overly thin, little nose. The nose has got to preserve character." He has the perfect example. "Here is a big guy, and another surgeon gave him a cutesy little nose." Doctor Tobias broadened it, building up the bridge and the tip. "He has a strong jaw and a strong neck. He's a handsome man — but without a nose, he looked like a wimp!" I learn the man is a major executive. "He needs a certain size nose to match his facial features. "On the other hand, here is a very cute woman. I made her nose a little perky. Someone might say, 1 want that nose.' But I have to say, I'm only going to give you that nose if you have that face!" "Yes, her nose is 'perfect,' but only for her face. That's the art." One would never imagine she had her nose done. Dr. Tobias smiles. "If you fix this problem, it takes a huge weight off their shoulders. It gives them the opportunity to show who they are." The doctor tells us he gets good results about 95% of the time. "I let them know that, in about 5% of the cases, I will go back a year or two later and do a slight 'touch up.' That's part of the process. I tell them before the surgery, and patients accept that. Again the nose is the only visible part you cannot hide. That's why I feel you must find someone devoted to it. My goal is to provide this kind of surgery in a way that is predictable, natural, and esthetically pleasing, without the tremendous fear of failure." We look at a photo of a very attractive young woman before she had any nose surgery. "The only possible imperfection was a small little bump on the bridge of her nose, a very .minor thing. Overall, she was absolutely stunning." But in the other photo, she has undergone two unflattering nose jobs in the last three years. Her nose is pinched, with knuckle type ridges, and, with one side pushed in, it's no longer symmetrical. , "The surgeon had said, 'We're '. going to make you look beautiful for your wedding.' But she was gorgeous! And after the first operation, she was dissatisfied, so he re-operated on her, but it only got worse." To her great pleasure, Dr. Tobias essentially returned her nose to its original, preoperative condition. Dr. Tobias has developed a number of approaches to correcting surgery done by others which has gone awry. "Think of the nasal cartilage in terms of a tripod, with a support down the middle. "The cartilage is a delicate tissue that lasts a lifetime. Those patients whose nasal cartilage was almost entirely removed were dealing with doctors who thought, 'To make it better, make it look smaller.' In many cases, unfortunately, far too small." To reshape the nose, Dr. Tobias recreates an entirely new cartilage foundation in the tip. "We see a dramatically enhanced and esthetically attractive nose once again." In addition to his support for the Princess Grace Foundation and the young artists they assist, Dr. Tobias also has worked with a number of up and coming actors, actresses, and models, to help further their careers. His greatest joy? "Working on someone who for years has been bur-dened by an unsightly nose, for whatever reason — and bringing it back to a normal state: that's my greatest satisfaction." For more information: Dr. Geoffrey Tobias, 815 Park Avenue, NYC 10021 - (212) 245-0202 - www.rhinoplasty.com |
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