Dec. 10, 2007 -- When it comes to noses in Hollywood, more and more people are wondering "did she or didn't she?"
We've heard the line time and time again, celebrities caught in a before-and-after photo clearly showing two very different noses. "I had a deviated septum," Ashley Tisdale, star of "High School Musical," recently confessed.
With that, Tisdale joined an elite group of Hollywood A-listers who have admitted to having a nose job to fix a deviated septum, but are their claims justified or is a deviated septum just a convenient excuse for a new nose?
As much as Americans are obsessed with their celebrities, so are they equally intent on pointing out even their most minor imperfections. Celebrities live in front of the camera, so when they decide to go under the knife, even the most subtle changes are instantly recognizable.
Cameron Diaz, Jennifer Aniston and Ashley Simpson have all made headlines in the last year for stepping out with slightly altered noses. And like Tisdale, all three women say their new noses were a medical necessity, not a vanity.
Raj Kanodia, the Beverly Hills plastic surgeon who performed all of their surgeries, says a deviated septum is one of the most common problems he sees in his office.
"I would say in my practice as high as 95 percent of the people I see have a deviated septum, so chances are when someone says they have a deviated septum, they do," said Kanodia. "Most septums and noses are broken when you're a toddler because the upper bone is not developed yet so when a child is learning to walk or crawl and they fall on their face, they traumatize their nose."
The septum, a thin wall inside of the nose that divides the left and right nasal cavities, is deviated when a trauma causes the septum to block one side of the nose and reduces airflow, causing difficulty breathing. A surgery called septoplasty is the best way to remedy a severely deviated septum.
But Kanodia says the procedure to repair the septum takes place almost entirely internally, differing from the more common nose surgery known as rhinoplasty.
"Septoplasty means it's a functional operation, you're straightening the septum. And rhinoplasty means you're doing cosmetic improvement on the nose," said Kanodia. "I do a septorhinoplasty [a combination of the two procedures] on pretty much every patient."
Stretching the Truth
Though a deviated septum can be a serious problem, signs of the problem are often difficult to detect from the outside. By definition a septoplasty should not change the exterior appearance of the nose, so when a celebrity says he or she had surgery to repair a deviated septum, they may be leaving out a few details.
Seth Faison, deputy director of Sitrick and Company, a public relations firm in New York City specializing in strategic communications, says clouding over the truth may not be the best strategy, but for those under a public microscope, it may be necessary.
"I always advise clients to tell the truth," said Faison. "But when it comes to plastic surgery, the less said the better."
If publicists are advising their celebrity clients not to fully disclose the truth, it may explain the recent revelations of surgery to repair a deviated septum.
"I didn't do this because I believe in plastic surgery," Tisdale told People Magazine. "I did this to help my health. I literally could not breathe out of the right side of my nose."
A Cosmetic Side Effect
While cosmetic enhancement is not required to repair a deviated septum, most patients have trouble saying no to fixing that bump or tweaking that slope if they're already going through the complicated procedure. Most times, altering the outside appearance of the nose is not a necessary part of a septoplasty.
But if celebrities opt to have the more complicated septorhinoplasty procedure, why not admit to having a few imperfections cleared up then?
"Plastic surgery is kind of like the act of procreation," said Faison. "It's private even if it's there for everyone to see and I think it's better if it's kept private."
Kanodia said the pressures of Hollywood and the new technology of HDTV that highlights any imperfection can get to a celebrity. Yet he disagrees with the secrecy of shrouding surgery in the disguise of the deviated septum line.
"I think celebrities should be a little more forthright in saying I had a deviated septum fixed but I also had it straightened a little bit," said Kanodia. "If they were more forthright people wouldn't have this stigma about it."
Hollywood may be bringing the stigma upon itself because there's always speculation surrounding secrecy. Just this week actress Scarlett Johansson filed a lawsuit against US Weekly magazine for accusing the actress of having a nose job.
"Scarlett has always been straightforward with the press regarding her body image, and she's very concerned that her fans will feel misled," Johansson's publicist told OK! Magazine.
Whether a celebrity did or didn't have his or her nose fixed, the decision to go public is ultimately his or hers.
"Rumors and accusations frequently need to be addressed," said Faison. "But they can be addressed by telling the truth while keeping some things private."
Yet until plastic surgery is no longer considered taboo, the rumors, and lawsuits, will ultimately prevail over full disclosure.