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Friday, July 10, 2020

Jewish patients taking new look at rhinoplasty

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Whether to assimilate or meet a specific standard of American beauty, generations of Jewish teens and young adults have turned to rhinoplasty and other cosmetic surgeries in hopes of improving their career, romantic prospects or social acceptance.

More recently, however, as Jewish patients redefine their notions of beauty, Los Angeles area Jewish plastic surgeons are changing the way they communicate with their patients about what cosmetic surgery — if any — should be done.

These doctors report they also are getting a new wave of Jewish baby boomer clients who have had second thoughts about rhinoplasties done earlier in their lives. Whether they acquired the “button” nose (a standard nose job “style” from the mid-20th century) or something a bit more natural done recently, they want to rediscover their identity by having their original nose reconstructed.

“It’s the Jennifer Grey effect,” Dr. Alexander Z. Rivkin explained, referring to the Jewish actress whose rhinoplasty affected her appearance dramatically. “[My patients] felt like they had lost their uniqueness, a part of their body that connected them to their family and heritage.”

“Mark,” a New York native and California transplant, experienced this effect. After finding success during the 1980s San Francisco tech boom, he decided to have a nose job, thinking it would enhance his status and acceptance in the comparatively less-Jewish milieu of the Bay Area.

“I used to have a Bob Dylan nose, not large but clearly Semitic,” he said. “After the nose job, my cousin told me I looked like an Episcopalian.”

health1Even after a successful procedure, Mark realized he no longer looked like himself. When a music industry job brought him to Los Angeles a few years later, he embraced the city’s larger Jewish community but felt guilty about his nose job. Fully comfortable in his Jewish skin, he found he wanted his old nose back.

The procedure, revision rhinoplasty, can cost from about $14,000 to $24,000, depending on the surgeon, location and specific techniques required. According to Mark’s Beverly Hills-based doctor, Behrooz Torkian, the rebuilding of ethnic features involves using grafts from cartilage elsewhere in the body, such as an ear or a piece of rib, to re-establish features of the nose that were removed. Reversal procedures, he said, are performed more often for Ashkenazi Jews who received “cookie cutter” noses that did not fit their faces in the days before computer imaging.

“Mark’s story resonated with me because I think the worst thing that can be done to a face is to change it in such a way that does not respect its original anatomy or the ethnic features of the face,” Torkian said.

Rivkin, a Westside surgeon and assistant clinical professor at the David Geffen School of Medicine at UCLA, started offering a less invasive and expensive alternative to revision rhinoplasty 13 years ago in response to Jewish patients who said they felt as if they had lost a critical part of themselves when they had their ethnic bump shaved down.

The procedure, which involves injected cosmetic fillers, ranges from $2,000 for a temporary procedure lasting up to 18 months to $4,000 for a “permanent” procedure, lasting 10 years or more.

health2Dr. Nima Shemirani, a Beverly Hills facial plastic surgeon, said although younger Jewish patients explore rhinoplasty and other procedures to fit Hollywood ideals of beauty, future generations will be more accepting of their natural ethnic features. He recommends beginning the “Why rhinoplasty?” conversation earlier in life with a board-certified practitioner, especially because revision rhinoplasty is always more complex than primary rhinoplasty, with double the healing time — especially for Middle Eastern and Sephardic Jews.

“A rhinoplasty can be more drastic for these patients and take away ethnic features which may be desirable as they get older,” Shemirani said. “Ashkenazi Jews have more Caucasian features and, therefore, a rhinoplasty can simply help enhance their looks without losing their ethnicity. Even so, we like to catch patients before they make the mistake of getting a nose that doesn’t match their face.”

Torkian pointed out that the standardized “button,” “cookie cutter” or “pixie” nose associated with baby boomer patients does not match up with many other Jewish features and, therefore, telegraphs that a procedure has been done.

However, with advances in preoperative imaging and surgical techniques, today’s primary and revision procedures reflect a more ethnically sensitive approach to the face as a whole. While these advances give the advantage to patients undergoing surgery for the first time, they also have sparked a
trend among patients who previously had not had the opportunity to avoid the “cookie cutter” nose.

“We live in a world in which cultural tolerance and religious sensitivity are greater than they have been in the past,” Torkian said. “I think the desire to keep some cultural or ethnic features is multifaceted and complex, but it appears that people generally are embracing their heritage, are proud of it, and want to ensure not to completely wipe it off of their faces.”

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