Today, all four have new noses - symmetrical, straightened, smoothed-out, or cartilage-enhanced, reshaped at the tip or narrowed at the bridge. Together, they represent the current face of rhinoplasty, a procedure no longer limited to a stereotypical clientele of Long Island girls who get nose jobs for their Sweet Sixteens.
"There's no longer just one ideal appearance for the nose," said Julius Few, a plastic surgeon in Chicago whose practice includes Latino, African American, and Asian patients. "There are many definitions of beauty now."
According to the American Society of Plastic Surgeons, 252,000 people had rhinoplasties in 2010. Of those, 25 percent were men and 57 percent were over age 29. And as patient demographics shift - ethnic minorities accounted for 29 percent of all cosmetic procedures in 2010, up from 14 percent in 2000 - some surgeons have developed a specialty in "ethnic rhinoplasty," preserving the signature look of a patient's heritage while reshaping his or her nose.
"Everyone comes in and wants to look like themselves," said Robert Glasgold, a facial plastic surgeon in Highland Park, N.J. "They don't want to look like they had their nose done."
That was true for Bruce, a Philadelphia physician who asked that his last name not be given because of privacy concerns. A football injury in high school left his nose with "a little twist," and an earlier rhinoplasty was not successful, he said. "Everybody else said they didn't notice it. But I knew," especially when he grew a mustache that emphasized the asymmetry at the tip of his nose.
Three years ago, at 57, he underwent a second rhinoplasty. When he first looked at the results, one week after surgery, "it was swollen, but it looked good. It looked great. A lot of nose jobs look like nose jobs. With mine, nobody would ever be able to tell."
Eric Dimant had lived with a crooked nose ever since he tumbled on the playground as a toddler. Friends and family told him he looked fine. But the Israeli-born Dimant felt differently. An impulsive nose job, done in Israel when he was 22, was "horrible. [The surgeon] took out too much cartilage, so there was a collapse. My breathing became worse."
When Dimant lost weight after contracting a parasite in South America, his nose seemed even more noticeable on his thinned-out face. Sometimes he stuffed toilet paper into his nostrils to make his nose look less squashed.
"Suddenly I became less confident. I felt like I had to [fix] it." Back in New York and working as a nightclub manager, he sought out Samieh "Sam" Rizk, whose facial-cosmetic-surgery clientele is 40 percent male. Dimant, 26, had a rhinoplasty in October. When he first glimpsed his altered nose, two words came to mind: "Wow. Magic."
"It's still swollen, and the nostrils aren't that straight yet, but I think it's 95 percent of what I asked for. The crookedness is gone completely. In my field, appearance is very important. I deal with a lot of models and celebrities. It still needs some time until I really feel confident. But I'm definitely getting there."
Surgeons who specialize in rhinoplasty say that not only demographics or standards of facial beauty have changed; surgical techniques for the procedure, which averages $4,300, have also evolved.
Nose jobs used to involve a lot of "scooping" and "pinching," says Rizk, who performs about 600 rhinoplasties a year. Now, the emphasis is on creating "a strong bridge and a tip that's more rounded but not pinched" by using cartilage grafts from other areas of the nose. That sturdier "scaffolding" prevents the nose from looking collapsed later on, and also preserves breathing passages.
Rizk uses a power-sanding tool rather than a surgical knife to sculpt cartilage grafts; with a high-definition instrument, he can get an accurate view of the bridge of the nose during surgery, to prevent him from filing down the bone too severely.
While Glasgold cautions that a rhinoplasty "just changes your nose; it's not going to change your world," he and other surgeons acknowledge that patients' self-esteem can be fed, or undermined, by the appearance of the face's most prominent feature. Rizk says that may be especially true for teens, who find themselves increasingly on display through Facebook, Skype communication, and easily transmitted cellphone pictures.
Rizk recently did a rhinoplasty on a 13-year-old girl who had been bullied on Facebook about her nose. He said about half of his teenage patients mention bullying or teasing as reasons for wanting their noses fixed.
Casey Wiener used to sit in class, fingertips wandering to the familiar bump on the bridge of her nose. "If I was sitting next to a guy, I'd think: Is he looking at my nose? Does he notice the bump in it?" By freshman year in high school, the Manalapan, N.J., teen started talking to her parents about rhinoplasty; she had surgery the summer before her sophomore year.
During the consult, Glasgold used photo-imaging to take front, side, and top views of Wiener's nose, then altered them to give her a sense of how she might look after surgery. Afterward, Wiener remembers feeling sore and swollen. "I couldn't really smile or move my face."
But three weeks later, she was back at field hockey practice. Now she credits her rhinoplasty for boosting her confidence. "I'm definitely more outgoing with new people than I used to be. I smile every time I look at my nose. I just got back my senior pictures, and I look so much better. I'm so happy I got it done."
For Nadia Hoffman, 39, a psychotherapist in New York, rhinoplasty meant grappling with feelings about her Jamaican heritage. She had always liked her Caribbean features - her eyes, her lips, the shape of her face - but thought her nose was out of proportion. Still, she grew up believing that people of color did not get cosmetic surgery.
"I felt like I was betraying my mom, betraying my culture. But all my life I would stare at my nose in the mirror." She would use her hands to envision an altered nose, with one palm covering the bridge and the other narrowing her nostrils. She volunteered to be the photographer at family gatherings so she would not have to appear in the pictures.
Few patients' motivations have changed over the last generation, says the Chicago surgeon who specializes in ethnic rhinoplasty. "There's a clear desire not to change or mask ethnicity. I'm African American; when I was growing up, the idea was that plastic surgery was only for white people." Today, he said, "I'm not trying to make [people of color] look Caucasian; I'm trying to make them look in proportion."
When Hoffman's bandage came off and she first saw her nose after her rhinoplasty two years ago, she cried. "It was very cathartic for me, very poignant. My nose isn't a small nose. It's not a pinched nose. It's a nose that finally fits my face. That's what I wanted, just to be comfortable with my face."
Contact Anndee Hochman at firstname.lastname@example.org.