In today’s highly visual and youth-focussed culture, physical appearance has become important, both on a personal and a professional level. In the radio days of singing, how a performer looked was relatively unimportant. Today, with video telecasts, DVDs, and YouTube, appearance is (sadly) almost as important as the voice and professional longevity requires singers to look, as well as to sound, good for the duration of their career.
Not infrequently, my patients ask me about rhinoplasty. The topic typically comes up during an office visit for other nasal problems and varies from “I’ve always hated my nose” to “While you’re there, could you . . . .” Since among the various facial cosmetic procedures rhinoplasty is potentially the most vocally significant, this column will give my perspective on what a rhinoplasty is, what it should be and, most importantly, what it shouldn’t be.
A “plasty” usually refers to a procedure that alters the shape, and often the appearance, of a structure, such as a breast reduction—mammoplasty. It conjures up the image of plastic surgery, but it is not done only by plastic surgeons and is not always visible. For example, a common nasal procedure, septoplasty, straightens the cartilage that divides the inside of the nose into two airways, and the result—while quite dramatic at times—is not normally seen.
The purpose of a rhinoplasty is to make the nose appear symmetrical and aesthetically pleasing. The first part is easy enough—a nose that has been broken or is bent to one side is obviously “not right,” and repositioning the nose in the middle, even without any additional changes, makes sense. The second part, however, is a bit more tricky. What is a beautiful nose? A tall, narrow, aquiline nose may be perfect in some cases—whereas a more petite and upturned nose may be more appropriate for others. There is no single ideal nose.
The shape and size of your nose is inherited and, apart from those familial differences, there also exists a great range of ethnic variation. As a stereotype extreme, the Jewish nose can be tall and large (other groups also have this—old textbooks on rhinoplasty often referred to the “Armenoid” nose), whereas African Americans may have noses that are flatter on top and broader at the tip. Erasing ethnic or racial features has become the norm in some societies. In Korea, cosmetic surgery is almost routine, and young girls graduating high school routinely undergo cosmetic procedures to correct nonexistent defects, simply to make themselves more Caucasian looking and more competitive for work or marriage.
Importantly, the nose must be seen in the context of the face. Is your face large or small, round, ovoid, or elongated? The perfect nose should be not only symmetrical but also proportionate: “the right nose for your face.” But even this general statement is debatable, since a man with a rugged face and strong features may consider an asymmetric and larger nose to be perfect! So, if you are considering this procedure, make sure the nose you wish for is in harmony with your face. A nose should never look “done.” As with singing, the art is to hide art—to make artifice (in this case, surgical change) look natural.
When going for a consultation for rhinoplasty, you may be given the opportunity to see what the expected results look like. There is computer software that allows the surgeon to virtually create a new nose for you on the screen, incorporating the various features that you find attractive and that he suggests are appropriate. Removing a hump, narrowing the top, projecting the tip, changing the angle between your columella (the little dividing strut between your nostrils) and the upper lip—all done with the click of a mouse.
While computer imaging helps you to visualize the results, keep in mind that this is just an image, a wish list. How nearly this can be achieved varies, depending on the surgeon, your nasal anatomy, and the quality of your tissues. A nasal tip that is thicker skinned and more fleshy, for example, is more difficult to refine than one that is covered by thin skin, with its shape more defined by the underlying nasal cartilages. An experienced surgeon will usually tell you what is possible to achieve, given your specific nasal structures, and not try to make you “look like . . . .”
But, when it comes to facial cosmetic surgery, the nose is different from wrinkles, sagging jowl and eyelids, and other impediments. It is a structure with specific functions—and one that plays a significant role in singing. Your nose has to work for you as a singer. I remember many years ago, when Met mezzo-soprano Bianca Berini had her nose made smaller, I asked her whether it changed her singing. She laughed and said, “Now I can finally fully open my mouth without my upper lip getting caught under my nose!” (Of course, a big nose is not always a hindrance, as witnessed by this picture [see previous page] of yours truly with tenor Roberto Alagna, sporting a rather elongated proboscis, singing Cyrano at the Met last season.)
First and foremost, a good nose means you are able to breathe! Nasal breathing is physiologic breathing and has many positive effects, including increased lung compliance. I have seen many rhinoplasties where the appearance may have been more pleasing but the patient was unable to breathe! There are numerous reasons for this, including an uncorrected septal deviation, a nose that has been made too small, or excessive intranasal scarring. Solution? Don’t reduce the nose excessively, be sure your septum is corrected also (an area where an ENT surgeon may be more experienced), and be congnizant of any tendency you have toward scar formation. Less is more: the less extensive the surgery and the fewer incisions that are made, the less likely you are to experience postoperative scarring.
Secondly, your nose is an important souce of vocal resonance. For the voice to come forward in head voice and for you to be able to easily place the voice into the mask requires open nasal cavities, regardless of the outside appearance. For this reason, you should have as much room in both nasal cavities as possible, and this should not be sacrificed for the sake of “beauty.” As I told one of my patients, an architect, the ideal nose is one that has a Gothic exterior and a Romanesque interior. A silly analogy, but it does make the point that a nose is not an ornament but needs to work for you, especially as a singer.
Let me make a couple of final points. If you are conisdering a rhinoplasty, or any other cosmetic procedure, honestly ask yourself, “Why?” This question can be asked with or without the help of your analyst. If there is a specific correctible defect that bothers you, by all means go ahead. If a minor procedure can make you look more youthful and professionally competitive, by all means go ahead.
But if you are trying to look like someone you emulate (or not look like someone you dislike), if you are unreasonably trying to turn back the clock, or if you are trying to win back your ex, these are all bad reasons. The extreme in this regard, called body dysmorphism, is seen in patients who are never happy with their bodies, blame all their unhappiness on their appearance, and eventually wind up unrecognizably remolded, injected, reduced, augmented, and otherwise mutilated—their neuroses aided and abetted by medical professionals with questionable judgment and motives.
And last but certainly not least, as always, get more than one opinion. Ask fellow singers and gather recommendations before having surgery.
Disclaimer: The suggestions Dr. Jahn provides in these columns are for general information only and are not to be construed as specific medical advice or advocating specific treatment, which should be obtained only following a visit and consultation with your own physician.
