Is Jackson’s nose what the doctors ordered?

It’s a wonder the jury can focus on the breach-of-contract case when the more pointed issue in the Santa Maria courtroom where defendant Michael Jackson is testifying this week is the pop star’s nose. An apparent plastic surgery lifer, he seems to have gone under the knife so many times that the tip of his raw-looking schnoz now comes to a point.

“In his zeal to have this sharply defined nose, he’s had so many things done, the tissue is no longer able to withstand it. The skin is so thin from operations that the bone or cartilage or silicone implant is pushing through,” said Dr. Les Bolton, a Beverly Hills plastic surgeon, who made his assessment, as did other doctors, after looking at photos shot Wednesday in court.

“What he’s done is to go from a Negroid or black nose, which is round and broad and flat, to a Caucasian nose that’s narrow and projecting,” said Dr. Harvey Zarem, a former chief of plastic surgery at UCLA who practices in Santa Monica. “To do that, you have to put cartilage or silicone or bone in the nose like a tent stake to make the nose stick out. But when you do that enough, the cartilage or silicone or bone pokes through.”

After so much work, it would seem that the Peter Pan of pop may be beyond repair. Can this nose be saved? Never say never, say doctors, especially about the king of Neverland.

“If what is protruding is artificial material such as an implant, the treatment of choice would be to remove the implant, let the nose heal and reconstruct it later with some of his own tissue, such as cartilage from the ear or bone from the rib,” said Bolton.

Dr. Edward Domanskis, a Newport Beach plastic surgeon, agrees. “Short of wearing a prosthesis, which maybe he even does now and that’s why he covers his face with a mask [Jackson entered the courtroom with a surgical mask over his nose and mouth, then removed it before taking the stand] you could take tissue from the forehead or the back of the ear to build up the area. But I don’t think he wants that. It seems like he’s fairly comfortable with the way he looks, which is unfortunate because it’s a bad reflection on all of plastic surgery.”

Presumably, Jacko is getting what he asked for. Most surgeons say that without a code of ethics that addresses when to say no to patients who can’t say no to themselves, it’s difficult to know when to refuse a request for more surgery.

“What is a plastic surgeon there for but to achieve what the patient is seeking and make them happy?” Zarem asked. That said, he concedes that doctors confront an ethical dilemma with patients who, like Jackson, seem insatiable. “This is a common thing. We do our best, and the patient says it’s an improvement, but they want more,” he said. “That’s why I always tell my residents that the enemy of good is better.”

Domanskis believes that drawing a line with some patients is particularly difficult. Jackson “probably should have stopped three or four noses ago. But it becomes very difficult with a person who is powerful and wants his way. There are enough plastic surgeons out there who are going to feel special if he comes to them that he is probably always going to find someone willing to operate.”

Dr. Josh Korman, a plastic surgeon in Mountain View, Calif., and a faculty member at Stanford University Medical School, agrees. “A lot of times, doctors are trying to help patients, but it comes down to a judgment call. I always say that plastic surgeons can operate on the ears but not on what’s between the ears.”