What Makes Rhinoplasty Challenging? Some Answers from 45+ Years of Clinical Experience.

Rhinoplasty is considered one of the most perplexing procedures to master in the field of plastic surgery. Given the varied and complex anatomy of the nose, along with the dynamic interplays between maneuvers, rhinoplasty demands precision, intuition, and adaptability from the surgeon to achieve favorable outcomes. Evolving patient expectations, spurred by technological advances in information-sharing and imaging, warrant additional caution from the surgeon. The incidence of psychological disorders, like body dysmorphic disorder, also requires surgeons to consciously screen patients to determine ideal candidates for rhinoplasty. The current landscape of rhinoplasty training is observational, and plastic surgeons are ceding cases to other specialties, a worrisome trend for the future. This Special Topic paper draws on over 45 years of experience to present an analysis of the many "puzzle pieces" that make rhinoplasty such a difficult yet rewarding medical procedure. The article also projects the future of rhinoplasty and what can be done to ensure that the new generation of plastic surgeons are adequately trained and hold ground in this core procedure.