Rhinoplasty

Where the surgeon works from. In a closed rhinoplasty every incision is inside the nostrils. In an open one there is an additional short incision across the columella, the strip of skin between the nostrils, which lifts the skin and shows the framework directly. Neither is the better operation in the abstract — the choice follows what has to be rebuilt, and a nose that needs cartilage grafted or straightened is a different problem from one that needs a hump reduced.

In a closed rhinoplasty the incisions are inside the nose and nothing is visible from outside. In an open one there is a line across the columella, in the skin between the nostrils; it is a few millimetres long and it sits in a fold. How any incision settles is partly your skin and partly how you heal, which is one of the things a surgeon asks about before choosing the approach — no page can tell you how your own scars behave.

They are assessed together rather than as two subjects. A deviated septum, collapsed valves or one side that has been blocked for years are structural problems in the same nose the shape belongs to, and separating them means operating twice on one framework. Say at the consultation which side is worse and whether it has always been that way.

The starting point. A revision is surgery on a nose that has already been operated on, where scar tissue has replaced some of the original planes and the cartilage that would normally provide support may already have been taken. It is planned differently and often needs cartilage brought from elsewhere. If you have had any nose surgery before, however minor and however long ago, it belongs in the conversation.

Where the bony part of the nose is being narrowed or a hump taken down, the surgeon makes controlled cuts in the nasal bones — osteotomies — so that they can be moved into a new position. It is not a break in the sense an accident produces one: the lines are planned and the bones are set where they are meant to sit. Not every rhinoplasty involves it; an operation confined to the tip is working on cartilage.

Bring them. They are the clearest way to say what you are after and far more use than an adjective. What they cannot do is set the plan: a nose is drawn against the forehead, the chin and the cheekbones it sits between, so the same photograph gives a different answer on a different face. Expect the conversation to move from the picture to what your own skin thickness and cartilage will carry.

In an accredited Istanbul hospital rather than an office, under general anaesthetic, with an anaesthesia team of its own in the room. The surgeon named to you beforehand is the one who operates. An interpreter is there for everything said to you, and the hospital is written into your plan before you book a flight.

Photographs of yourself from the front and the side in ordinary light, any earlier nose surgery or injury with roughly when it happened, and any imaging you have had. Add the medicines and supplements you take, including anything for allergies or a blocked nose, and a note of how you bruise and scar. If one side has been harder to breathe through, say which one.