Twice the Challenge: Conserving Identity during Twin Rhinoplasty

The challenge of a rhinoplasty is difficult enough. The nose lies in the central triangle of the face and is scrutinized heavily by both patient and surgeon alike. Aesthetic changes that a patient may desire must be balanced with maintaining function and providing a lasting result. For these reasons, rhinoplasty has continued to be one of the most challenging procedures that facial plastic surgeons encounter.

To add another element of challenge is the rare rhinoplasty request by a pair of identical twins. Over and above the intricacies of a rhinoplasty, now the surgeon is presented with unique questions surrounding the nature of identical twins. In a series of 12 twins who underwent rhinoplasty, Al-Sebeih and AbouSheleib explore the topic in their article “Identical Twin Rhinoplasty: Challenges and Pyschological Aspects”.

Al-Sebeih and AbouSheleib discuss the evaluation of twins as a “twin unit.” The authors poignantly mention that alterations of the physical form take on additional meaning when dealing with “two parts of one whole set.” Often times the twins are encountered as a unit but surgically must be treated as individuals. Nevertheless, it is usually the case that identical twins wish to remain identical, as this similarity has always been a part of their shared identity [1].

This brings up a few interesting questions pertaining to the perception of identical twins: did the twins feel more, less or similarly identical after rhinoplasty? Did their perception of change correlate to an outsider’s perception? In the age of facial recognition software, is there a computerized method to quantify this? There are indeed, however they are not nearly as adept as the human eye at discerning subtleties of facial relationships. It would be interesting to quantify before and after identical twin rhinoplasty; to what extend is a sense of identicalness conserved?

If a facial plastic surgeon does encounter a pair of identical twins who wish to undergo rhinoplasty, it is imperative that the surgeon critically discusses aesthetic changes with an eye towards their shared identity. In addition to the considerations of rhinoplasty, if the surgeon recognizes the importance of maintaining a pair of twin’s identicalness he or she can address these unique and challenging cases [2].