The English Nose

The Problem

The common presentation is of a young woman, with a simple nasal hump in mid-profile and with a straight septum and normal tip. Many would consider these to be excessive concerns ( Fig. 66.1 ). Usually there had been systematic bullying during their adolescence at school, being hurtfully called variants of “big nose.” All that these women want is a gentle curve to their nasal profile, instead of the hump, and they are not seeking major change otherwise. There may be a profound psychological impact that can cause introversion and failure to attain or make friends. They may appear strong minded externally but are also constantly unhappy with their appearance when alone.

The desire for an “English Nose” is peculiar to girls with nasal humps that have developed during adolescence. There is likely to be a familial history. Patients present just prior, or just after university, between the ages of 18 and 23, when they may be just independent and financially competent, or still have parental financial support. Generally, parents can understand their daughter’s concerns. As these young women age, the psychological impact may become more complex to include other features on the nose, possibly requiring more invasive surgery, therefore there is an advantage to operate on the nasal hump in the early 20 s.

The classical comment at consultation is that they hate being photographed from the side and as car drivers, they particularly hate the lateral exposure created when stopping at traffic lights, because they feel people are staring at them. They use their hands to cover the side of their faces and clearly this is a disproportionate response, but it is a measure of the psychological impact that a nasal hump has on some patients in British society. It is unlikely to be corrected by counselling alone, and surgical improvement can be adequately performed with a closed approach, without the need for open rhinoplasty.

The Background—Defining the “English Nose”

The world has become even more ethnically diverse over the past two centuries with many ethnic groups now occupying the same piece of land. The obvious result is an interracial mix that has diversified human appearance considerably, to the point that there is no descriptively beautiful nose that can fit all cultures in each country, even though some nonclinicians feel differently. The “English nose” is a take-back to the classically beautiful Anglo-Saxon female with a small nose, petite tip with a narrow base width, a gentle slope to the profile and with a slight tip elevation ( Fig. 66.2 ). Culturally this is of little importance, other than to suggest that this is a biased view of an attractive nose in Western society and to many of those inhabiting these shores. Attempting to create this appearance with some ethnically diverse noses, especially in patients with sebaceous skin, is nigh on impossible.