Who is qualified to decide whether someone really needs a nose job? i have a friend who is really obsessed about his nose shape. i keep telling him that is it not so bad. i meet people with much more serious problems. i think it is more of a psychological

Yes, : Yes, rhinplasty surgeons can assess a patient and not offer surgery if they don't think the patient is a good candidate. That being said just because your friend doesn't have a severely abnormal nose shape doesn't mean that rhinoplasty can't help. That's where the consultation proves most useful.

Your : Your question is actually quite complex and the answer is not always an easy one. The process of finding a physician to perform nose surgery is a personal one. What one person sees as a problem may not be obvious to anyone else but a trained professional so it is important not to superimpose your own feelings on someone elses situation or motivation. With that said, every board certified (american board of facial plastic and reconstructive surgery) facial plastic surgeon is trained to identify patients with body dysmorphic syndrome, unrealistic expectations or personality traits that may lead to poor outcomes for both physician and patient. Remember that most patients seeking changes to their appearance do so for self esteem enhancement...Not vanity... They are making changes for themselves... Not to please others. The physician develops a relationship with the patient and understands the motivation behind the surgery as part of the surgical work up... If there is a real anatomical issue and good motivation then the procedure usually proceeds but there are many times when a physician may not feel that the desired surgical goals of the patient are warranted or realistic and surgery is declined... I hope this helps -bwc.

It : It is between the doctor and the patient to decide if cosmetic nasal surgery is indicated. If a surgeon has a concern about the patient's expectations, s/he may decide against performing the case, refer to a second surgeon for an opinion, or in extreme cases perhaps suggest a psychological evaluation. If there is a consensus opinion to do a surgery and both sides are comfortable with each other then i suggest you be as supportive as you can.

Depends: As rhinoplasty is elective only the person can judge if they "need" it. They should get a consult with a rhinoplasty surgeon to see of they have realistic expectations.

Rhinoplasty: your friend should has his nose evaluated by a board certified facial plastic surgeon.