The nose is a complex area and unless you understand it firstly and secondly able to examine it, the area is fraught with problems. And with respect the only people able to examine a nose comprehensively are the Ear Nose and Throat group.One needs experience of what reality is, not fantasy, and the ability to examine which requires not only headlight, but also either microscope or Endoscope. Unless these elementary tools are used and available, the opinion you'll get is inadequate. Also the ability from external viewing to assess the nasal situation.
Cosmetic surgery of the nose can be difficult and controversial and results cannot always be guaranteed. There's a lovely saying about cosmetic nasal surgery, which is simply this, "they say it's easy surgery to do, but hard to produce a good result." That can be true.
Patients must understand the vagaries of nasal structure, how they interrelate and our predictions can be difficult.
One needs to be aware of a surgeon saying, "What kind of nose do you want." You can't make a grade 10 nose into grade 1 nose. The best is make a 10 into a 7. It's a complex area and everything interrelates.
An improved nasal appearance could leave you with a less functional nose. That noses tend to change shape as we age, and so a good result initially might change over the years. Those of us involved in nasal surgery can really tell whether a person has had cosmesis when they walk into the rooms. There's almost always a tell tale sign situation. And the bottom line is if you're going to make an error of judgement, take away too little tissue than too much.
Functional surgery for a fractured nose is in some ways more pragmatic in that it's not cosmesis but function, which is the bottom line. The two are almost always hopefully combined.
Surgery for either cosmetic or functional reasons, can either be endonasal where there's no external incision, or "open" when an incision is made across the septum of the nose externally. The columella. The latter gives excellent vision, but needs to be selectively advocated, not used as a routine as there's more small print attached to it.
With a fractured nose it's usually a combination of not only the nasal bones which are displaced, but also the nasal septum which has been deviated. So you get a combination of poor function and an inappropriate looking nose. Surgery tries to correct both these problems. Patients must also recall that when they come with the nose fractured many years ago, that one can do a reconstruction and that all looks absolutely fine on the table, but that the nose drifts afterward. That is due to the old scar tissue and the well-known aphorism namely, "that the told fracture has a memory." The patient must be made aware of this prior to surgery.
Although pictures of the nose are usually taken, one needs recall how pictures can lie. In fact there's a lovely case which one should talk about, namely when one cosmetic surgeon is showing excellent results on his noses and is asked how he's produced this... he smiles and says, "I just change the camera angle." So beware of photographs being the be all and end all.
Nasal surgery in general is relatively painless but of course there's swelling afterwards and this takes time to settle. One can only assess the results of the surgery after, at the earliest, probably 6 month's.
Functional and cosmetic surgery will on occasion need additional input from sinus surgery especially when airway is involved.
So essentially if you're going to go for nasal surgery, you need go to someone who understands and can examine the nose comprehensively and who has experience of the reality of what nasal surgery can and can't achieve together with being fully informed about all the pros and consultation.
Recall that lovely maxim by one of the giants of nasal surgery. A surgeon called Auficht.
"It's an easy operation to do, but hard to produce a good result."