If someone else in the streets feels insecure because they've seen someone else with a smaller nose (they're not going to know if it's a 'fake' nose or not) then that's their problem.
IMO counselling can only do so much. I tried counselling 6 months before I had surgery. (Not on my nose) it's something I had that I could not change. Something that chemotherapy did and it destroyed a part of my body and I hated it with a passion. No amount of counselling would change that. If someone wants to change something that's their prerogative. I never thought once 'maybe I shouldn't get this done in case someone in the street will look at me and feel insecure.' If anyone said that to me, I would think well fuck whoever thinks what of me in the street (whether they're insecure because of me, OR the comments 'you can hardly notice it / you don't need it')
If it's done right, cosmetic surgery can change lives. I have a striking confidence I didn't have before. I love myself. I'm confident and happy in my mind and body. I deserve to love myself and think of myself worthy and beautiful. If surgery can give that to someone, go ahead!
If surgery will achieve that, then go for it. And don't for a Damn minute think about what other people think. I couldn't care less if I made someone else feel insecure because I wanted to fix something myself. I'm not about to keep my insecurities for other peoples benefit.
Plus, like rhinoplasties, with my surgery if done well, you wouldn't know it was done. Only immediate family knew what I had done, and my other family and friends didn't even notice. I just get the odd compliment years later which day 'your (insert surgery place' looks fab!'
Shall we stop wearing makeup or dying our hair now in case someone on the streets feels insecure because they're not wearing it that day?
No. Of course not.