Precautions and Limitations


We may say no to surgery.

The Perfect Nose

The Perfect Nose

We may sometimes say no to surgery if after a clinical assessment of your nose we find that you’re not a good candidate for Rhinoplasty, and that surgery, in our opinion won’t deliver a pleasing result. Equally, if surgery exposes a client (patient) to possible risk, we won’t proceed.

Rhinoplasty is not a life saving operation. It is an ‘elective’ (voluntary) procedure, sometimes defined as ‘luxury’ surgery. For this reason, emphasizing safety, common sense, the welfare of our patients and the need for pleasing results, we will say no to surgery if you’re obese or anorexic. This is not a judgment of character; it merely reflects our concern that the anesthetic procedure – even the mild form of conscious sedation we use – could expose you to unnecessary risk.

Obesity and anorexia

Obesity introduces a risk of breathing and heart function complications while under anesthesia. Anorexia presents similar or related organ failure risks. In both instances, we will advise you of the risk and decline surgery.

Thick, sebaceous skin

Thick, sebaceous (oily) skin textures connected to weak, rudimentary (under-developed) nasal cartilage, especially around the tip of the nose indicate that a client should not undergo cosmetic Rhinoplasty.

Just as a heavy blanket draped over your shoulders would conceal the outline of your body, a thick skin linked to under-developed cartilage would hide the very changes you wanted before embarking on surgery. Just like a tent without supporting poles, the exterior appearance of your nose would not display the changes under the skin prominently enough to make a significant difference to the overall appearance of your nose. We know from experience that at best, we may only be able to produce a minor (slight) change, or in less severe cases, a moderate change. The procedure would not warrant the cost of surgery, and you would ultimately blame us for the disappointing result.

If you feel that your skin texture might disqualify you from surgery, please email us four (4) reasonably close-up images of your face taken against a plain background – one from the front, one of each side view (the profiles), and one of the nostrils taken from below. Our surgeon can then make a preliminary assessment that may save you the cost and time of a wasted appointment. Send the images in jpg format to

An obsessive quest for perfect results

Cosmetic nasal surgery is a complex procedure. Be wary of a surgeon who agrees to radical suggestions, or offers to guarantee a perfect result. Likewise, Body Dysmorphic tendencies, associated with an obsessive concern with body image or physical perfection is warning sign to an experienced Rhinoplasty surgeon. A quest for perfection suggests that the patient may have what psychiatrists term, a *Body Dysmorphic Disorder (see below). We encourage patients caught in this dilemma to consider psychological counseling rather than surgery.

*Body Dysmorphic Disorder (BDD) – BDD, says a medical research paper published in JAMA Facial Plastic Surgery (the Journal of the American Medical Association), is a psychiatric condition characterized by excessive preoccupation with non-existent or minor defects in one’s appearance, often associated with the skin, hair or the nose. This preoccupation, the paper says, may impair social interaction through withdrawal from work, family and social activities caused by anxiety, depression, and in its extreme form, suicidal tendencies.

Up o 76% of people affected by BDD seek to alleviate their symptoms by undergoing cosmetic surgery. However, studies indicate that patients with BDD need psychiatric care, not cosmetic surgery, and that cosmetic treatment rarely improves BDD. “Patients who receive cosmetic treatments are typically dissatisfied with the result,” the paper says.

“Not only does cosmetic treatment fail to help the patient with BDD, but it also puts the surgeon at undue risk. These patients “often consume the surgeon’s time with frequent telephone calls and requests for additional consultations and procedures.” In extreme instances, they may file malpractice lawsuits and even resort to physical violence.
The paper concludes that it is a condition that is both unrecognized and under reported in most cosmetic surgery practices.

[JAMA Facial Plastic Surgery March/April 2015 Volume 17, number 2]


Surgery, in our considerable experience, is not a cure for nasal allergies that obstruct breathing, or cause sinus complications. Consult, rather, a suitably qualified ear, nose and throat (ENT) specialist. Our reputation depends on ‘doing the right thing’ for our patients, and this sometimes means saying ‘No’ to surgery.

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The Art and Science of Functional and Cosmetic Nose Surgery