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Rhinoplasty

Rhinoplasty

Featuring Articles By

Minas Constantinides, MD, FACS

updated

Rhinoplasty is among the five most popular plastic surgery procedures performed in the United States, with more than 200,000 procedures performed in 2013 alone. [i] During the procedure, a plastic surgeon sculpts the cartilage and bone of the nose to achieve a patient's desired look. For men and women who are unhappy with the size and shape of their nose, rhinoplasty, otherwise known as nose reshaping surgery or a "nose job," offers a safe, effective, and time-tested cosmetic solution. When performed by an experienced, skilled cosmetic surgeon, rhinoplasty can greatly improve the balance of facial features, helping patients discover newfound confidence. Rhinoplasty can also be used to correct structural defects, including those that cause breathing problems.

If you have considered undergoing rhinoplasty, there are a few important things to consider. Here you can learn more about the procedure, its costs, the possible risks and benefits, and much more.

Candidacy

The majority of individuals who undergo nose reshaping surgery are dissatisfied with the appearance of their noses and wish to improve the proportions of their facial features. A smaller percentage of rhinoplasty candidates are patients who deal with discomfort or breathing difficulties due to structural abnormalities or previous nose injuries. The optimal candidates for rhinoplasty are in good general health, understand the risks associated with surgery, and have realistic expectations regarding the surgery results.

Ideal Nose Reshaping Candidates

A good candidate for nose-reshaping cosmetic surgery may:

  • Have a nose that he or she feels is too large or too small in comparison with other facial features
  • Have a bump on the bridge of the nose
  • Have a wide nose
  • Have a nasal tip that droops, protrudes, or is enlarged
  • Have a bulbous tip
  • Have nostrils that are excessively flared or pinched
  • Have a nose that is crooked or off-center
  • Have been injured so that the nose is asymmetrical
  • Have problems breathing due to irregularities with internal nose structure (i.e. a deviated septum or related problems)

Is Surgery Safe for Teens?

Rhinoplasty is one of the most popular cosmetic surgeries among teenagers. It is important for teenage patients and their surgeons to consider whether or not nose reshaping is an appropriate cosmetic surgery option. Doctors should ensure that the decision to undergo rhinoplasty is the patient's own choice, rather than the result of peer or parental pressure. Regardless of the reason for surgery, doctors recommend that girls wait until age 14 or 15, and that boys wait a few additional years to undergo rhinoplasty. By this time, the nose should have finished growing.

Specific Goals

Rhinoplasty can be used to modify the shape, size, and overall appearance of the nose. In some cases, a plastic surgeon may recommend that a chin implant be inserted at the same time. This will help to balance out the facial features more completely. Many times, rhinoplasty patients ask their surgeons to:

  • Narrow the bridge of their noses
  • Widen or narrow their nostrils
  • Straighten their crooked noses
  • Reshape the tip of their noses
  • Alter the angle between their noses and upper lips

In most cases, the incisions used for nose reshaping cosmetic surgery can be hidden inside the nose or placed inconspicuously outside it. Minimal scarring fits in with the overall goal of improving appearance and maintaining a natural look.

General Considerations

The best way for a patient to determine his or her candidacy for rhinoplasty is to schedule a consultation with a qualified surgeon. The physician will assess medical history, skin quality, cosmetic goals, and mental preparedness before recommending treatment.

Cost

Because rhinoplasty is different for each patient, the cost of rhinoplasty treatment will vary depending on a number of factors. Patients should discuss the total cost of surgery with their physicians, as well as payment and financing options.

Read Minas Constantinides, MD's Take:Factors that Affect the Cost of Rhinoplasty

Rhinoplasty can cost between $3,000 and $15,000 depending on your surgeon's reputation and level of expertise, the complexity of your surgery, the geographic location of your surgeon's practice, and many other factors. Read Full Article

Determining the Cost of Rhinoplasty

There are several considerations that will determine the final cost of rhinoplasty. These include:

  • Surgeon's experience: A doctor with an outstanding reputation and top-notch training will typically charge more than a less experienced or respected practitioner. However, many patients are willing to foot the extra cost, since an experienced surgeon be more likely to provide the desired results.
  • Surgical facilities: If a doctor does not have his or her own operating facilities, the procedure will take place at a hospital or ambulatory surgical center. These locations charge separate fees, which will vary depending on location, reputation, and equipment. Again, many patients are willing to pay slightly higher costs to enjoy greater safety and comfort.
  • Geographic location: Like most goods and services, plastic surgery costs vary by location. Typically, rhinoplasty will cost more in a metropolis, such as New York or LA, than in a rural location.
  • Anesthesia: Rhinoplasty may be performed under general anesthesia or IV sedation, and the type a doctor recommends will affect the cost of treatment. Additionally, like surgeons, anesthesiologists charge different fees, typically in correlation to experience and reputation.
  • Care during recovery: Following rhinoplasty, patients may need certain medications or follow-up care. These may impact the final cost of treatment.

It is important for patients to remember that facility costs, anesthesia fees, and post-operative care are not always included in the initial treatment estimate. For a more accurate figure, patients should inqure about these costs and related fees.

Payment

When rhinoplasty is performed primarily for cosmetic purposes, it is rarely covered by insurance. However, insurance companies will often pay for procedures to correct a deviated septum or other breathing issues. A doctor's administrative staff can help patients determine whether they are eligible for insurance coverage. In many cases, they will even file the claim and handle any other paperwork.

In-House Financing

Doctors realize that most rhinoplasty patients are not eligible for insurance coverage. For this reason, many surgeons offer in-house financing options. With approved credit, patients may be eligible for low-interest or fixed-interest repayment plans. Additionally, many doctors offer significant discounts when patients pay for their procedures in full prior to treatment. Most cosmetic surgery practices accept cash, check, and all major credit cards.

Flexible Financing

When patients are researching their payment options, they should also consider third-party financing. Many lenders offer fixed-interest repayment plans. Patients who pay within a specific time frame may even be eligible for a no-interest plan. A doctor's office team can explain more about these options and help patients choose the repayment schedule that best fits their budget.

How to Choose a Surgeon

Rhinoplasty can have dramatic lifelong effects on a patient's appearance. Therefore, patients should be extremely judicious when choosing their plastic surgeon. Ideally, they should talk to several doctors before making their final choice. When interviewing doctors, there are several important things to consider.

Affiliations

Patients should seek out a surgeon who has been certified by the American Board of Plastic Surgeons. This certification ensures that a doctor adheres to stringent standards of safety and ethics, and that he or she performs procedures approved by the board. It is also important to find a surgeon who has been certified by the state medical board.

Additional affiliations and certifications can indicate that a doctor has extensive experience and a good reputation. Other notable plastic surgery affiliations include:

  • The American Board of Plastic Surgeons®
  • The American Association of Plastic Surgeons
  • The American Academy of Facial Plastic and Reconstructive Surgery

Training and Experience

All doctors are legally permitted to perform rhinoplasty, but only a qualified surgeon can ensure safety and good cosmetic results. Patients should choose a doctor who focuses on cosmetic and reconstructive surgery. If possible, they may want to find a surgeon who specializes in facial procedures and nose reshaping.

It is important to choose a doctor who addresses the airways, as well as the external structure of the nose.

When interviewing doctors, prospective patients should ask them about their approach to rhinoplasty. It is important to choose a doctor who addresses the airways, as well as the external structure of the nose. Even if a patient is undergoing the procedure for purely cosmetic reasons, the doctor should work to protect the nasal passages so that the patient can maintain normal breathing patterns.

Surgical Facilities

While some doctors work at a nearby hospital, many work at outpatient surgical centers. These facilities should be certified by the American Association for Accreditation of Ambulatory Surgery Centers. To earn this accreditation, a center must maintain high safety standards and offer the proper equipment.

Hospital Privileges

When doctors operate at these outpatient centers, they should have hospital privileges with at least one local medical center. A doctor must pass rigorous screenings to earn these privileges, so patients can rest assured that their surgeon maintains proper ethical and safety standards. Surgical complications during rhinoplasty are extremely rare. However, hospital privileges ensure that a patient will have access to emergency care in the unlikely event that something does go wrong.

Practice History

Naturally, patients should choose a doctor who has a good reputation for success. Individuals should ask friends, family, and general practitioners for recommendations. Additionally, all state medical boards are required to make a doctor's information public. Patients may access these records to look for any past lawsuits or infractions. In many areas, these records are available online, but in some states, they can only be accessed through the mail.

Personal Rapport

Rhinoplasty is a highly personal procedure that can affect a person's mental well-being, as well as his or her appearance. Therefore, it is vital that patients choose a surgeon with whom they feel comfortable. They should select a doctor who truly listens to their concerns, answers their questions, and creates a treatment plan that will address their specific goals. Patients should never choose someone who makes unrealistic promises or pressures them to undergo more surgery than they actually want.

Additionally, almost all doctors have galleries of their past work. Patients should closely examine these galleries and ask themselves:

  • Do I like this doctor's aesthetic approach?
  • Do the results look natural?
  • Can I see myself with this look?
  • Are the photos well lit and taken from various angles?

By following these guidelines and choosing a doctor with whom they feel comfortable, patients are more likely to be satisfied with the results of their procedure.

View Rhinoplasty Before & After Photos

The Initial Consultation

After a patient has selected a plastic surgeon, the doctor schedules a comprehensive consultation. This allows patient and doctor to develop a personal relationship and begin planning out the treatment.

The Exam

Before anything else, the surgeon determines a patient's candidacy for rhinoplasty. He or she takes the patient's health history, asks about medications and whether the patient smokes, and addresses other concerns. It is important for the patient to be honest with the doctor. Withholding certain information could increase the risk of surgical complications.

Smoking does not necessarily disqualify a patient from rhinoplasty, but he or she will need to stop for at least two weeks before and two weeks after the procedure. Additionally, certain medications can inhibit healing. If possible, doctor may recommend safer alternatives. Of course, the doctor also examines the patient's nose. He or she checks skin quality, shape, the amount of tissue, and the condition of the septum.

When seeking rhinoplasty for cosmetic reasons, patients may want to bring in pictures of what they want their noses to look like.

Goals for Surgery

After the doctor determines that a patient is physically qualified for surgery, he or she asks about the aesthetic or health-related objectives. When seeking rhinoplasty for cosmetic reasons, patients may want to bring in pictures of what they want their noses to look like. An exact replication may not be possible. However, these images will help the doctor create a treatment plan in keeping with the patient's cosmetic goals.

Planning the Procedure

Plastic surgeons typically encourage patients to be active participants in their care, and they will work together to develop a treatment plan. Among other things, they will discuss:

  • What type of rhinoplasty will work best
  • The technique that most suits a patient's needs
  • The preferred type of anesthesia

Types of Rhinoplasty

Nose reshaping surgery can be divided into several categories, depending on a patient's goals for treatment.

Reduction Rhinoplasty

Reduction rhinoplasty is one of the most common types of nose reshaping surgery. This procedure can give a patient a nose that is more proportionate to the other facial features. In particular, it can address bumps on the bridge of the nose, an elongated nasal tip, or excessively flared nostrils. The doctor removes small amounts of bone or cartilage to achieve the desired results. To reduce the size of the nostrils, the doctor may need to use a technique called alar base reduction. During this process, he or she removes small wedges of tissue from the area where the nostrils meet the cheeks.

Often, doctors use advanced computer programs to plan the reduction rhinoplasty and simulate the appearance of a patient's nose after surgery.

Augmentation Rhinoplasty

Augmentation rhinoplasty is another popular type of nose reshaping surgery. During this treatment, the doctor performs bone or tissue grafting to build up the nasal tip and/or bridge. In many cases, he or she uses cartilage from other parts of the nose, usually the nasal septum. However, if a patient does not have enough tissue in this area, the doctor may use rib bone, cartilage from other areas, synthetic material, or other biological tissues.

As with reduction rhinoplasty, the doctor carefully plans out the treatment. Many times, he or she uses computer software to create a two-dimensional or three-dimensional model of the final results.

Post-Traumatic Rhinoplasty

If a patient has suffered an injury to the nose, he or she may benefit from post-traumatic rhinoplasty. This procedure can address both appearance and functionality. Doctors may use this procedure to straighten the nose and correct the nasal septum. Often, post-traumatic patients have suffered a broken nose. In these cases, a doctor may have to re-fracture the nose and re-set it to achieve the desired results. A doctor can usually set a simple broken nose within 10 days of the fracture. However, if a patient has suffered a serious nose injury, he or she may have to wait several months before undergoing extensive surgery.

Reconstructive Rhinoplasty

Patients may require reconstructive rhinoplasty if they have lost all or part of their noses to an accident, skin cancer, or another serious illness. During the treatment, a surgeon rebuilds the nose using skin grafts, flap techniques, and other advanced methods. Due to the complex nature of this procedure, patients may require multiple surgeries over a period of several months. Additionally, reconstructive rhinoplasty is a specialized procedure, and patients should look for surgeons who have extensive experience in this area.

Ethnic Rhinoplasty

Ethnic rhinoplasty uses the same methods as other forms of nose reshaping surgery. Typically, ethnic rhinoplasty refers to procedures performed on individuals of African American, Afro-Caribbean, Asian, Hispanic, and Middle Eastern descent. These patients typically have softer nasal contours, and the doctor takes special care to preserve the unique features of a these patients' faces.

Adolescent Rhinoplasty

In most cases, doctors advise teenage patients to wait until their noses have stopped growing before they undergo rhinoplasty. There are exceptions, however, especially in cases of trauma or breathing difficulties. When young patients undergo rhinoplasty, the doctor must take special care to protect the still delicate nasal features. Additionally, a doctor should make sure that the patient is emotionally and mentally prepared for nose reshaping surgery.

Aging Rhinoplasty

Although the nose stops growing around age 16, the shape may change over time. The tip may begin to droop, or the nasal passages may constrict, causing breathing difficulties. With aging rhinoplasty, a doctor can correct these issues to enhance breathing and give a patient a younger, rejuvenated appearance.

Rhinoplasty Techniques

No matter which type of rhinoplasty a patient requires, the doctor will typically use one of two primary techniques.

Closed Rhinoplasty

Closed rhinoplasty is generally the preferred procedure because all surgical incisions are made inside the nose, eliminating external scarring. Although the incisions are hidden, the surgeon can still access most of the nose to address a range of cosmetic and structural concerns.

Open Rhinoplasty

Open rhinoplasty gives the surgeon greater access to the cartilage and bone of the nose but it will leave some scar tissue. By creating an incision across the columella (the area of cartilage between the two nostrils) the doctor can lift the skin off the tip of the nose and shape the cartilage very precisely. When healed, the incision leaves a very small, almost negligible scar on the underside of the nose.

Choosing the Right Technique

Both open and closed rhinoplasty can be extremely effective. The doctor will determine the right technique for each patient, based on the natural shape of the nose and the goals for surgery. If the patient desires dramatic changes, or if the doctor is performing post-traumatic rhinoplasty, an open technique may work best. This method gives the doctor access to a larger part of the nose. In many cases, it also helps him or her to make small adjustments to the nasal tip. If a patient wants to address the bridge of the nose, closed rhinoplasty may work well. However, because each patient is different, there are no hard and fast rules regarding the "right" procedure to use.

Advanced Technology

The medical field is rapidly changing, and some doctors use advanced methods to minimize discomfort and recovery time. While these methods are not widely used, they provide a fascinating glimpse into the future of plastic surgery. These innovative techniques include:

  • Using high-power tools to make tiny alterations to the bone. These devices disturb less of the surrounding tissue, and the doctor can often correct a nasal injury or deviated septum without re-fracturing the nose.
  • Using the patient's own blood as a natural adhesive. This allows the doctor to seal incisions from the inside, minimizing scarring and post-surgical bruising.

Before the Procedure

Prior to nose reshaping surgery, there are several steps that patients can take to speed their recovery, minimize their post-surgical discomfort, and reduce the risks of complications.

Diet

In the weeks before any surgery, it is important for patients to eat a healthy diet. Proper nutrition will speed healing and minimize the risk of infection. In particular, individuals should eat plenty of fruits and vegetables, whole grains, and lean protein. Nutrition supplements are also beneficial. Doctors may recommend specific supplements, including vitamin A, vitamin C, and bromelain.

At the same time, patients will also need to avoid certain foods and supplements, which could slow healing and cause surgical complications. In particular, patients should steer clear of vitamin E supplements, ginger, gingko, and ginseng. Some homeopathic and herbal supplements can cause complications with anesthesia, so patients should check with their doctors before taking additional nutrition.

Because alcohol can affect the liver's ability to metabolize correctly, many doctors advise patients to avoid drinking in the weeks leading up to their surgeries.

Medications

When preparing for rhinoplasty, patients should inform their doctors about all medications they are currently taking. Certain drugs could cause problems before or after surgery. A doctor may temporarily take a patient off of a medication or prescribe a safer alternative. In particular, patients should avoid aspirin, ibuprofen, and blood thinners.

Smoking

Tobacco use slows blood flow throughout the body. Because oxygen cannot reach the incision sites very quickly, smokers may face a longer recovery and a higher risk of infection and unfavorable scarring. Although smokers are not automatically disqualified from rhinoplasty, they should quit the habit for at least two weeks before and two weeks after the surgery.

Preparing for Recovery

Recovery from rhinoplasty can take several weeks, and patients should prepare accordingly. In particular, they should take at least two weeks off of work and arrange for a ride home from the hospital or surgical center. If possible, they should find someone who can stay with them for a few days to help with daily tasks. After rhinoplasty, chewing can be uncomfortable, so patients should buy plenty of soft foods to eat during the first several days.

The Day of Surgery

The night before their procedures, patients should get a good night's rest, and they should not eat or drink anything after midnight. Before coming to the hospital or surgical center, they should wash their faces and hair to avoid bacterial contamination. For the same reason, they should avoid makeup and other cosmetic products.

The Procedure

Because there are so many types of rhinoplasty and different goals for the treatment, the procedure varies widely for each person. However, there are certain steps that are common to all nose reshaping surgeries.

Anesthesia

Doctors perform rhinoplasty using one of two sedation methods:

  • General anesthesia: Administered with a mask or IV, general anesthesia puts patients completely to sleep.
  • IV sedation: A doctor numbs the face with local anesthesia and administers a powerful intravenous sedative. The patient experiences a "twilight sleep" and will remember little, if anything, about the surgery when the medication wears off.

Doctors work with each patient to determine the best type of anesthesia for his or her needs. With both methods, patients do not experience any discomfort during the surgery. However, some individuals may experience less anxiety, knowing they will be completely asleep.

The Surgical Process

After the patient is sedated, the surgeon creates tiny incisions inside the nostrils or on the columella. Then he or she carefully lifts the skin to access the underlying bone and cartilage. The surgeon can then remove or graft tissues, as needed. Typically, a doctor uses conservative methods to minimize the impact to the surrounding tissues while still achieving the desired results. When the reshaping process is complete, the doctor lays the skin back down over the new contours of the nose and closes the incisions.

Nasal Packing

In the initial days after rhinoplasty, it is important that the changes to the nasal tissue be preserved. After closing the incisions made during surgery, a surgeon will place a splint to help retain the new shape of the nose. In some cases, the doctor may also place pieces of gauze, or nasal packing, inside the nostrils. The material will help reduce bleeding and keep the septum in place. The gauze may cause some discomfort. However, it is typically removed within a few days of surgery, and goes a long toward maintaining the results of surgery.

Combining Rhinoplasty with Other Procedures

Because the nose plays such a prominent role in the facial structure, many patients choose to have additional treatments along with their nose jobs. These procedures can help to maintain the balance of the face and provide more dramatic results. In most cases, combining rhinoplasty with one or more additional treatments is quite safe. However, to ensure safety and good results, patients should choose surgeons who are experienced in all areas of facial plastic surgery.

Chin Surgery

Chin augmentation and chin reduction are the two most common treatments to combine with rhinoplasty. To perform chin augmentation, a surgeon places a silicone implant through an incision inside the mouth or just under the chin. In chin reduction, the incisions are placed in the same locations. Then the surgeon reshapes the chin bone, carefully removing millimeters of material to create a more aesthetically pleasing shape.

Cheek Augmentation

With an improved nose, many patients want to enhance the surrounding areas with cheek augmentation. This can be performed in one of three ways. First, a surgeon may place silicone implants, often through incisions on the inside of the mouth. More conservatively, a doctor may recommend fat grafting or dermal fillers.

To perform fat grafting, a doctor uses liposuction to remove unwanted fat cells from another part of the body. Then he or she will purify the cells and inject them at varying depths in the face to create more defined cheekbones and a youthful appearance. Dermal fillers add volume to the face, and in some cases, they can even increase collagen production. The results can last for months, and patients may undergo routine touchups.

Facelift

Many patients choose to combine rhinoplasty with a facelift for dramatic results and an overall more youthful appearance. This procedure can treat creases and sagging skin, particularly around the eyes, cheeks, chin, and mouth. There are several types of facelifts, and patients can choose a mid, mini, or lower facelift to address specific areas of concern. Through carefully concealed incisions, the doctor raises the facial muscles, removes unwanted fat deposits, and trims away extra skin. Following a facelift, patients may look significantly younger.

Brow Lift

Like facelift surgery, brow lift surgery eliminates sagging skin and reduces deep creases. However, brow lifts specifically target the forehead and the area between the eyebrows. The doctor creates an incision along the hairline or the crown of the head. Then he or she lifts the underlying muscles to reduce frown lines, vertical creases, sagging eyebrows, and hooded brows.

Blepharoplasty

Blepharoplasty, or eyelid surgery, is a great way to address sagging eyelids and give patients a more alert, youthful appearance. The treatment can address the upper eyelids, lower eyelids, or both. The doctor creates tiny incisions in the lash line or along the eyelid crease. Then he or she raises the surrounding muscles and removes fat deposits.

Recovery

Rhinoplasty can involve several weeks of recovery, and patients should take special steps to enhance their recovery and ensure good aesthetic results.

The First Several Days

During the first 48 hours after surgery, it is important to get plenty of rest. In particular, patients should:

  • Sleep with their heads elevated
  • Wear clothes that button, rather than go on over the head
  • Brush their teeth gently to avoid irritating the upper lip and nose
  • Keep their faces still as much as possible
  • Apply cold compresses to the nose and mid-face
  • Eat soft foods that still have plenty of nutrients and fiber
  • Take baths, rather than showers, while the bandages remain in place
  • Avoid blowing their noses
  • Change bandages and gauze, as instructed by their doctors

The First Several Weeks

Typically, patients can return to work within two weeks of their surgeries. However, they should continue to monitor their activity level and protect the tender nasal tissues. Among other things, patients should:

  • Avoid strenuous exercise until otherwise instructed by their surgeons
  • Limit sodium intake to reduce post-surgical swelling
  • Wear sunscreen with at least 30 SPF whenever they go outside
  • Not wear glasses or sunglasses for at least four weeks (if needed, patients can use chin rests to support the frames)

It is especially important for patients to make routine follow-up appointments with their surgeons. Usually, the first appointment will take place one week after surgery. At this time, doctors will typically remove any stitches and nasal packing. Then patients will have periodic checkups for the next several months.

Results

Rhinoplasty surgery is one of the most common plastic surgeries performed each year. This procedure allows surgeons to make a number of changes to the structure of the nose, drastically altering a patient's appearance. However, as with any other surgical procedure, it is important for individuals to understand all possible outcomes and set realistic expectations before undergoing rhinoplasty.

Setting Expectations for Nose Surgery

Rhinoplasty surgery, also known as nose reshaping surgery, can be used to correct a number of aesthetic flaws. The surgery can result in a greater balance of facial features, the elimination of bumps or unevenness, and a noticeable change in the size of the nose. In order to achieve ideal results, however, it is important for patients to be completely candid with their surgeon prior to surgery.

In the initial surgical consultation, patients should discuss their specific needs and aesthetic goals to ensure that these goals are realistic. While rhinoplasty can achieve dramatic results, the procedure will not completely alter a patient's appearance. Rather, it is intended to enhance an individual's beauty and correct minor to moderate imperfections. Fortunately, even small changes can have major, positive effects on a patient's overall appearance.

A Preview of Rhinoplasty Results

With modern technology, patients can actually get a picture of the results of their rhinoplasty surgery. Digital imaging technology allows surgeons to construct 3-D virtual models of a patient's face and the future appearance. It is important to note, however, that while this 3D model will serve as a guide for the surgeon, there is no guarantee that the nose job will yield those precise results.

View Rhinoplasty Before & After Photos

How Long until I See the Final Results?

Rhinoplasty is unique in that the final results of the surgery can take up to one full year to develop. Side effects such as swelling and bruising around the nose and eyes can hinder the appearance of the nose for the first two to three weeks. While more obvious changes may be visible in the first weeks following surgery, most individuals will need to be patient in regards to the final outcome. In the months following surgery the nose will begin to settle in to its final shape. Because the final results of rhinoplasty take a significant amount of time, doctors usually discourage patients from undergoing revision rhinoplasty until a full year has passed.

Will There Be Permanent Scarring?

As with almost all forms of plastic surgery, there is a possibility for scarring following rhinoplasty. In closed rhinoplasty, all incisions are made inside the nostrils and will therefore not leave behind any visible scars. In open rhinoplasty, an additional incision made across the columella may leave a small scar behind. Fortunately, due to the size and location of the incision this scar is usually unnoticeable.

What If I Am Not Happy with My Results?

Unfortunately, despite a surgeon's best efforts, in some cases a patient may be unhappy with the results of his or her surgery. This can result from numerous causes, including surgical error or unrealistic expectations on the patient's part. Because the final results of rhinoplasty can take up to a year to develop, patients should not panic if their noses have not taken their ideal shape in the first few months. If a patient is unhappy with the nose even after the final shape has stabilized, there are options for treatment and correction. Depending on the extent of changes that need to be made, a surgeon may recommend non-surgical nose reshaping or secondary (revision) rhinoplasty.

Aesthetic Benefits

The most common reason for patients to undergo rhinoplasty surgery is to improve the appearance of their nose. Many individuals feel that the size or shape does not match the rest of their facial features, and they choose surgery to bring a harmonious balance to the face. During rhinoplasty, changes can be made to the bridge, tip, and nostrils, making nose reshaping a versatile procedure. Choosing a qualified surgeon to perform rhinoplasty surgery will ensure that patients receive the most beneficial outcome. Among the aesthetic rhinoplasty benefits are:

  • Facial Symmetry - The slightest imbalance in a person's nose can make a distinct difference in their appearance. Rhinoplasty can create a more balanced look.
  • Improved Shape- Altering the bridge or tip of the nose can draw attention to other areas of the face.
  • Proportionate Size - Reducing the width of the nose, even by a small amount, can have a significant effect on how the nose fits in with the rest of the facial features.
  • Removal of Bumps or Crookedness ­- Whether congenital or caused by past injury, rhinoplasty can correct imperfections on the bridge of the nose.

Health Benefits

In addition to cosmetic advantages, rhinoplasty can correct health-related issues. The two main functional rhinoplasty benefits are:

  • Improve Breathing Difficulties - Rhinoplasty can open narrow nasal passages and correct structural abnormalities, improving a patient's breathing abilities
  • Correct Birth Defects - Nose surgery can address external abnormalities, as well as internal birth defects, such as a deviated septum.

When rhinoplasty is performed for functional reasons, insurance may actually cover the cost of the procedure.

Quality of Life

In addition to the physical benefits of rhinoplasty, the procedure has psychological benefits as well. Individuals who are unhappy with the size or shape of their nose often feel self-conscious about their appearance and may suffer from low self-esteem. After undergoing rhinoplasty surgery, however, many patients report a marked boost in confidence. This benefit alone can be a great reason for patients to choose rhinoplasty.

Risks

When performed by a qualified plastic surgeon, rhinoplasty is a safe procedure with few long-term complications. However, all surgeries do carry some risks. It is important for patients to be aware of these risks so that they can monitor their healing and contact their doctor if they notice anything unusual.

Potential Complications

Though rare, rhinoplasty risks may include:

  • Infection
  • Adverse reactions to anesthesia
  • Unfavorable cosmetic outcomes, including asymmetry
  • Unfavorable scarring
  • Numbness
  • Difficulty breathing
  • Chronic nosebleeds
  • A perforated septum
  • Hematoma (blood collecting under the skin)
  • Burst blood vessels
  • The possibility of revision surgery

Minimizing Risks

As stated above, these complications are unlikely. However, patients can take steps to reduce their risks even further. First, they should choose a qualified surgeon, according to the guidelines listed above. Selecting an outstanding doctor, who maintains proper safety standards, can minimize the chances of infection, perforation, and other difficulties. An experienced surgeon can also ensure aesthetically pleasing results.

Second, patients should follow all pre-surgical and post-surgical instructions. These guidelines do not only help to minimize discomfort; they also speed healing and protect patient safety.

Finally, individuals should maintain open communication with their doctors throughout the process. They should be as specific as possible regarding their treatment goals, and they should be honest about their medical history, medications, smoking habits, and related concerns.

Temporary Side Effects

Although long-term complications are rare, rhinoplasty can have some temporary side effects. These include:

  • Bruising: Bruises are typically located around the eyes, and they usually dissipate within 10 days of surgery.
  • Discomfort: Patients may experience soreness and irritation, particularly in areas where the doctor reshaped the nose or removed tissue for a bone graft. In most cases, patients can control discomfort with over-the-counter pain medication.
  • Swelling: The most noticeable swelling will usually subside after a few weeks. However, it may take six months to a year to completely go down.
  • Anesthesia side effects: Some patients may feel nauseous under anesthesia, but this sensation typically wears off with the effects of the medication.
  • Sinusitis: Patients may experience some inflammation of the sinus passages, along with temporary changes in voice and excess mucus production.
  • Nosebleeds: It is normal to have some blood discharge for up to 72 hours after rhinoplasty. Although spontaneous nosebleeds after this period are not typically serious, patients should alert their surgeons if this occurs.

Minimizing Side Effects

Although these side effects will eventually go away on their own, patients can take precautions to minimize their severity and speed recovery. Pain medication can reduce discomfort, and antibiotics can help control the symptoms of sinusitis. Some surgeons may prescribe drugs immediately after treatment. Patients should take these medications as directed. They should always finish each prescription, unless otherwise instructed by their doctors.

The other way to minimize side effects is to get plenty of rest. Patients should follow the tips listed above, in regards to recovery. They should adhere to any additional guidelines provided by their doctors.

Secondary Rhinoplasty

Revision (secondary) rhinoplasty is a cosmetic surgery that is performed when a patient is not satisfied with the outcome of his or her initial procedure. In some cases, patients may be unhappy with the appearance of their noses, while others may experience functional difficulties after surgery. Additionally, a patient may need a secondary procedure if he or she suffers traumatic injury following the first nose reshaping surgery.

Revision rhinoplasty is similar to primary rhinoplasty, and it can be performed as an "open" or "closed" procedure. In closed rhinoplasty, the surgical incisions are made inside the nose to eliminate the appearance of scarring. With open rhinoplasty, an additional incision is made across the columella. While this leaves a small scar, it gives the surgeon more access to the nasal tissue and bone. The goals of your rhinoplasty revision will dictate the type of surgery you receive.

Secondary rhinoplasty differs from the primary procedure in that it may require cartilage or bone grafting. If too much tissue or bone was removed in the first surgery, the doctor will need to replace this in order to achieve the desired look. Often, cartilage is taken from the ear or other areas of the nose. In rare cases, it is harvested from a rib, in what is known as a costal cartilage graft.

Secondary rhinoplasty procedures may also be more difficult to perform than traditional rhinoplasty surgery because the septum may have been altered or partly removed during the first surgery. Additionally, secondary rhinoplasty may be more complex if the skin is thicker and more difficult to work with or if the patient's airway has been impeded.

Candidacy

Patients who are unhappy with their previous nose job results are candidates for secondary rhinoplasty. Whether the nose is deemed too small, too large, or improperly shaped, a skilled surgeon may be able to correct the problem. Patients who experience breathing difficulties following rhinoplasty may also opt to undergo a second procedure. Factors influencing candidacy for revision rhinoplasty include:

  • The number of past nose surgeries
  • Goals for revision surgery
  • The amount of nasal tissue

Patients who have significant scar tissue left from previous surgeries may not be suited for revision rhinoplasty. A personal consultation, which many cosmetic surgeons provide free of charge, is the best way for patients to determine if they are good candidates for the procedure.

Risks and Benefits: What You Should Know about Secondary Nose Reshaping

The main benefit of revision rhinoplasty is that it can help patients receive the final outcome they desire, and it can give them their long-awaited boost of confidence. This secondary surgery can also improve breathing and the functionality of the nose.

Revision rhinoplasty has the same risks as first-time rhinoplasty, including bleeding, infection, scarring, nerve damage, and burst blood vessels. Patients also run the risk of further disappointment with their results, and following one revision surgery, they may not be able to undergo another secondary procedure.

Patients should communicate with their surgeons to ensure satisfaction with the results of their surgery. It is also important to choose a certified, well-recommended plastic surgeon. Patients should select a rhinoplasty surgeon who understands their aesthetic goals and makes realistic predictions about the final results.

Safety Data

Dr. S. Valentine Fernandes, the Conjoint Senior Clinical Lecturer, at the Department of Otorhinolaryngology, Newcastle University, conducted a comprehensive study about the risks of rhinoplasty. According to Fernandes, the complication rate of nose surgery falls between 4 and 18.8 percent. While this may seem an alarming number, Fernandes reports that there is a much lower 1.7 to 5 percent risk of life threatening complications. He also notes that the complication rate falls in proportion to the doctor's surgical experience.

Specific Risks

Fernandes also provides a detailed breakdown of the risks for individual complications:

  • Excessive bleeding during surgery occurs in 0.3 to 1 percent of nose surgeries.
  • Excessive bleeding after surgery occurs in 2 to 4 percent of nose surgeries.
  • Wound infections occur in less than 2 percent of all nose surgeries.
  • The rate of toxic shock syndrome following rhinoplasty is 0.016 percent. 11 percent of these cases are fatal.
  • Anosmia (the inability to smell) affects 1 percent of rhinoplasty patients.
  • Reports of septal perforation vary widely, and they may occur in 3 to 24 percent of rhinoplasty cases.
  • Bossae (bumps that arise on the tip of the nose) appear following 2 percent of nose surgeries.
  • 5 to 15 percent of patients require secondary rhinoplasty.[ii]

Statistics

According to the American Society of Plastic Surgeons®, rhinoplasty is the second most popular cosmetic procedure in the country. Doctors performed 221,053 nose jobs in 2013. The treatment enjoys immense popularity among both sexes; 163,662 rhinoplasty patients were women, and 57,391 (26 percent) were men.[iii]

Age

When performed by a qualified surgeon under proper circumstances, rhinoplasty is safe for a broad age range. As you can see from the following 2013 data, supplied by the ASPS, the procedure enjoys widespread popularity:

  • 30,672 were between the ages of 13 and 19
  • 69,748 were between the ages of 20 and 29
  • 53,254 patients were between the ages of 30 and 39
  • 45,299 patients were between the ages of 40 and 49
  • 1,434 patients were 55 or older[iv]

Geography

You may be surprised to learn that rhinoplasty is more popular in some parts of the country than others:

  • 65,458 (30 percent) of nose jobs occurred in the New England/Mid Atlantic region (CT, ME, MA, NH, RI, VT, NJ, NY, PA)
  • 57,598 (26 percent) of nose jobs occurred in the Mountain/Pacific region (AZ, CO, ID, MT, NV, NM, UT, WY, AK, CA, HI, OR, WA)
  • 39,955 (18 percent) of nose jobs occurred in the East and West South Central regions (AL, KY, MS, TN, AR, LA, OK, TX)
  • 30,485 (14 percent) of nose jobs occurred in the East and West North Central regions (IL, IN, MI, OH, WI, IA, KS, MN, MO, NE, ND, SD)
  • 27,557 (12 percent) of nose jobs occurred in the South Atlantic Region (DE, DC, FL, GA, MD, NC, SC, VA, WV)[v]

Frequently Asked Questions

How long does rhinoplasty take?
Typically, nose-reshaping surgery takes about an hour to two hours, although it may be longer, depending on your surgical goals. Secondary rhinoplasty often lasts around four hours. Again, this will depend on your needs and your doctor's specific techniques.

Am I too old for rhinoplasty?
There is no upper age limit for nose reshaping surgery. However, to avoid risk of infection and anesthesia complications, you should be in good physical health. Additionally, for optimal aesthetic results, you should have good skin elasticity. Some doctors may recommend that older patients receive IV sedation, rather than general anesthesia.

Are there any non-surgical alternatives to rhinoplasty?
Doctors have recently developed a non-surgical nose job, using dermal fillers to enhance the shape of the nose in one 15-minute treatment. By injecting fillers, such as Radiesse® or Restylane®, the doctor can correct minor asymmetry and make other changes. However, if you are looking for more dramatic results, or if you require reduction rhinoplasty, surgery is the only option. Additionally, a non-surgical nose job cannot treat a deviated septum or other breathing issues. While nasal strips can enhance your breathing, surgery is the only way to permanently treat these conditions.

Can I fly after rhinoplasty?
Some doctors may advise you to wait about a week before getting on a plane. However, other surgeons say that it is safe to fly immediately. If you do choose to fly, be sure to keep your nose hydrated with saline spray during the course of the flight.

Should I eat special foods after rhinoplasty?
On the day of your surgery, you should not eat anything before the procedure. Because chewing involves moving the entire face, doctors typically recommend a soft or liquid diet for the first several days. You will be able to return to solid food whenever it is comfortable for you. Additionally, you should avoid spicy foods, as they can constrict the blood vessels and lead to increased bruising.

Can a doctor correct my broken nose, even if the injury occurred years ago?
Yes. Although it is best to seek treatment as soon as the break happens, a doctor can usually correct the injury by re-fracturing and re-aligning the bone.

Will my nose keep growing and will this affect the outcome of my rhinoplasty procedure?
The nose stops growing at around age 16. Over time, however, the skin may stretch and the tip may begin to droop. Rhinoplasty can correct these effects, but it cannot stop the aging process.



[i] 2013 Cosmetic Plastic Surgery Statistics. (American Society of Plastic Surgery®, 2014) < http://www.plasticsurgery.org/Documents/news-resources/statistics/2013-statistics/cosmetic-procedures-national-trends-2013.pdf>

[ii] Fernandes, S. Valentine, MBBS, MCPS, FRCSEd, FRACS, FACS, LLB. Complications of Rhinoplasty. (Medscape, 2012) < http://emedicine.medscape.com/article/843439-overview#a0101>

[iii] 2013 Plastic Surgery Statistics Report. (American Society of Plastic Surgery®, 2014) <http://www.plasticsurgery.org/Documents/news-resources/statistics/2013-statistics/plastic-surgery-statistics-full-report-2013.pdf>

[iv] ibid

[v] ibid

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