A few days ago, I had the great pleasure of visiting the recording studios of Estetic.es (Grupo ConSalud) to participate in their flagship podcast, ‘The Skin Footprint’ (La Huella de la Piel).
In a deep, rigorous, and very pleasant chat with the fantastic journalist María Velasco, we had the opportunity to discuss aesthetic surgery from a place of honesty and science.
For nearly half an hour, we broke down everything a patient should know before entering an operating room, moving away from social media filters and focusing on medical reality.
For all of those who couldn’t listen to the interview, I want to share with you the fundamental pillars we discussed:
The secrets of a harmonious nose: Key themes of the interview
1. Invisibility as our greatest success
María and I agreed on a vital point: the best rhinoplasty is the one the human eye cannot detect. My goal in the operating room is never to create a “catalog nose”, but to restore harmony to the face.
If after surgery your acquaintances tell you that you have more light in your eyes or that you look more rested, but they cannot identify what has changed, we have done a good job.
2. Ultrasonic Rhinoplasty: The end of pain and nasal packing
One of the biggest fears for patients is the postoperative period. I explained to María how ultrasonic technology has changed the rules of the game: by using vibrations to sculpt the bone, we do not damage soft tissues.
To better understand this technical advance we talked about in the podcast, I always share this comparison with my patients:
| Feature | Traditional Rhinoplasty | Ultrasonic Rhinoplasty |
|---|---|---|
| Tool | Manual chisel and hammer | Piezoelectric device (ultrasound) |
| Precision | Less control over the bone | Millimetric cut by vibration |
| Soft tissue damage | Possible trauma to vessels and skin | Respects muscles, nerves, and cartilage |
| Postoperative (Breathing) | Uncomfortable nasal packing | Silicone tubes (immediate breathing) |
| Pain and swelling | Greater swelling and bruising | Painless, reduced swelling and bruising |
3. Custom techniques: Preservation vs. Structural
We talked about how we adapt the technique to each anatomy. There is no single approach; depending on the case, we opt for a preservation rhinoplasty (where we preserve the patient’s original anatomy as much as possible) or a structural technique (open or closed) to provide the necessary support when the base structure is weak, or a hybrid one, combining the concepts of preservation and structural techniques.
4. The forgotten factor: Skin and "Vitamin P"
The skin is the “suit” that covers the nose. Very thick skin, common in ethnic rhinoplasties, is a major surgical challenge. It requires very specific support techniques and demands a lot of “Vitamin P”: Patience from the patient.
The definitive result of a rhinoplasty, especially in thick skin, can take between a year and a half to two years to fully settle.
5. The danger of non-surgical rhinoplasty with hyaluronic acid
María brought up non-surgical alternatives. Hyaluronic acid can camouflage a hump, but it adds volume (makes the nose bigger) and does not solve breathing problems.
Furthermore, its repeated use generates internal fibrosis, forcing us to dissolve the product with hyaluronidase before we can operate safely.
6. Today's patient and the ethics of knowing how to say "NO"
Faced with increasingly younger patients and the rise in male demand, I highlighted the enormous responsibility we surgeons have to manage expectations.
The ethics of knowing how to say “no” is fundamental when the request puts respiratory function at risk or is not harmonious with the patient.
Listen to the full episode and discover more
I want to thank María Velasco and the entire Estetic.es team once again for the fantastic treatment and for giving a voice to quality medical outreach.
If you are thinking about taking the step, remember that the best rhinoplasty is the one done only once in a lifetime. Always consult a specialist.