The Effect of Rhinoplasty on One’s Identity: The Importance of the Facial Identity Zone in One’s Beauty

When we want to hide a person’s identity in a photograph, we cover the eyes. That means our eyes and the structures surrounding them constitute our identity. In other words, the naso-orbital complex determines the identity of a person.^1,2 Let’s call this area of the face the “facial identity zone.” The center part of the facial identity zone is composed of the nasion and the upper half of the nose.

Cosmetic procedures that are done to improve one’s face, like rhinoplasty, blepharoplasty, facelift, and so on, should not result in changing one’s identity. If a cosmetic procedure results in changing a patient’s identity, the main element of this change is due to what has been done to the structures around or between the eyes (ie, the facial identity zone). In plastic surgery literature, evaluation of rhinoplasty results are primarily focused on comparing the before and after photographs of the nose with no attention to the eyes. I am suggesting that for a more complete comparison, we also should compare the status of the eyes as well. That means comparing the facial identity zones before and after rhinoplasty.

In the 1980s, there was an actress who became famous for her role in a popular movie. She had a nose that could have been improved by rhinoplasty without changing her facial identity, but unfortunately, the rhinoplasty that she got changed the look of her eyes, hence her identity. For her fans, the change in her looks disconnected her from her past. As a result, she could not get any roles in the movie industry for a long time. In other words, her rhinoplasty procedure ended her blooming movie career.

We now know that in gender-affirmation surgery, changing the naso-orbial complex (facial identity zone) plays a major role in creating a new identity for the patient.^1–3 We, as plastic surgeons, should be acutely aware of our patient’s identity and characteristics of their facial identity zone.

For the past 25 years, it has been my observation that in a successful rhinoplasty procedure, the eyes are also enhanced, and a bad rhinoplasty has a negative effect on the look of the eyes. There are numerous factors related to a rhinoplasty that could negatively affect the eyes and change one’s identity.⁴ These factors include but are not limited to:

• A.Damage to the medial canthal ligaments during osteotomy;
• B.Creation of an open roof deformity;
• C.Aggressive removal of dorsal hump;
• D.Creation of unevenness of nasal bones.

When patients see a negative change in their face as a result of a bad rhinoplasty, their emotional element also contributes to how they look (ie, sad, unhappy, etc).

Another example of change of identity due to a change in the facial identity zone is related to the eyelids, and the most common mistake is aggressive fat removal from the eyelids that we have seen in a few famous celebrities.

In conclusion, I believe that we as plastic surgeons should be aware of the anatomic role of the naso-orbital structures in one’s identity and beauty⁵ in evaluating rhinoplasty procedures, and utmost attention should be paid to the patient’s eyes as well as the nose. A good rhinoplasty always enhances the eyes, whereas a bad rhinoplasty could change one’s eye expression and even the patient’s identity, like what happened to that actress.

DISCLOSURE

The author has no financial interest to declare in relation to the content of this article.