It is very important that any patient contemplating rhinoplasty understands the limitations of this operation. Our understanding of this difficult operation, the most difficult of all cosmetic procedures, continues to develop but we will never know everything, just as we can never reach the horizon. The nose is very complicated structurally. Whilst specialisation means knowing many sophisticated ways to change the shape it is not possible to make an attractive, normal shape for every part of every nose. The complexity of the nose also means we don’t know exactly what the shape and position of every part of the nose under the skin should be like to create a perfect nose – the intricacies are so fine and so three dimensional. Nor can the skin on the outside change infinitely, particularly to become smaller or for that matter stretch to regain its shape as in the collapsed cocaine nose. So there are limitations on what we can achieve. Furthermore there are limitations on predicting what the final result will be. We cannot completely predict before surgery what we are going to find and therefore be able to do at surgery. We don’t know exactly what changes even the most accepted and well used techniques are going to produce in the individual patient and we don’t know how patients are going to heal. These limitations on predicting outcome amount to the fact that the risk of complications always exists. I have blogged before about complications in rhinoplasty. Unpredictability means lack of control over outcome and therefore possibilities for not achieving hoped for aims. Not achieving aims when considered strictly means having a complication or unwanted outcome. It is vitally important to understand and accept that an unwanted outcome means not just not achieving as good a result as hoped for but potentially a worse looking nose. If you cannot accept this risk you must not undergo rhinoplasty.