Not every patient who requests rhinoplasty has previously made a detailed study of the procedure. Some patients do not even know that the surgeon should show enough competence to perform either a closed or an open rhinoplasty. Only with an open rhinoplasty does the surgeon need to make an incision in the skin of the nose. During open rhinoplasty, the surgeon will use a knife to make an inverted V on the base of the tissue between the nostrils.

Can that small incision take away from the "prettiness" of a nose? The answer to that question could well become the focus of at least one discussion between the surgeon and the patient. The ultimate answer would probably depend on the nature of the problem that the patient hoped to eliminate through plastic surgery.

Some patients want to have a noticeable lump removed from the nose. Some patients want the surgeon to fix a deviated septum in the patient's nostril. Some patients see cosmetic surgery as a foolproof way to decrease the width of their nose tip. In reality, any one of those procedures could truncate the triangle formed by the nose. Any one of those procedures could fail to create a pretty nose.

At that point, plastic surgery, the operation that produced a less than pretty nose, has the potential to correct for any truncation inflicted on the natural triangle of the nose. The surgeon generally performs those corrections by narrowing the nasal bones. Society has chosen to equate close bones in the nostril with possession of a pretty nose.

Patients who seek a pretty nose can find that, following surgery, they have a pretty and congested nose. During the course of the operation, blood can work its way into the nasal passageways. Yet a patient does not always have to pay for a pretty nose by dealing with bloody nasal congestion. Chances for severe nasal congestion diminish, if the patient makes an effort to keep his or her head elevated immediately after the rhinoplasty.

Yet the patient intent on getting a pretty nose should accept certain facts of nature. During the course of a rhinoplasty, the nose can undergo unpredictable changes. The surgeon's hands push and pull on cartilage, a material that's more flexible than bone or muscle.

The surgeon could, unknowingly push or pull in the wrong direction. That could leave the patient with a less than pretty nose. That could produce a nose with correctable "mistakes". A patient with an honest surgeon should hear about the possible need for further corrections. Those possible corrections represent one of the numerous risks associated with the quest for a pretty nose.