Board Certified Plastic Surgeon | Facial Feminization Surgeon | Rhinoplasty Surgeon | Aesthetic Craniofacial Surgeon
You may have different motivations for seeking rhinoplasty (nose job), whether it’s to change the appearance of your nose, help you breathe better, or a combination of both. To me, function and aesthetics go hand-in-hand. I will focus on your specific goals and meticulously analyze your nose as well as your overall facial anatomy to create a customized plan to achieve your aesthetic desires while optimizing your nasal breathing function.
GUIDE TO RHINOPLASTY
WHAT MAKES A BEAUTIFUL NOSE?
While all noses are different and your ideal nose should be unique to your face, there are several qualities of an attractive nose that are universal to all ethnicities and genders.
Straight and symmetric: If you draw a line down the middle of your nose, each side should match the other as a mirror image.
Does not stand out: An attractive nose is discreet and blends seamlessly with the rest of your face. Your nose should not be the focal point of your face, those should be your eyes.
Breathes well: When there are structural asymmetries or cartilage weakness, not only will you see these as aesthetic deformities, but the nasal breathing will likely be impaired. Therefore, a beautiful nose should also breathe beautifully.
Ethnically and gender congruent: While many textbooks describe the ideal nose as a petite, feminine, Caucasian nose with no dorsal hump, this nose is not ideal for everyone. Your facial shape, skin thickness, ethnicity, gender, and most importantly your aesthetic wishes should all be taken into account when planning the rhinoplasty.
WHAT’S THE DIFFERENCE BETWEEN REDUCTION AND AUGMENTATION RHINOPLASTY? HOW DOES ONE’S ETHNICITY PLAY A ROLE IN WHAT KIND OF RHINOPLASTY IS PERFORMED?
Caucasian, Persian, and Hispanic patients often seek “reduction” rhinoplasty to make the noses smaller in some way. These patients tend to have a longer, more projected nose and thinner skin. The two most common goals for those seeking reduction rhinoplasties are eliminating the bump on the bridge of the nose and refining a thick/bulbous tip.
Asian patients often have shorter, less projected noses, thicker skin, softer cartilages, and less tip definition. These patients often seek to enlarge their nose with an “augmentation” rhinoplasty, which is achieved by adding volume to the bridge (I use cartilage and never use synthetic materials), and increasing projection and definition of the tip.
Reduction and augmentation rhinoplasties are in many ways opposites of one another, and it is important to find a rhinoplasty surgeon who is experienced in both types of rhinoplasties.
WHAT’S THE DIFFERENCE BETWEEN OPEN AND CLOSED RHINOPLASTY?
An open rhinoplasty involves a small incision at the columella (the skin between the nostrils, below the tip), which leaves an inconspicuous scar, while a closed rhinoplasty uses all internal incisions and no visible external scars.
In experienced hands, beautiful results can be achieved with both techniques, but each has its benefits and drawbacks.
The benefit of the open technique is precision: the entire nasal anatomy is widely exposed, allowing the surgeon to not only see but to trim, mold, graft, and suture the cartilages with extreme accuracy. Because of this, open rhinoplasty can achieve significant changes in the nasal anatomy. The downside is having that small external scar, which is difficult to see in most patients. The other downside is that the swelling lasts slightly longer than in the closed technique, but all swelling will eventually resolve in both techniques. Open rhinoplasties are also considered more technically demanding due to the additional dissection and exposure required. Because of the benefits, open rhinoplasties are widely used today by many of the world’s top rhinoplasty surgeons.
In closed rhinoplasty, the main benefits are no external scar, faster surgery, and quicker resolution of swelling. The downside of this technique is only parts of the nasal anatomy are directly visible, and much of the surgery is done by feel and by evaluating the external nasal form. Cartilage grafts can still be placed but are usually not secured with sutures.
While many rhinoplasty surgeons exclusively perform only one technique or the other, I am experienced in both and will recommend the technique to best suit your nose. Typically, if I need to alter your tip in a significant way or correct major asymmetries, I recommend the open technique so I can precisely re-shape the cartilages to the desired form. However, if we are only taking off the dorsal hump, narrowing the bones or doing a small adjustment of the tip, then a closed technique may be ideal.
WHAT IS RECOVERY LIKE AFTER RHINOPLASTY?
After rhinoplasty, I ask patients to take 2 weeks off from work or school. You should expect mild to moderate nasal pain, discomfort and bruising during these first two weeks. After two weeks, you should be back to your normal work and life routine, but should avoid contact sports for 6 weeks. Expect bruising of the nose and under the eyes, which will mostly be resolved by 2 weeks. You can shower but should avoid getting your nose wet. Avoid blowing your nose for 6 weeks after surgery. I see my patients 6 to 8 days after surgery to remove sutures and splints. Because I place internal silicone splints inside each nostril, your breathing will be impaired until I remove these splints at your follow-up appointment.
HOW LONG DOES IT TAKE FOR SWELLING TO RESOLVE?
After peak swelling at 2 days after surgery, expect rapid decrease in swelling over the next 4 weeks. You should expect 80% of the swelling to resolve by 3 months. The 3-month mark is a good indication of how your nose should look long term. However, it takes 1 full year, and sometimes years for 100% of the swelling to disappear.
WHO IS QUALIFIED TO PERFORM RHINOPLASTY?
Aesthetic rhinoplasty is considered one of the most difficult plastic surgery procedures, which is why the majority of plastic surgeons do not perform it. It is important to seek an experienced plastic surgeon who does a lot of rhinoplasties (The Rhinoplasty Society quantifies this as more than 30 a year) and has a consistent track record of beautiful results and happy patients.
Two groups of surgeons are qualified to perform aesthetic rhinoplasty: plastic surgeons and facial plastic surgeons. General otolaryngologists and rhinologists are more than capable of performing functional rhinoplasty to tackle internal nasal breathing issues, but usually do not alter the nasal form for aesthetic purposes. Beware of “cosmetic” surgeons - they are usually physicians in other specialties who perform plastic surgery procedures without any formal training.
WHEN SHOULD I GET A RHINOPLASTY?
While you can’t be too old to undergo rhinoplasty, you can be too young. I only offer rhinoplasty to patients once they have stopped growing, which is typically 16 in girls and 18 in boys. If rhinoplasty is performed too young when a patient is still growing, other parts of their face such as the lower jaw may continue to grow, throwing off the facial balance achieved immediately after rhinoplasty.
WHAT ARE THE COMPLICATION RISKS OF RHINOPLASTY?
The specific risks of the procedure include bleeding, infection, poor scarring, asymmetries, worsening of nasal breathing, and septal perforation (a hole in the septum).
HOW MUCH DOES RHINOPLASTY COST, AND IS IT COVERED BY INSURANCE?
Insurances will sometimes cover functional portions of the rhinoplasty, which only target nasal breathing issues. These include septoplasty (removal of deviated portion of the septum), repair of cartilage collapse, and reducing the size of enlarged turbinates (internal structures that are not visible). However, aesthetic portions of the rhinoplasty, such as breaking and narrowing the bones, shaving off the hump, or refining the tip, are not covered by insurance. Aesthetic rhinoplasty prices can vary greatly from $5,000 to $50,000, and do not necessarily correlate with the quality or skill of your surgeon. Make sure to ask for photographs of your surgeon’s previous rhinoplasty results, and talk to patients who have undergone rhinoplasty by your surgeon.
WHY IS A REVISION RHINOPLASTY MORE EXPENSIVE THAN A PRIMARY RHINOPLASTY?
Up to 15% of patients who undergo rhinoplasty seek a revision, the highest of any plastic surgery procedure. This is most commonly due to poor aeshetic outcomes, asymmetries, or poor breathing resulting from the first rhinoplasty. Primary rhinoplasty refers to the first rhinoplasty, where the nose has not been previously altered. In revision rhinoplasty, the nose has scar formed from the previous surgery, and the anatomy is vastly altered. The septal cartilage (the midline structure dividing your nasal cavity from left and right) is likely not available during revision, so alternative cartilage is often used: ear or rib (patient’s own rib or cadaver rib). All of this adds time and difficulty to an already complex surgery.