Rhinoplasty — the bridge and the tip are two different problems

The nose is bone and cartilage layered under skin. Rhinoplasty is therefore not an operation that pulls skin but one that changes the structure underneath.

It divides into two parts.

The bridge is usually raised with an implant. Silicone and ePTFE are common, and one's own tissue is also used. Shaping it is relatively straightforward, but the implant is an object that stays in the body, and that fact is itself the risk.

The tip is not solved with an implant. Lifting or narrowing a tip needs cartilage, and that cartilage comes from your own body — septum first, then ear, then rib. This is why the tip is harder than the bridge and settles later.

Breathing is often bound up with it. If the septum is deviated, form and function get treated together.

An implant is something you keep for life. Over time it can show through, shift, or the tissue around it can contract so that the nose looks pulled up. Infection is uncommon, but when it happens the implant usually has to come out.

This is one of the slowest operations to settle. The bridge is tidy within two or three months; the tip keeps changing for six to twelve. Feeling that it looks "thick" during that window is mostly swelling.

Rib cartilage tends to warp. Revisions often use rib because there is no septal cartilage left, and the shape can drift slightly over months.

If breathing is worse than before, do not simply wait for the swelling to go down. Say so.

Check first whether you have a breathing problem. If the septum is deviated or you have had congestion, a plan that only changes shape may leave that alone or make it worse.

A more modest tip is a safer tip. Tip skin only stretches so far; past that limit it thins and the cartilage edges begin to show.

It is better not to use up all the septal cartilage in the first operation. It leaves material for the next one.

Avoid glasses for the first few weeks. Weight on the bridge presses on a structure that is still settling.

The nose sits in the middle of the face, which makes it the hardest region to undo. An implant can be removed, but removing it does not return you to how things were. The skin and the tissue beneath it have already been stretched once.

This is an operation people often have more than once. Each time there is less cartilage to use and more difficulty using it. It is worth planning the first one with the next one in mind.

It is a hard region to set a goal for from photographs. A nose is read through its relationship to the forehead, cheekbones and chin. The same nose looks different on a different face.