With 30 years of experience in reconstructive and aesthetic surgery, Professor Alfredo Borriello focuses on the delicate procedure that changes the perception of beauty
Rhinoplasty is a delicate procedure that changes not only the face, but the perception of beauty that people have of themselves. So says Professor Alfredo Borriello, director of the plastic surgery unit at the Ospedale del Mare in Naples and one of Italy's leading experts in this procedure. His training took place mainly abroad — in Brazil at the prestigious school in Rio de Janeiro under Professor Ivo Pitanguy, in Mexico City with Professor Ortiz Monasterio, and in New York at the Manhattan Eye, Ear and Throat Hospital.
Beyond cases where rhinoplasty is medically necessary — breathing problems, trauma and the like — the nose is one of the most challenging areas to work on. "It means changing not just the appearance of the nose, but also the gaze and the overall dynamics of the face," explains Professor Borriello. "Performing the surgery well means bringing about an important transformation in the patient." It is a choice with significant psychological impact: there is often considerable distress, especially in young patients, but also in adults — for whom it is often a long-held dream finally coming true.
Motivations vary: wanting to feel good about oneself, correcting a nose that has changed over the years, or simply a distorted self-perception amplified by social media. Approaches have also changed over time: "Before, people operated for functional reasons, with reshaping as an add-on. Now the reshaping itself is the primary goal, as if it were a psychological rebirth. Many people are moved at the first follow-up, seeing themselves in a new way."
Today's trend favours results that respect each person's physiognomy, addressing what the patient identifies as defects. "In short," explains Professor Borriello, "the procedure is personalised so that each person can recognise themselves in the result." Perfect noses don't exist: today we eliminate defects without distorting the face, with a more natural approach than in the past.
The expert's role is first and foremost to interpret the patient's requests and translate them into a result suited to their face. "People might see a nose on social media and want the same one, but my job is to bring their expectations back to a realistic and believable outcome for each individual face." Morphing technology helps achieve this precisely, restoring the exact anthropometric characteristics of the face so patients can evaluate the procedure through a realistic simulation.
Surgical techniques have also improved significantly. "Patients now return home almost immediately, whether under local or general anaesthesia. There is no post-operative pain, and tampons, when used, are removed painlessly." Current techniques are less invasive and more structural: the open technique allows cartilage to be shaped and corrected rather than removed, with frequent use of supportive cartilage grafts. "Function and morphology must be considered together," the professor stresses.
In terms of innovations, preservation techniques — even more conservative of the person's natural appearance — are gaining ground, as is the use of piezoelectric ultrasound to remodel bone. It is important to distinguish between rhinoplasty and rhinofiller: "A filler cannot replace a rhinoplasty and is often performed improperly, with the risk of worsening the situation. Rhinofiller should not be trivialised, even if it obviously has its place when there is a medical indication."
Professor Borriello also performs reconstructive nasal surgery in his hospital work. "This includes secondary or tertiary surgery — performed for the second or third time on previously operated patients with severe morphological and functional deformities — which requires the use of cartilage grafts taken from the ear or the rib."
This type of reconstruction also addresses the sequelae of malignant cutaneous tumours, which most frequently affect the tip and dorsum of the nose. "The nose is greatly affected by skin tumours, as is the ear, and in these cases our task is to reconstruct." Radical excision of tumour-affected skin necessitates using facial skin through local flaps and cartilage from other sites to restore the correct shape.
Perfect noses don't exist: the procedure is personalised so that each person can recognise themselves in the result.
Professor Borriello has been organising internationally renowned conferences for over fifteen years. The new Italian-Brazilian International Plastic Surgery Course (IBAM) is in preparation, bringing together Italian and Brazilian plastic surgeons to address topics including the nose, face and breast. He also serves as speaker and moderator at many national and international conferences, primarily on the subject of rhinoplasty.
This content is intended for informational and educational purposes only. It does not in any way replace professional medical advice, diagnosis, or treatment. For any medical questions or concerns, it is essential to consult your physician or a qualified specialist.
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