Nose Reshaping Surgery
The prominence of the nose makes it a natural focal point on the face. A beautiful and proportionate nose can enhance your entire appearance. Rhinoplasty can effectively reshape and balance the nose for an improved appearance and boosted confidence. It can also correct breathing issues and other functional defects. Choosing an experienced surgeon is absolutely essential to ensure natural-looking results, since this is one of the most challenging cosmetic surgeries to perform. I hold my rhinoplasty patients to rigorous candidacy standards and spend a considerable amount of time on the consultation and pre-operative experience.
An Introduction to Rhinoplasty
Also known as nose reshaping surgery or a “nose job,” rhinoplasty can include several types of refinements. The procedure can build up, straighten, or reduce the bridge of the nose. It can refine the nostrils. Some rhinoplasty patients may choose to have the tip of the nose refined in terms of size and shape.
History of the Procedure
The American Society of Plastic Surgeons reports that rhinoplasty is among the five most popular plastic surgery procedures. The first documented rhinoplasty was performed by a Hindu surgeon in about 500 BC. The reconstruction involved a flap of skin that was taken from the forehead and used to create a new nose. This method of transferring tissue from the forehead was used by the English into the 1700s. Throughout this time, rhinoplasty was used for reconstructive purposes, mainly to correct war wounds or the effects of syphilis. The first cosmetic rhinoplasty was performed in 1898. Undergoing rhinoplasty for cosmetic purposes surged in popularity in the 1930s, when Hollywood actors and actresses sought the treatment.
The American Society of Plastic Surgeons reports that rhinoplasty is among the five most popular plastic surgery procedures.
Today, advancements in both technology and techniques of rhinoplasty have made excellent results possible. Modern surgeons offer closed rhinoplasty (creating incisions inside the nose, with no need for external incisions resulting in visible scars), use porous grafting material that can guide the growth of new tissue, and perform revision rhinoplasty to correct unfavorable results of previous surgeries.
The Consultation Process
I have found that my patients are most satisfied with their results when we spend a significant amount of time in the consultation phase. The initial visit typically consists of reviewing medical, demographic, and background information. Your initial history will be conducted by a nurse who will discuss your medical problems, allergies, and any medications you currently take. Any breathing difficulties or history of sinus infections will also be discussed.
Patients will need to be in good overall health in order to be eligible for rhinoplasty. Any condition that makes surgery unsafe must be carefully considered. The quality of your skin will be evaluated, and if you smoke, you will be instructed to stop for a period of time before your surgery. Nicotine inhibits the body’s ability to deliver oxygen-rich blood to the treatment site, which can significantly delay healing and compromise the results of your treatment. Therefore, abstaining from smoking or breaking the habit altogether is advisable for anyone considering surgery of any kind.
Your Concerns and Desired Outcome
This appointment will also help your doctor gather information about your aesthetic concerns, pertaining either to the natural shape and size of your nose, or results of a previous rhinoplasty surgery. You will need to describe specific goals to your surgeon, such as:
- Narrowing the nostrils
- Reshaping the tip of the nose
- Straightening a crooked bridge or removing a hump
- Narrowing the bridge of the nose
- Modifying the angle between the nose and upper lip
I find it helpful to begin this discussion by handing the patient a mirror and simply asking, “If I could do anything, what would you like to see?” Although I let the patient lead this discussion, I make sure to gather specific and detailed information. Your doctor will examine the inside and outside of the nose, including the septum and nasal bones. At this point in the consultations I conduct, I sit the patient down again with a mirror and use a pointer to show them what I can improve.
Understandably, the most common question I hear during a consultation is, “Can you show me what I will look like?” The simple (and most accurate answer) is “no.” In my opinion, imaging software never provides realistic results. Remember: anything is possible on a computer screen, and may not represent what a surgeon can actually accomplish. Instead, ask to see before and after pictures of your surgeon’s work. Your doctor should be able to show you pictures of patients who have physical traits similar to yours, and have achieved aesthetic results similar to what you desire. It is also beneficial to watch testimonial videos or read reviews about the practice. Today, it is easier than ever to gain a fundamental understanding of a surgeon’s skill and reputation long before you even pick up the phone or send an email to his or her office.
You should also make sure to ask how often your surgeon must perform revision rhinoplasty, as well as the reasons why their patients pursue revision. I am transparent about not only what can go right, but also what can go wrong during rhinoplasty. Discussing limits of improvement, as well as a surgeon’s capabilities, is integral to developing realistic patient expectations and establishing trust.
Once your doctor has a complete and thorough understanding of your goals, and you have a clear understanding of what you can expect from your surgical results, your rhinoplasty can be scheduled. During a preoperative visit, the surgeon should explain the entire process and what to expect before, during, and after the procedure. You will likely need to undergo blood tests that require fasting, and you will be instructed to avoid certain medications like birth control, vitamins, and any drug that thins the blood. Our nurse is extremely detail-oriented, and takes time to recommend supplies to have on-hand after the surgery, along with other simple, helpful tips. Patient education is key to the success of any surgery, and it is important to choose a team that answers all your questions and addresses all concerns.
A Closer Look at the Procedure
On the day of your surgery, you will be greeted by a nurse who will escort you to a changing room. Many practices allow a loved one to accompany you until you must enter the operating room. Your medical records will be reviewed one more time, and you will be visited by an anesthetist who will explain what to expect. Rhinoplasty is often performed under light general anesthesia, and you will be closely monitored throughout the surgery. Before intravenous (IV) medication is administered, the injection site will first be numbed with a local anesthetic.
Patient education is key to the success of any surgery, and it is important to choose a team that answers all your questions and addresses all concerns.
Rhinoplasty generally takes about two hours to perform. During the procedure, the doctor will either remove, modify, or add tissue or synthetic materials. Surgery can be performed as an open or closed procedure. Open rhinoplasty involves lifting the skin off of the nasal structure to expose deeper layers of tissue. Closed rhinoplasty is performed using incisions hidden within the nostrils. Closed rhinoplasty is not only more difficult to perform, but also harder to teach due to a lack of visibility. Many surgeons who have little experience performing nose surgery use an open technique for that simple reason.
I perform a closed procedure in ninety-nine percent of my cases. This technique produces better outcomes since the patient will experience no visible scarring, and recovery time is minimized. Open rhinoplasty, in contrast, disturbs more blood supply and creates more scar tissue, which prolongs the healing process. And because the columella (the thin strip of tissue between the nostrils) is opened, the tip of the nose may remain swollen for a longer period of time. Once the refinements are complete, your surgeon will close the incisions and apply bandages.
Aftercare and Recovery
After your procedure, you will spend at least an hour in recovery. You can expect to have a plastic splint placed outside the nose, and soft packing will be placed in the nostrils. These bandages will make breathing through your nose difficult. A friend or family member will need to drive you home since you will be groggy from the anesthesia. Most patients will nap for at least a few hours after they return home.
You will be provided with detailed postoperative instructions that you will need to follow in order to achieve a fast and successful recovery. We provide printed instructions for easy reference. I personally follow up with each of my patients the evening of their rhinoplasty. Patients will generally be asked to return to their doctor’s office for a follow-up visit the following day. Packing inside the nose should be taken out within three to five days, and the splint will be removed about one week after surgery. I see my patients at three weeks, six weeks, three months, six months, and a year after surgery. Additional follow-ups can be scheduled to address any concerns at any time.
As you heal, swelling on the upper half to two-thirds of the nose will subside first. It is important to remember that it may take up to two years before swelling on the tip of the nose is completely resolved. I tell my patients that by following my instructions and attending their follow-up visits, they can expect to be 90 percent healed by one year after the procedure.
Weighing Your Benefits and Risks
Rhinoplasty can have a significant impact on your health, appearance, comfort, and self-esteem. But like any surgical procedure, it does carry a small degree of risk. You may be unhappy with the results of your procedure and require revisional rhinoplasty. Additional risks include an adverse reaction to the anesthesia, infection, numbness, chronic nosebleeds, a perforated septum, and difficulty breathing. In order to minimize your risk of complications, it is important not only to choose a board-certified surgeon with experience performing rhinoplasty, but also to research the surgical facility where your procedure will take place and make sure it is accredited. Standards vary state by state, so make sure to conduct research that is specific to your area.
Although more experienced surgeons do not always charge more for their services, the cost of your treatment should not be your primary concern.
In my practice, the surgeon’s fee for primary rhinoplasty is $5,000 and revision starts at $6,000. If the revision rhinoplasty is performed using an open technique, the cost will rise to $7,500. Facility fees begin at $1,700 and anesthesia costs range from $600 to $750. Rhinoplasty costs will obviously vary from practice to practice, but this is not a time to try and cut costs. Although more experienced surgeons do not always charge more for their services, the cost of your treatment should not be your primary concern. Costs will generally be higher in cities and metropolitan areas.
The cost of rhinoplasty should not be prohibitive. Your medical team should recognize the importance of the investment, and offer solutions to make the procedure affordable. In the case that your procedure is strictly cosmetic and not covered by insurance, you can expect to be presented with financing options to meet your budget. In addition to cash, check, and all major credit cards, most cosmetic surgery practices offer some type of in-house or third-party financing. Some third-party lenders offer fixed-interest repayment plans or no-interest plans for patients who pay within a specific time frame.
Choosing a Surgeon
Rhinoplasty is a very unique type of facial cosmetic surgery. It requires a three-dimensional approach, in contrast to procedures like a blepharoplasty or eyelid surgery. Simply put, it is one of the most difficult procedures a plastic surgeon can perform. For this reason, some doctors are hesitant to perform it, or do not enjoy it. Personally, I believe your chosen rhinoplasty surgeon should be genuinely passionate about the procedure and the enhancements it can provide.
I believe attractive, natural-looking rhinoplasty should not only provide a beautiful nose, but also enhance your other features. Your doctor should strive for balance and proper proportions, with the ultimate goal of complementing your entire face. In addition to choosing someone who performs rhinoplasty regularly, you should also feel comfortable with the doctor.
Case Study: Kim
My patient Kim suffered from a combination of breathing problems and cosmetic concerns from a prior rhinoplasty. She felt that the first procedure did not produce dramatic enough aesthetic changes.
“I was originally drawn to Dr. Newman due to his credentials and reputation, and certainly pictures of his work,” she said. “I consider myself a very good judge of character, and when I met with him in person, I was convinced he would do a good job. “
During the consultation, Kim noted that I was able to understand certain things that she couldn’t describe and also that I noticed certain deformities of which she was unaware.
“You want someone who is a specialist in the area, who doesn’t just do what the patient asks for,” she said. “Dr. Newman listened but he also educated me. He has the experience and confidence to explain limitations, and also the creativity and problem-solving skills to find a solution. It really comes down to the confidence that he instilled in me.”
Case Study: Monica
Monica was born with a cleft palate that affected the anatomy of her nose. Although she underwent surgery to correct her palate, as a teenager, she felt her nose had become more crooked over time. Monica received a referral from a friend, but as a medical professional, her intimate knowledge of what these procedures entailed led to some hesitancy.
“It’s a scary thing to surrender yourself in that way,” she said, “especially for an elective surgery.” After her initial consultation, however, Monica said, “I felt comfortable and welcome as soon as I walked in. Everyone was warm and non-judgemental.”
Monica repeatedly stated how she appreciated my staff’s communication. “Everyone was very clear about what to expect and what they were doing, and constantly checked in to see whether I had any questions or concerns,” she said.
She noticed small details that only another medical professional could, including how I make sure to speak to my patients at their eye level. “And one thing that stood out to me is before the surgery,” Monica said, “Dr. Newman sat with me, comforted me, and reaffirmed what we had discussed in my consultation. He said, ‘We’re going to get great results.’”
Today, she is extremely happy with the appearance of her nose. “Dr. Newman is professional, kind, and gentle,” said Monica, “and most importantly, incredible at what he does. He did a great job and I would absolutely recommend him to other patients.”
Improve Your Appearance with Rhinoplasty
When performed by an experienced surgeon who focuses on your goals, rhinoplasty can make a major improvement in your quality of life. Thoroughly researching a doctor is the first step in the process. Once you have selected a surgeon, understand the risks of the procedure, and have formed realistic goals for your rhinoplasty, you can expect to undergo a safe procedure that helps you feel more confident in your appearance.
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