Rhinoplasty

A rhinoplasty is a surgical procedure, commonly called a nose job. It is performed to reshape the nose, improve its proportions, and enhance the overall balance and harmony of the face. Without further delay, let's dive right in and learn everything there is to know about rhinoplasty surgery.

What is a rhinoplasty? Why is this nose surgery done?

In the simplest of terms, a rhinoplasty is a surgical treatment that changes the shape, size, or proportions of the nose. It can be performed for aesthetic/cosmetic reasons and/or medical reasons such as to repair an injury, correct birth deformities, or improve breathing. If it is deemed medically necessary, a rhinoplasty may be covered by your health insurance plan.

The nose is composed of skin, bone, and cartilage. A rhinoplasty can involve changes and adjustments in all three. Experienced, board certified plastic surgeons plan a rhinoplasty surgery after taking into consideration all of a patient's facial features. Therefore, rhinoplasty is a highly individualized nose surgery.

What concerns can rhinoplasty address?

Rhinoplasty can treat various concerns involving the structure of the nose, including the size of the nose to achieve greater facial balance; the shape of the nose, such as correction of a hooked, upturned, drooping, or bulbous tip; adjustments in the bridge of the nose; changes in the size or position of the nostrils which may be wide, large, or turned upwards; improvements in the nasal profile to correct depressions or humps; and correction of nasal asymmetry.

It is important to keep in mind that there is bound to be some asymmetry in the structure of your face, just like everyone else. While a rhinoplasty can correct obvious concerns and create better balance and proportion, the results may not be symmetric down to the last millimeter.

Can rhinoplasty fix a broken nose?

Yes, rhinoplasty surgery is frequently performed to repair a broken nose. When rhinoplasty is performed for repair of nasal fractures, the goal is to restore the nose to its pre-fracture appearance and function.

Can rhinoplasty correct a deviated septum?

Rhinoplasty does not fix a deviated septum. However, it can be combined with a procedure called septoplasty (this is called a septorhinoplasty) to relieve nasal obstruction, enhance breathing, and improve the appearance of the nose.

Who is a good rhinoplasty candidate?

The surgery is suitable for anyone who is in good general health and does not smoke (smoking can complicate the healing process post-surgery). As noted, rhinoplasty is a highly customized procedure. You are a good candidate for rhinoplasty if you are getting the nose job for yourself, not to achieve someone else's ideals or desires. A positive outlook and realistic expectations are key factors in getting the expected results from a rhinoplasty. The American Society of Plastic Surgery recommends that you wait until your facial growth is complete before going in for a rhinoplasty.

What are the different types of rhinoplasty procedures?

Open Rhinoplasty vs. Closed Rhinoplasty

An open rhinoplasty is performed from outside the nose. A small incision (cut) is placed in the columella (the fleshy bridge that separates the nostrils). A closed rhinoplasty is performed with incisions inside the nostrils. Your plastic surgeon will choose the appropriate type of rhinoplasty based on which method will achieve the best results.

Revision Rhinoplasty

A revision rhinoplasty is performed in a patient who has undergone a nose job one or more times in the past and desires further improvement in the appearance of their nose.

Is rhinoplasty different in men and women?

There is no fundamental difference in the surgical techniques used to perform a rhinoplasty in men and women.

How is rhinoplasty different from septoplasty?

Rhinoplasty surgery is primarily performed to change the shape of the nose. However, because the shape of the nose is related to breathing, a rhinoplasty may improve breathing in addition to improving the nasal appearance.

Septoplasty surgery is performed primarily to improve breathing. It involves straightening the nasal septum (the wall of tissue that divides the nose into the right and left nasal passage). A crooked septum can make it harder to breathe. A combined procedure called a septorhinoplasty, as noted above, can achieve both improved breathing and enhance how your nose looks.

How do you prepare for rhinoplasty?

Consultation

Before scheduling a rhinoplasty, you will need to meet with your plastic surgeon to discuss certain important things that will determine the success of the surgery. The consultation in the plastic surgery clinic will include a review of your medical history, a physical examination, and taking photographs of your nose and face from different angles for before/after rhinoplasty photos comparison.

Discussion

A key feature of the consultation in the clinic will be a discussion about your motivations and expectations from the rhinoplasty surgery. Your surgeon will show you rhinoplasty before/after photos of other patients to help you understand what to expect from the surgery and what it can and can't do for you. It is normal to be a little nervous or self-conscious, but you should try to be as frank as possible about your desires and aesthetic goals. Your surgeon may recommend other procedures in combination with a rhinoplasty - for instance, if you have a smallish chin, it can make your nose appear bigger. In such cases, the surgeon may suggest chin augmentation to achieve better proportions.

Preparation

After you are seen in consultation and are deemed an appropriate candidate for rhinoplasty, your surgery will be scheduled. In preparation for the procedure, your cosmetic surgeon may ask you to get some lab tests, take certain medications, or stop/adjust some medications that can increase the risk of bleeding. You will also need to stop smoking. Arrange for someone to drive you home after the rhinoplasty and stay with you for the first day or two to help around the house, because the anesthesia can temporarily lead to impaired judgment, slow reaction times, confusion, and memory lapses.

Can I see what my nose might look like after rhinoplasty?

Yes, at the time of your consultation, your surgeon will take a series of photographs of your face from multiple angles. These photos can be manipulated on the computer to give you a sense of what to expect after surgery.

How is the rhinoplasty procedure performed?

Anesthesia

A rhinoplasty can be performed in a hospital, ambulatory surgical center, or office-based surgical facility. The procedure can be done under local anesthesia with sedation or general anesthesia. Local anesthesia with sedation involves injection of medicines through an intravenous (IV) line that make the nose numb and make you groggy but not fully asleep. With general anesthesia, you are unconscious during the procedure. Your surgeon will discuss the anesthesia options with you during your consultation and talk to you about which type will be most appropriate for you.

Rhinoplasty Procedure Steps

There are no fixed steps in a rhinoplasty surgery because it is a highly individualized procedure based on the facial anatomy and aesthetic goals of a patient. As noted, the incisions can be placed in the columella (open rhinoplasty) or inside the nostrils (closed rhinoplasty).

Once the incisions are made, your surgeon will adjust and manipulate the bone and cartilage to change the shape and proportion of the nose and correct any deformities. A large nose may be refined by removing cartilage and/or bone. If additional bone and cartilage is required, depending on how much change is planned, your surgeon may take extra cartilage from deep inside the nose or from the ear or rib, and they may obtain bone from other parts of the body to reshape the nose.

After the procedure is complete, the plastic surgeon will close the incisions with stitches. If you have a deviated nasal septum and difficulty breathing, your surgeon may perform a septorhinoplasty to straighten the septum and improve breathing. You will be transferred to the recovery room at the completion of the surgery.

Is rhinoplasty painful?

The numbing medicine in the local anesthesia with sedation makes the procedure comfortable. If you have the surgery under general anesthesia, you will not feel anything. In the days after surgery, most patients have mild to moderate pain (typically rated 0-4 out of 10) that can be controlled with over-the-counter pain medication.

What is recovery from rhinoplasty like?

Post-Surgery Instructions

Your doctor will give you specific information about caring for the rhinoplasty surgical site, oral medications to take, topical ointments and creams to apply, signs and symptoms to be concerned about, and when to return for a followup visit. Following your surgeon's medical advice in the weeks after surgery will ensure you heal uneventfully from your rhinoplasty.

Splints and Packing

During recovery from rhinoplasty, your doctor will place a splint and/or packing inside your nose to support it while it heals. The splints/packing have holes in them to allow you to breathe. Your surgeon will likely remove them at your one-week followup visit.

Bruising and Swelling

Many patients wonder - how long will I be bruised after rhinoplasty? It is common to have some nasal bruising and swelling for about a week to two weeks. Your surgeon will advise you to rest with your head raised higher than your chest to keep the swelling and bruising down. Do not put ice packs on the nose unless advised by your surgeon. There may be some slight swelling of the eyelids after nose surgery. You may have some bleeding or mucus drainage after the dressing is removed. Your doctor may put a drip pad (a small piece of gauze) to catch any blood or drainage. You will need to change this pad as directed.

Return to Normal Activities

During the rhinoplasty healing process, you will need to avoid strenuous physical activity and baths (showers are okay) while you have bandages in place. Your doctor will advise you to avoid blowing your nose or making extreme facial expressions for two weeks. You will need to brush your teeth gently to avoid pulling on the upper lip and nose. Wearing clothes that fasten in the front with buttons or zippers is advisable to avoid pulling clothes over your head. You won't be able to wear eyeglasses for 4 weeks after rhinoplasty surgery as they can put pressure on the nose. You may need to tape your glasses to your forehead or use cheek rests. Also, eating a high-fiber diet is advised because straining during bowel movements with constipation can put pressure on the nasal surgical site. Finally, after you heal from rhinoplasty, be sure to wear sunscreen SPF 30 or higher because too much sun exposure can lead to skin discoloration of the nose.

Will I have scars from rhinoplasty?

A closed rhinoplasty is a scar-less nose job, meaning all incisions are inside the nose and there are no visible scars from the surgery. If you have an open rhinoplasty, such as to correct a bulbous tip, the incisions can be hidden in the natural curve of the nose, so no scar will be visible after the procedure.

Will I need to stay the night in hospital after rhinoplasty?

Most patients are able to go home on the day of their rhinoplasty procedure. Rarely, your doctor may ask you to stay overnight if you're having symptoms such as nausea or other health issues that need to be medically monitored.

How long is the rhinoplasty recovery period?

You should plan to take at least one week off from work or school. Most patients are back to all normal activities in 2-4 weeks. Keep in mind that the swelling in your nose can take several weeks to months to resolve.

When will I see the results of my rhinoplasty?

You will see the results of your nose job once the post-surgical swelling subsides in a few weeks. However, it can take up to one year for the swelling to completely go away and the contour of the nose to be fully refined. During this time, you will notice gradual changes in your nose as it settles into the permanent outcome. Keep in mind that the nose changes throughout life, so it is difficult to pinpoint exactly when you will get your final rhinoplasty result.

How long do rhinoplasty results last?

The results of a rhinoplasty are long-lasting but not permanent. This is because as your face ages, there will be gradual changes in your nose. However, most of the improvement in the nose is more or less permanent. You can prolong your results by leading a healthy lifestyle with a balanced diet, regular exercise, and sun protection.

What if I'm not happy with my nose job?

Even small changes (measured in millimeters) in the nasal structure can make a noticeable difference in the appearance of your nose. Experienced plastic surgeons can mostly get you the results you desire by fine-tuning the surgery. If you are not satisfied, it may be possible to do a revision rhinoplasty. However, you will need to wait at least a year before the second surgery to allow the nose to settle into its new shape.

What are the risks of rhinoplasty?

Rhinoplasty is a surgical procedure, and as with any surgery, it carries the risks of bleeding, infection, and anesthesia risks. Additional risks specific to rhinoplasty include problems with breathing through the nose, uneven or asymmetric results, permanent numbness of the nose, persistent pain, skin discoloration, poor wound healing, scarring, septal perforation (a hole in the wall between the nostrils), and the need for additional surgeries. You can reduce your risks by choosing an experienced board certified surgeon. In general, complications after a nose job are rare. Your doctor will fully discuss all the potential risks with your when they obtain surgical consent.

Can I get a non-surgical rhinoplasty?

A non-surgical rhinoplasty or liquid rhinoplasty can be performed by injecting dermal fillers, such as hyaluronic acid fillers, under the skin of the nose. This is a quick office procedure with no downtime or recovery period, but the results are temporary, typically lasting around 6 months to a year.

How much is a good nose job?

Based on estimates by the American Society of Plastic Surgeons, on average, a nose job or rhinoplasty costs around $5,500. However, this can vary greatly depending on the complexity of the surgery, the surgeon's experience and skills, and your geographical location.

Does insurance pay for rhinoplasty?

If it is performed for purely cosmetic reasons, your health insurance plan will not cover a rhinoplasty. However, insurance may pay for your rhinoplasty or part of your nasal surgery if it is deemed medically necessary. Coverage will depend on your specific plan. You can get a quote for out-of-pocket expenses by asking for pre-authorization from the insurance company.

Choosing the best rhinoplasty surgeon near you

You want only the best facial plastic surgeons and cosmetic surgeons for your rhinoplasty nose job. If you are in the United States, a good place to start is a board certified physician registered with the American Society of Plastic Surgeons. Elsewhere in the world, training and certifications are good starting points as well.

The MeTime app makes it easy to find a surgeon with extensive experience in rhinoplasty surgeries. You can chat with providers, send photos across, do a video consult, and book an appointment when you're ready. Download the MeTime app today!