A nose for voices

Nose jobs are so commonplace as to seem routine – to everyone but singers, that is.

But whether you sing or not, rhinoplasty, as nasal surgery is formally known, is not to be undertaken lightly. It changes the size and shape of the nose and can have functional consequences on breathing. Indeed, the overall result of even small changes to the nose on facial symmetry and proportion can be significant, with rippling effects on the appearance of the eyes, mouth, chin and profile of the face.

Internally, changes in the nasal septum (the cartilage-based structure that divides the nose in two internally) and turbinates (the hillocks located on the inner side of the nose that help warm and filter air) can improve airflow in nasal breathing and reduce or eliminate snoring.

Then why do singers avoid nasal surgery like they do air conditioning or anyone with a case of the sniffles? Perhaps they like what they have. As Barbra Streisand told Barbara Walters in a 1985 interview: “The real reason (I didn’t fix my nose) is I didn’t trust the doctors to make my nose right … I thought my nose went with my face, ya know, it’s all rather odd.”

But singers also know that the nose is the voice’s speaker system. Seven years earlier in a Playboy magazine interview, Streisand credited her deviated septum with giving her voice its unique timbre. Fixing it “would ruin my career,” she said.

Such fears, however, would seem to be unfounded. The consensus among most plastic surgeons is that vocal changes are a rare and unusual consequence of the surgery. In addition, any change is so subtle that only a person who uses his or her voice professionally would notice it. (And therein lies the problem. If the singer thinks he sounds different, he may begin to use his voice differently.)

Here knowledge is the path to dispelling fear. Think of the nose as an upside down pyramid, with paired nasal bones attached at the forehead spreading out to upper and then lower cartilage that ends at the opening of the nose. Overlying this bony framework is the inner surface or mucosa of the nose and the outer surface of soft tissue and skin. Nasal surgery begins by going through the skin under the nasal tip in an open rhinoplasty or through the inner mucosal surface in a closed rhinoplasty. Either way, the surgeon gains access to the structural framework of the nose, which can then be reduced or enhanced with implants or grafts. When healing is complete, the skin and outer surface of the nose assume the shape and contour of the changed framework and the desired result can be obtained. In the same operation, if necessary, the septum and/or the turbinates can be reshaped or reduced to improve airflow through the nose. Packing is then placed in the nose for a day or two and a nasal splint or cast placed on the nose and healing occurs over the next seven to 10 days.

Depending on the extent of the surgery being contemplated, local anesthesia with intravenous sedation or general anesthesia can be used. Swelling and bruising around the eyes are common and can last 10 to 14 days. Once the swelling has been completely resolved, which can take up to three months, the nose will assume its new, permanent shape.

As with any surgery, there are risks associated with rhinoplasty, and a frank discussion of the risks and benefits of the surgery with your surgeon is a critical step in deciding whether surgery is right for you. Be prepared to seek out more than one opinion and make sure to look for before-and-after pictures at your consultation. In addition, nasal surgery lends itself to computer imaging, which can show you how your nose might look after the proposed surgery. This is particularly important in rhinoplasty, as changing the width or tip projection can affect the overall look of your face in ways that you need to be aware of prior to surgery.

Please send any questions or comments to mrosenberg@nwhc.net.

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