Dr. Pietro Palma
Dr. Pietro Palma MD, FACS
Medical Doctor (Italy)
  • Director, YOUnique Rhinoplasty at The Face Clinic / Clinica del Viso, Milan, Italy
  • Fellow, American College of Surgeons www.facs.org
  • Former Consultant & Clinical Professor, Dept ORL/HNS, University of Insubria, Varese, Italy
  • Director, International Milano Rhinoplasty Masterclass www.milanomasterclass.it
  • Past-President, International Federation of Facial Plastic Surgery Societies iffpss.org
  • Past-President, European Academy of Facial Plastic Surgery eafps.org
  • Past-President, Italian Society of Facial Plastic Surgery Societies http://www.aicef-chirurgiaplasticafacciale.it
  • Former Member of The Presidential Council, Treasurer of the Confederation of European Otorhinolaryngology – Head and Neck Surgery
  • Chair, International Relations Committee, European Academy of Facial Plastic Surgery www.eafps.org
  • Faculty member of the Canadian Board of Aesthetic Medicine www.cbamedicine.com
  • Corresponding Member, German Society of Otorhinolaryngology, Head and Neck Surgery https://www.hno.org/en
  • Member of the Executive Board, Italian Academy of Rhinology www.accademiarinologia.it
  • As a world recognized rhinoplasty expert, Dr. Palma has been invited to lecture and operate in courses and meetings all over the world.
  • Dr. Palma has published numerous scientific papers, mainly covering the topics of rhinoplasty.
  • He co-authored two textbooks, and authored several chapters in reference international textbooks.
  • Pietro is Co-Editor of Rhinoplasty Archive www.rhinoplastyarchive.com

Changing trends of beauty. A rhinoplasty surgeon perspective.


Pietro Palma, MD, FACS


YOUnique RhinoplastyTM at The Milan Face Clinic, Milan, Italy

Clinical Professor – Dept Otorhinolaryngology Head&Neck Surgery, University of Brescia, Italy



The evolution of surgical techniques and patient preferences in rhinoplasty have undergone a seismic change over the past Century. In the current atmosphere of constant technical progress and increasing patient awareness, the provision of patient-specific surgery based on a tailor-made and unique set of surgical techniques has gained a position of primary importance.

Before planning and executing a rhinoplasty, the astute surgeon needs to acquire a thorough understanding of the changing trends of beauty.

Mass migration and cultural exchange in the 20th and 21st Centuries have led to a fundamental change in our idea of what can be considered beautiful. Our aesthetic criteria are no longer defined by rigid “Western” dogma. Indeed, many countries around the world now consist of such a tangled mixture of races, colours, and textures, that it may seem impossible to apply a single set of aesthetic criteria in patient assessment and counselling.

Despite the influences of fashion, culture, race, and even politics, the aesthetic surgeon can utilise several fundamental rules in the aesthetic assessment of his or her patients. There is no point in measuring every single angle, and line described in morphometric texts. Instead the surgeon should concentrate on the patient’s wishes, and whether these changes can be achieved with technical expertise and long-term safety. Computer technology such as basic facial analysis, and “morphing” software form the basis of a gentle, but frank discussion with the patient and should not be used to promise a certain result with absolute certainty. The standards of facial aesthetic proportions must not form a rigid mould for patients to fit into. The experienced aesthetic surgeon will consider each patient’s desires and requirements based on an individualistic approach.

No face is absolutely perfect. Patients need to appreciate that many of the world’s most beautiful people have imperfections. Indeed, a faultless face looks odd, with an alien quality. Although the surgeon may make a note of these imperfections, the patient’s attention is not drawn directly to this list as it may be misconstrued as confrontational. At times, patients are not aware of a single problem, such as a hypoplastic chin, a receding hairline, a misaligned nose, or facial asymmetry, that may require attention, and improve the final outcome. In these cases, the surgeon may suggest additional procedures such as a chin implant to enhance the result beyond the patient’s expectations. These discussions need to be carried out with utmost sensitivity, as the facial aesthetic patient has had many years to peruse his or her own face, develop deep-seated psychological reactions to these thoughts, and develop a list of expectations that may or may not be realistic or achievable.

Our understanding of the human face in the 21st Century is increasing at an exponential rate, and while we struggle to keep up with these scientific and technological advances in surgery, the bulls eye of facial aesthetics remains unchanged: the satisfied, and happy patient. This can only be achieved if the surgeon considers the whole patient, the entire face, and develops a workable and fluid sense of what can be considered as “beautiful.”