Rhinoplasty (Nose Job)

The nasal bones form the upper third of the nose and contribute to the size and shape of the nose overall. These bones can be shaped or manipulated in many ways during rhinoplasty surgery. Often, they are filed down or rasped to take away a bump. They can also be cut and moved around to narrow or widen the bridge. Nasal bone reshaping is often necessary after nasal trauma or fracture as well.

Nasal polyps are benign, soft growths that arise from the lining of the inside of the nose or sinuses. They often grow in clusters and can get progressively larger over time. If not treated, a severe case of polyps could slowly change the shape of the nose over time by pushing on the walls of the nose. However, polyps this severe would likely be causing nasal obstruction, or other symptoms, and be treated long before the outer shape of the nose was affected.

Rhinoplasty is one of the most common cosmetic procedures performed around the world. It has a very long track record, and when performed appropriately, the procedure is perfectly safe. However, there can be risks to the anesthesia required so a full preoperative medical evaluation should be considered for any patient undergoing rhinoplasty surgery.

Surgical changes are generally permanent, so it’s unlikely your nose will one day “return” to how it looked before your surgery. However, your nose will continue to mature over time, regardless of whether you had a rhinoplasty procedure, and depending on the technique used during your surgery, you may see changes as your nose ages. Most of the time these changes are consistent with normal aging, like the rest of your face, and don’t represent a problem. Rarely, these changes can negatively affect the appearance or function of your nose and might need a revision procedure. Here at the Cohen Clinic for Plastic Surgery, we prefer to use advanced techniques that return structure and support to your nose so that it holds up better over time.

The nasal septum is the inside wall running down the middle of your nose that divides the left airway from the right. It is made from cartilage and bone and can be crooked, bent, or deviated either from birth or from nasal trauma. This can lead to both functional and cosmetic issues, since the septum supports the bridge of your nose as well. Just like a center pole supporting a tent, if the septum is deviated it can make the outside of your nose look crooked as well. Depending on which part of the septum is being operated on, septum surgery could, therefore, affect the outside of your nose. If only the bottom is addressed, to improve breathing for example, then the outside should look the same. If it’s the top of the septum that needs adjusting, then altering this portion of the septum could change your nose, but typically this is done to achieve a straighter and more functional nose.

Every surgeon has specific preferences for the best way to prepare for a rhinoplasty so follow the preoperative instructions provided by their office. Generally speaking, you’ll want to avoid any medications or supplements that could increase bleeding for at least 2 weeks before your procedure. Smoking and alcohol should also be avoided prior to surgery. Stock up on nasal saline spray (salt water) in order to keep your nose hydrated, and also keep a humidifier at your bedside to moisten your airways at night. A wedge pillow or a recliner can be helpful to keep you elevated and minimize your swelling during sleep. Small reusable ice packs are also good to have around to reduce postoperative bruising. Lastly, take this time to ensure you are comfortable with your surgeon and your operative plan and review any last minute questions if necessary.

Recovery after rhinoplasty can vary greatly depending on many factors. Swelling typically gets worse for the first several days and peaks between days 2 and 4 for most patients. Topical ice and oral supplements can help minimize this early swelling. During the second week of healing many patients notice significant improvement and often feel “restaurant ready” by around day 14. Swelling near the tip of the nose tends to linger the longest, and may persist for 3 to 6 months before improving. The nose will continue to subtly refine for an additional 6 months to reach its “final” shape around one year after surgery.

Non-surgical, or “liquid,” rhinoplasty can last for months to years based on multiple factors including technique, product used, and placement. Typically, patients enjoy their results for 9 to 12 months, at which time a “touch-up” can be performed to further enhance or restore the result. It is extremely important to consult with a board-certified expert injector who performs this procedure frequently as there are significant risks that should be thoroughly discussed prior to proceeding.

Recovery after a rhinoplasty varies from patient to patient. Each patient has a different experience based on surgeon, technique, and individual case complexity. We often advise our patients that while you should hopefully look “restaurant ready” by two weeks, healing can sometimes take up to one year or longer to see the “final” results. It is important to have an open and trustworthy relationship with your surgeon and their team in order to have the best experience and ensure optimal recovery after your rhinoplasty.

A closed rhinoplasty means all of the incisions are placed on the inside of the nose, so there is no chance of visible scarring. This technique is preferred by many surgeons since it can decrease operative time and may lead to a shorter recovery. However, visibility is significantly reduced and it can be difficult to precisely secure cartilage grafts that are used for added support and structure. For these cases, an open rhinoplasty is preferred, which adds a tiny incision across the columella (which is that strip of skin dividing your nostrils). When closed meticulously, this incision should result in a nearly invisible scar.

There are a variety of nose job or rhinoplasty types ranging from surgical to non-surgical. Common surgical rhinoplasties include open rhinoplasty, closed rhinoplasty, septoplasty, and alarplasty (nostril base reduction). Non-surgical rhinoplasty is often called “liquid” rhinoplasty, and is done by injecting a dermal filler gel into the nose to alter its shape. The type of rhinoplasty that is right for you is based on your individual anatomy, your desired result, and your relationship with your surgeon.

A rhinoplasty can help with sinus problems, but does so indirectly. Sinus disease typically requires topical medications be used within the nose, but if your nose is blocked or crooked then these medications may not be able to get into the sinuses effectively. Rhinoplasty surgery can help open your nasal airway and ensure you have good access to treat your sinus problems as prescribed. It is important to find a surgeon that understands your goals clearly and can help educate you on the role of rhinoplasty in treating your sinus problems.

Nasal splint types and duration vary based on surgeon, facility, technique, and case specifics. Here at the Cohen Clinic for Plastic Surgery we almost never use internal splints or packing after septoplasty or rhinoplasty. These are reserved for very specific septum repair procedures. If placed, they are typically removed one week later, but as noted, this is unusual in our practice.

An external or “open” rhinoplasty is a specific technique that includes a small incision across the columella (the skin between your nostrils). This allows the surgeon to fully visualize the nose and make more precise sutures or cartilage graft placements. When closed appropriately, the small external incision should result in a nearly invisible scar that generally heals very well.

Rhinoplasty or “nose job” results are dependent on your individual anatomy, your goals, and also the aesthetic of your surgeon. Here at the Cohen Clinic for Plastic Surgery a “smaller” or more “refined” nose is one of our most popular requests! This is typically done by trimming excessive cartilage and shaving or recontouring the nasal bones, which are common maneuvers done during rhinoplasty. It is very important to review digital simulations with your surgeon during your consultation to ensure you are on the same page when it comes to your desired results.

Spreader grafts are pieces of added cartilage placed between the septum and the upper lateral cartilages. They are often used to open a part of the nasal airway called the “internal valve,” which helps improve breathing. They can also be used to help straighten a very crooked nose. However, since the upper lateral cartilages form the sides of the nasal bridge, spreader grafts can definitely widen the nose. This should be accounted for to ensure the added width is not excessive.

Recovering from a rhinoplasty is a very individualized experience. Overall, most of our patients report a relatively smooth recovery and usually just complain of mild “discomfort”. Our team is extremely dedicated to patient care and is always available every step of the way to ensure your recovery is as good as possible.

The time it takes to perform a rhinoplasty varies widely and depends on multiple factors including surgical technique, anesthesia protocol, and patient characteristics such as bleeding. Depending on the complexity of the procedure a surgery could take anywhere from one to several hours, or longer. Secondary or revision procedures, or those needing additional maneuvers like ear or rib cartilage harvest, may take longer. It’s important to realize that doing the procedure quickly should never be the goal. Your final result is all that matters.

Cost of cosmetic surgery varies greatly based on factors such as location, surgeon experience, and case complexity. As a result, a rhinoplasty could be done for as low as $5,000 in some cases, or as high as $50,000, or more. Regardless, it’s important to find a surgeon and team where you feel a connection, so at whatever the price you recognize and appreciate the value. The information contained in this transmission may contain privileged and confidential information, including patient information protected by federal and state privacy laws. It is intended only for the use of the person(s) named above. If you are not the intended recipient, you are hereby notified that any review, dissemination, distribution, or duplication of this communication is strictly prohibited. If you are not the intended recipient, please contact the sender by reply email and destroy all copies of the original message.