About 80% of AAFPRS members report that more than 10% of patients seeking these rhinoplasties are seeking revisions of previous surgeries. Rhinoplasty is considered the most challenging cosmetic procedure–its inherent complexity leading to a high revision rate, especially for extreme rhinoplasties like Barbie nose that do not age well with time.
Courtesy of Iuliia at Adobe Stock
Barbie nose is a relatively new trend in rhinoplasty, but it’s received quite the buzz on social media as of late. Plastic Surgeon Anil Shah, MD, who authored the book Nosecentric, a guide designed to educate patients and young practitioners on the art and science of rhinoplasty, has reported a recent uptick in requests for this look at his practice, particularly for young women. Despite popularity, this kind of procedure often leads to revisions due to disregard for natural anatomy. Advanced technology and a new technique involving expanding the nasal cavity while keeping the structure narrow, however, are aiding some success.
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Barbie nose is a relatively new trend in rhinoplasty, but it’s received quite the buzz on social media as of late. Plastic Surgeon Anil Shah, MD, who authored the book Nosecentric, a guide designed to educate patients and young practitioners on the art and science of rhinoplasty, has reported a recent uptick in requests for this look at his practice, particularly for young women. Despite popularity, this kind of procedure often leads to revisions due to disregard for natural anatomy. Advanced technology and a new technique involving expanding the nasal cavity while keeping the structure narrow, however, are aiding some success.
Surge in Revision Rhinoplasties Highlights Challenges of Cosmetic Perfection
The 2024 annual survey of the American Academy of Facial Plastic and Reconstructive Surgery [1] showed rhinoplasties, facelifts and blepharoplasties as the top three surgical procedures in 2024, with rhinoplasty continuing to be the most frequently requested surgery, consistent with the last five years.
About 80% of AAFPRS members, however, report that more than 10% of patients seeking these rhinoplasties are seeking revisions of previous surgeries [1]. Mark Hamilton, MD, FACS, chair, public information committee at AAFPRS says rhinoplasty is the most challenging cosmetic procedure–its inherent complexity leading to a high revision rate [2], especially for extreme rhinoplasties like Barbie nose that do not age well with time.
“These more extreme rhinoplasties create structures that often do not wear well with time,” he says. “On the table before and after glamour shots as seen on social media may be dramatic and enticing, but they do not reflect real results that can only be seen after complete healing and years of contractile forces.”
Shah has seen many revision requests for the barbie nose specifically, mainly among patients who went overseas and underwent this procedure without proper information and fully understanding what they were signing up for. These patients experience difficulty recognizing themselves after such a dramatic change and report feeling disconnected from their own appearance.
More female patients, he adds, have become more concerned about achieving this smaller look to their nose and less about how dramatically it might differ from their natural anatomy, leading to undesirable results and the need for revisions.
“Some patients come in seeking absolute perfection, which doesn’t exist,” Shah says. “Many patients bring in a filtered, angled reference image, [so] I always remind patients that inspiration photos are often unrealistic or show just one flattering angle, [and] when they see full, unedited images of those same people, they sometimes feel differently.”
One of the biggest challenges and reasons why this particular trend can lead to revisions is creating the desired “Barbie” curve while avoiding over-projection.Courtesy of Rabizo Anatolii at Adobe StockOver-Projection and Airway Narrowing: New Rhinoplasty Approach Aims to Preserve Breathing While Achieving Barbie Nose Look
One of the biggest challenges and reasons why this particular trend can lead to revisions is creating the desired “Barbie” curve while avoiding over-projection, Shah says. In an attempt to create a delicate curve, some surgeons push the nose out too far, initially pleasing in the operating room, but sometimes appearing unnatural or exaggerated in real life.
Another major concern for undergoing a Barbie nose, he adds, is breathing. As noses become smaller and narrower, the airway can become compromised, but Shah practices a technique that diverts from the traditional rhinoplasty method of narrowing the nose by cutting and pushing the nasal bones inward using a chisel.
“While this makes the nose look smaller, it often narrows the airway too, which can lead to breathing issues,” he explains.
Instead of pushing the bones inward, his technique that he writes about in the Aesthetic Surgery Journal [3] increases the size of the pyriform aperture by removing a small piece of bone from the inner part of the nose to shape a narrower, more refined bridge on the outside, while widening the airway inside.
“Imagine sculpting a hallway wall: I’m making the outside sleeker, but I’m also carving out space on the inside so the hallway feels bigger—not more cramped,” he explains.
How Advanced Tech and Custom Planning Can Reduce Revisions
To make this technique possible, as well as adjusting a desired look to fit the individual’s unique nose and avoid these mishaps, Shah depends on technology to visualize end results for him and the patient, and make corrections without the need for revision, including 3-D Imaging and ultrasonic tools.
For Barbie nose procedures specifically, Shah spends more time personalizing surgical plans to ensure it enhances a patient’s identity rather than erases it, as this kind of procedure is very distinct and dramatic. In consultations, the priority is to design a nose that harmonizes with the patient’s unique facial features and not always replicating the exact reference photo.
As technology has helped advance techniques to stay true to the patient’s unique frame, 3-D imaging provides a visual of how this style would actually look on a patient’s face and allow them to understand how certain aesthetic elements can preserve individuality.
Because traditional chisels don’t offer the level of precision modern rhinoplasty requires, Shah says that’s where ultrasonic tools come in. Ultrasonic instrumentation allows surgeons to sculpt with much greater accuracy, creating smoother contours and reducing the chance of residual irregularities and potential revisions.
Shah advises patients interested in achieving a Babrie nose to choose a surgeon whose results they consistently admire, not just a single post or photo, and one who understands facial anatomy to design a nose tailored to your unique features.
Hamilton warns that these types of extreme and trendy noses are only temporarily "in style," and once the fad has passed, the patient will be left with a nose that is no longer aesthetically pleasing.
“It is important when selecting a rhinoplasty surgeon to find someone with a special focus on this most complex of all cosmetic surgeries,” he says. “Experience is also important–it takes years for rhinoplasty surgeons to perfect their technique and become proficient.”
One of the biggest challenges and reasons why this particular trend can lead to revisions is creating the desired “Barbie” curve while avoiding over-projection.Courtesy of Rabizo Anatolii at Adobe Stock
One of the biggest challenges and reasons why this particular trend can lead to revisions is creating the desired “Barbie” curve while avoiding over-projection.Courtesy of Rabizo Anatolii at Adobe Stock
