Nasal Attraction

by : Jullene Du Toit

South African Dr Pieter Swanepoel is one of the top five nose surgeons in the world. He has pioneered the next great step forward in nose jobs in South Africa.

A kindly aunt of mine once offered me a nose job. “Unfortunately you've inherited the Du Toit beak," she said briskly. “And you know that noses only get longer the older you get. I've just come into a bit of money, so if you ever have the urge…"

I spared a wistful thought for my aunt while sitting under twin spotlights, every bump obvious on the computer screen showing my image from a digital camera.

Now, as you can see," said Dr Pieter Swanepoel, wielding a pen-shaped mouse and special pad, “your nostrils are not symmetrical, and the tip is maybe too pointy. If we just smooth this part here…"

I blinked as the tip of my nose waggled on the computer screen and Dr Swanepoel started doing a virtual resculpting, shortening it, smoothing it and lifting it up ever so lightly at the end. Rather nice, I thought, gazing at the colour print-outs at the end of the session.

The Nose Clinic in Pretoria East is tucked into a sprawling property of indigenous bush, completely private and hidden from the road. It is one of the best in the world and so highly respected that Dr Swanepoel was invited to present a paper on his method of using local anesthetic to the American Academy of Facial Plastic and Reconstructive Surgery in New York .

He has pioneered the next step forward in rhinoplasty – painless, quick-healing, and much less stressful to the body than going under general anesthetic.

It's a technique known as ‘conscious sedation' or ‘regional sensory nerve blocking'. A special computer linked to a microneedle measures and injects tiny quantities of anesthetic under the skin – a gentle, painless procedure. You have the operation in the morning, are conscious throughout, and in the afternoon someone can take your woozy self home to sleep it off. In ten days or so, all the bruising and swelling is gone and you have yourself a beautiful new nose, and chin too, if that's needed.

Dr Swanepoel is one of seven surgeons worldwide testing the procedure, and is the only one using local anesthetic for nose and reconstructive surgery.

Then of course, there's the specially designed American software that allowed him to tweak my nose into something of beauty. It's only used by one other plastic surgeon in South Africa . All the rest, I'm afraid, are still sketching noses onto photographs and drawings.

Rhinoplasty, according to the good doctor, is the surgery of minutiae of millimetres. Tiny changes make big differences. You change an imperfect nose, and suddenly the face looks different. “That's because the human eye always focuses first on imperfections. The nose is the centre focus of the face, the fulcrum, so to speak. You cannot hide it with clothes or hair. Once a defect is rectified, the attention goes to the strongest part of the face, usually the eyes. In fact the Americans have a saying: A good rhinoplasty is seen in the eyes."

That's why it fascinates him so much. Dr Swanepoel has super-specialised in this niche, from qualifying as an ear, nose and throat specialist. But within this very narrow specialisation, he does a wide variety of work. Apart from the plastic surgery, he also does reconstruction for those who have had accidents or some kind of trauma, and functional surgery for people with blocked sinuses or deformities. The three can also be combined. “It's very challenging surgery – demanding, exacting and variable."

It's also half art, half technique and technology, says Dr Swanepoel. Like many plastic surgeons, he's an artist too, and sculpts in clay, sometimes working with it to figure out how he'll operate on a particular patient.

Plastic surgery is not the cure-all though, and patient and doctor need to know the limits. Michael Jackson's first nose job was very good, “an excellent result", says Dr Swanepoel. But Jackson wanted it perfect. “I always say perfection is the enemy of good, and now he's gone well over the peak of the bell curve. As my uncle used to say, the worst disease a surgeon can suffer from is itchy fingers."

It was his uncles who inspired him to become a surgeon when Dr Swanepoel was growing up on a farm between the tiny towns of Koster and Ventersdorp. “It seemed like magic to me that they could hear people's hearts with a stethoscope, and that they could heal people. They'd sometimes throw a white cloth over my parent's kitchen table, and operate on emergency cases like appendix or even Caesarians. I would hide underneath and peep at what was going on.

“One day, I'll never forget. They caught me there, and my dad was going to take me out, but his eldest brother who was very stern, looked at me and said: “No, let him stay. Who knows, maybe one day he'll become a doctor too."

I darted discreet looks at Dr Swanepoel's less than beautiful schnozz. Would he ever have his done, I asked. “Well, I know it needs some work," he mused fingering it. “But there's no one in this country I'd lie down for. There are maybe two in the States I'd consider, but otherwise no," he said, eyes twinkling.

Did you know?

  • Nose surgery began about 3 000 years ago, in response to the lopping off of noses in battle, or in India , because of infidelity. Surgeons would graft rolled up skin from the forehead onto the gaping wound.
  • Noses have 240 anatomical variations.
  • Twenty years ago, a nose job would have cost the same as a small house.
  • Before an operation, avoid pain pills, curries, chillies and arnica. They all thin the blood and cause excessive bleeding and bruising. Arnica should only be used afterwards.