European Stars And Stripes (Newspaper) - February 21, 1989, Darmstadt, Hesse                                The benefits of a nose Job by Janee Brody new York times a t 15, Diane s. Had Large flashing eyes a Well developed body and a razor Sharp mind. Butas far As she was concerned All that anyone noticed was her enormous nose. Throughout High school in the mid-1950s, she sat in class with her hand and hair Over her face and avoided social contacts and events lest her nose be a cause for teasing and rejection. Though she desperately wanted it to be fixed she was told she had to wait for surgery until she was 17 or 18, when her nose was certain to have completed its growth. Finally after graduating from High school Diane had a nose Job and within months her Long suppressed Gregariou Ness burst Forth like an impatient Spring Blossom. Her Only regret that she had missed High school because she had to wait so Long before she Felt comfortable about joining the  now some plastic surgeons say corrections of distressing nasal deformities through plastic surgery need not be delayed until a teen Ager is fully grown. Even when the teen agers Are As Young As 13, rhinoplasty As the procedure is called seems to produce lasting results in the vast majority of patients according to a report in the journal aesthetic plastic surgery. This is not to suggest of course that a big nose necessarily detracts from one s appearance. Such celebrities As barbra Streisand Anjelica Huston Jamie Farr and Walter Matthau offer proof that sometimes a big nose can be an asset. But for Many people noses that Call attention to themselves have Long been a source of embarrassment and cause for social and emotional withdrawal. And rhinoplasty has Long been one of the most popular forms of cosmetic surgery even among adults who might be considered professionally and socially successful. The author of the new study or. Peter Bela Fodor a new York plastic surgeon believes that too Many of his colleagues have improperly accepted surgical gospel to delay rhinoplasty without fully examining the outcome of surgery done sooner. In the plastic surgery literature the accepted Wisdom is not to operate on girls before age 15 and on boys before age 16. But for properly selected teen agers Fodor and other experts say there is value in performing cosmetic surgery on the nose Early in adolescence before the body image solidifies and self consciousness about perceived defects peaks. In selecting appropriate patients doctors judge emotional adjustment and tissue development and bodily growth. The Early surgery can avoid years of reshaping the nose in nose surgery the incision is usually made in the lining to avoid an external scar. Skin is then lifted to give Access to the Bones and cartilage that determine the shape of the nose. Nasal Bone fibrous tissue cartilage dense resilient tissue cartilage to remove a bump some cartilage is shaved away. This May Widen the nose so that Bones must be broken and reset to narrow it. To soften the tip for sculpturing cartilage at the end can be trimmed. To build up a nose Bone or cartilage can be moved from elsewhere in the body. Source plastic surgery for men Reardon and Mcmahon distress and perhaps permanent emotional scars. In Fodor s study of 22 teen agers operated on before age 14 and followed for four or More years the deformity that had been corrected did not reappear As they grew and no further surgery was required. Similar results have been described by others including or. George Peck a plastic surgeon in Clifton . He says that when a child is 11 through 15, doctors can determine whether it is too Early to perform surgery by taking tissue samples to determine if the nose is close to its full growth. Two orthodontists at Oregon health sciences University in Portland studied nasal growth through the years in youngsters aged 6 to 18 and found that about 90 percent of nasal growth is attained by age 13 to 14. Still Fodor continues to warn prospective Young patients that they May need minor surgical corrections later if they undergo rhinoplasty before age 14. He noted that even in older patients As Many As one in 10 May need minor revisions later. Through the years several surgeons have reported that from a psychological perspective rhinoplasty tends to be far More successful in Young patients operated on before their noses has become an integral part of their Personas. A study in the Early 1980s by or. Alvin i. Glasgold an otolaryngologist who does plastic surgery in Highland Park ., found that the youngest group of rhinoplasty patients those 15 to 19, made the greatest improvements in self esteem social relationships and self rated physical appearance. Glasgold said his findings indicate the importance of establishing a positive physical self image during the period of emotional and social  he now operates on even younger teen agers especially girls who tend to mature physically sooner than boys. This is not to say of course that every teen Ager who hates his nose is a potential candidate for plastic surgery hypercritical attitudes about various parts of the body Are extremely common during adolescence and often these attitudes Are not shared by More objective observers. A plastic surgeon has to also be something of a psychiatrist Fodor said. A full assessment must be made not just of the teen Ager s nose but also of the youngster s social Scholastic and emotional  in other words simply disliking one s nose is not sufficient justification for surgery at least not in Early adolescence. As teen agers mature and their faces and bodies fill out and personalities develop preoccupations about various physical departures from societal ideals often fade. In assessing Young candidates for rhinoplasty responsible surgeons try to determine whether both the deformity and the Adverse effects on a child s development Are significant and whether the child is extremely determined to have the operation. Plastic surgeons also try to assess the patient s psychological state. A person with grandiose expectations about the results of surgery is generally considered a poor surgical risk. Once accepted for surgery the patient s face will be photographed from Many different angles assessing the size and shape of the nose in relation to the rest of the face. The doctor and patient then arrive at a probable surgical plan. Surgeons warn against bringing in a photograph of someone else and requesting a similar nose. A Well trained surgeon does not create a particular Type of nose on All patients but rather sculpts a nose that Best fits in with the rest of the individual s facial features. Furthermore a Good surgeon will not try to erase ethnic features but merely modify those that Are considered too extreme. In some cases the nose in t too big rather the Chin is too Small. In such cases rhinoplasty is often combined with Chin augmentation to produce a More pleasing profile. The surgery itself can be done in a Hospital or often in an outpatient surgical Center typically under local anaesthesia. In most cases the surgical correction can be made inside the nose leaving no external scar. Typically some of the nasal cartilage is shaved away and the Bones of the nose Are deliberately broken and reset to reshape them. In some cases Bone or cartilage from elsewhere in the body is used to build up a nose that is too Small. The surgery typically takes an hour to an hour and a half. Afterwards the nostrils Are usually packed with Gauze to support the nasal passages As they heal. The nose is also fitted with an external splint or cast that is removed after about a week. Swelling and Black and Blue discoloration of the tissues around the eyes and nose typically persist for weeks. It May be six to nine months before the final finished product can be fully assessed. Memory is better preserved. Youth generally has the added advantage of fewer distractions from psychological burdens such As depression from increasing physical problems from the loss of loved ones and major lifestyle changes such As retirement or moving. Besides depression which can affect motivation As Well As concentration stress disorganization and fatigue can become bigger obstacles to remembering things. Sometimes the culprit is a physical illness and it May be treatable such As an infection. Or the problem can be related to nutrition or to prescription or non prescription drugs that should be changed or curtailed. Vision and hearing problems also can interfere with the ability to record information. Marked memory problems May require a doctor s attention. Most of the nearly 30 million people Over 65 in this country need not be resigned to poor memory problems Stern stresses even if they find it takes longer to recall or to learn things. Almost anybody can improve their memory if they work at it. Frequently people just give up trying to learn or remember  Stern and Janet Fogler also a social worker at the clinic at the University of Michigan medical Center wrote improving your memory a guide for older adults and offer a number of memory techniques. Association forming mental connections with things you already know happens automatically when you learn something. Consciously creating the association and repeating it several times either aloud or in your head strengthens the memory. Visualization also can strengthen a memory in the same sense that a picture is said to be Worth a thousand words. Hold an image in your mind of what you want to remember or translate a word into a picture that evokes its sound. Another method for remembering things requires tuesday february 21, 1989 interest. Active observation Means making an Effort to involve yourself rather than passively letting an event go by without thought. Think about the meaning of the subject or event and ask yourself questions like How you feel about it who is involved what Are some of its details what do you care about remembering verbal or written instructions to yourself can be combined with other techniques like visualization. For example you might remind yourself out loud to turn off your headlights when you reach the grocery store visualize the lights shining on the store window As you arrive and then see yourself turning them off. Tension can interfere with the memory process. Stern and Fogler suggest taking a deep breath while trying to remember something like a name or title and the memory May surface As you relax. In general allowing enough time and avoiding having to Rush is helpful keeping the mind Active whether through activities Reading or crossword puzzles is recommended to stay mentally tuned up. The stars and stripes Page 17