Written by Andrew Proulx, MD
What is rhinoplasty?
Are you unhappy with the current shape, size or appearance of your nose? If yes, you may be an ideal candidate for rhinoplasty. Rhinoplasty may be performed for aesthetic reasons or for reconstructive purposes following trauma, developmental defects, or skin cancer.
During rhinoplasty, the bone, cartilage, and other tissues in the nose are reshaped to create the desired appearance or functionality.
What concerns can it address?
Some of the most common complaints from people considering rhinoplasty are:
- Nose is too thick
- Nose is too thin
- Tip is too pointy
- Tip is upturned
- Nostrils are too wide or flared
- A bump on the bridge
- Nose bends to the left or right or is not symmetrical
In addition to these cosmetic conditions, rhinoplasty may be used to correct a deviated septum, which often contributes to sleep apnea. Rhinoplasty surgery is also used to repair damage caused by an injury, accident, or birth defect.
Are you a candidate?
In most cases, rhinoplasty patients should be at least 18 years old so that the nose can fully develop. However, younger patients may undergo rhinoplasty surgery in the case of birth defects or structural damage.
There is no upper age limit for rhinoplasty candidates, and it can be performed on men and women of any ethnicity.
In general, you may be a good candidate if your:
- Facial growth is complete
- In good overall health
- A non-smoker
- Realistic expectations about your results
One of the most important factors to a successful rhinoplasty result is the thickness of the skin covering the nose. In patients with thin skin, comparably minor corrections in the underlying bone or cartilage create significant visual changes. In patients with thicker skin, the same changes may have less noticeable results.
What to know beforehand
Today’s rhinoplasty is now more predictable, more accurate, and more effective than at any other time in its history. With the right combination of surgical skill and favorable tissue, cosmetic rhinoplasty can produce a naturally beautiful nose that will flatter the face and last a lifetime.
It is important to educate yourself and have realistic expectations before you undergo surgery. These are some things rhinoplasty patients wish they had known beforehand:
- There’s a big distinction between septoplasty and rhinoplasty. The term “nose job” conflates these two separate procedures. A deviated septum is a condition where the bone and cartilage that separate the nasal cavity is off-center or crooked. Septoplasty is an internal surgery that straightens the septum and helps alleviate any breathing issues stemming from blockage of the nasal passages.
- Rhinoplasty can be performed when the nose has completed 90% of its growth, which can occur as early as age 15 or 16 in boys and 13 or 14 in girls however parental consent is required for patients under the age of 18.
- There are non-surgical options. Rhinoplasty surgery is the best way to make long-lasting changes to your nose. However, if you are only seeking subtle changes, there may be a non-surgical solution. Dermal fillers like Restylane, Juvederm and Radiesse can help with minor issues including small humps, bumps, or slight asymmetry. While non-surgical options are associated with minimal discomfort, results are temporary.
- Rhinoplasty is among the most difficult of all cosmetic surgeries. Poor surgical technique can lead to permanent deformity, so it is important to choose your surgeon carefully.
- No rhinoplasty result is ever absolutely perfect. An accomplished surgeon who specializes in rhinoplasty can deliver exceptional results, but without experience, artistic skill and technical expertise, a good cosmetic outcome is all but impossible.
- One size does not fit all. Although you may desire a specific style, a nose that looks great on someone else may look awkward on you.
- Great surgical skills alone do not guarantee a good outcome. Good tissue and favorable healing responses are also necessary for a successful rhinoplasty. Weak cartilage, poor healing ability, and thin skin can negatively affect even the most skillful surgery.
- Young adults have the best prognosis. All other factors being equal, a young individual with a smooth, clear complexion, firm nasal cartilage, forgiving skin, and good overall health will have the best prognosis for a favorable rhinoplasty outcome.
- Final results may not be apparent for 12 months. In most cases, post-surgical swelling will distort the nose for several months after surgery. Even good results may look disappointing at first. It can take a year or longer to see your final results.
Rhinoplasty procedures can include the removal of bone, cartilage, or the addition of synthetic tissues, to increase or decrease the size of various elements of the nose. The visual effects may be subtle or dramatic, depending on your needs and desires.
The exact techniques used for your procedure depends on the current shape and size of your nose and the desired results; no two rhinoplasty procedures are exactly the same.
It helps to know some of the official terms used by surgeons for rhinoplasty. Here’s a list of four of them:
- Open method: With the open method, the surgeon makes an incision in the columella (the bridge of tissue that separates the nostrils) in order to gain access to the underlying cartilage and tissue of the nose. Additional incisions made be made inside the nose.
- Closed method: The closed (or endonasal) method is a less invasive type of rhinoplasty that involves making an incision inside the nose and working entirely beneath the skin of the nose with limited visual access.
- Non-surgical: The term “non-surgical” typically implies the use of an injectable dermal filler to temporarily correct small imperfections.
- Nasal implants: Involves the use of silicone implants to help alter the shape and size of nose.
Today, more and more people are seeking rhinoplasty that is tailored to their specific facial features. It is particularly popular among those of Asian and African descent.
Many of these patients feel that the bridge of their nose is too flat, or that their nostrils are too wide. Some of these patients seek to ‘Westernize’ their facial features through surgery, while others simply want a more defined nose to bring balance to their face.
While rhinoplasty is performed in the same manner regardless of the patient’s ethnic background, the aesthetic goals of the patient may differ. When researching plastic surgeons, look for those that have experience in performing procedures on a wide array of ethnicities.
There is always a risk that the results of your initial rhinoplasty procedure will not look exactly as expected. In this situation, your surgeon may recommend revision or secondary rhinoplasty. This term refers to a rhinoplasty procedure performed on any patient who has previously undergone one or more nose procedures.
The intention is to improve upon or modify the results of a previous operation. It can be a way of fixing a “botched” rhinoplasty or one that simply produced less than satisfactory aesthetic results. Some common reasons why you might consider secondary rhinoplasty include:
- Too much tissue was removed from the nostrils
- The bridge of your nose was not narrowed enough
- The tip was upturned more than you wanted it to be
- Difficulty breathing through the nose as a result of their first surgery
It is recommended that patients wait at least two years after the initial surgery before considering revision rhinoplasty. Although it may only take a couple of months for the nose to appear healed, it could actually take several years for the nasal tissue to settle into a more permanent position. Once the nose has settled, meet with a plastic surgeon to determine whether or not another procedure would be an appropriate option for you.
Recovering from rhinoplasty takes about two to three weeks. Most patients return to work after one week.
During the first one to two months, it’s important to avoid strenuous activities, including sports that may cause trauma to the nose. This includes baseball, soccer, basketball, weightlifting, and other similar sports. A trauma to your nose during the recovery time can end up causing your new nose to deviate from its proper location.
When will you see results?
Although initial results will be visible within a few weeks of your surgery, it will take a 6-12 months or more before the nose is fully stabilized and all swelling has subsided.
How long will your results last?
Once the tissue has stabilized, the results of rhinoplasty are relatively permanent.
Cost of rhinoplasty
The total cost of rhinoplasty usually averages between $5,000 and $10,000. There are several factors associated with the cost of rhinoplasty that may influence how much you pay, such as:
- Anesthesia fee
- Your surgeon’s fee
- Facility / hospital fee
- The extent of your procedure
- Your location
- Revision rhinoplasty – tends to be more complicated
If cost is an issue, ask your surgeon whether they offer financing options. Many plastic surgeons are willing to offer flexible monthly payment plans.
As with most surgical procedures, there are potential risks and side effects associated with rhinoplasty. Some of these may include:
- Nose asymmetry
- Nasal blockages
- Excessive bleeding
- Breathing is difficult through the new nose
- The septum is damaged
- Nose numbness that is temporary or permanent
Before moving forward with surgery, discuss all the potential risks and complications with your surgeon.
Q: How long is it normal to have swelling after rhinoplasty? A: In most cases, swelling after rhinoplasty begins to subside in the first week after surgery, but minor swelling often persists for several months. Full resolution of all residual swelling may take up to a year.
Q: I’m of African American ethnicity and my nose is very wide. Can rhinoplasty work for me? A: Yes. The goal of cosmetic rhinoplasty is to reshape the nose, and the techniques are effective no matter what your ethnicity is.
Q: I’m afraid that my surgeon won’t understand what type of results I want. What should I do? A: You can search for photos from magazines, tear them out and bring them in with you. Before you undergo the surgery, make sure that you and your surgeon are on the same page as far as your goals and desired outcome.
Q: How long do I have to wear the splint after surgery? A: Usually one week.
Q: Is rhinoplasty covered by insurance? A: In most cases, rhinoplasty is considered a cosmetic procedure, meaning that the costs must be paid out-of-pocket by the patient. Insurance will only cover rhinoplasty for those who have structural defects (and breathing problems), birth defects, or damages due to a trauma.
How to choose your surgeon
The best way to get the nose that you want is to find a skilled, experienced surgeon who specializes in rhinoplasty. Check with the American Board of Medical Specialties to make sure any surgeon you are considering is board-certified in in facial plastic surgery or plastic surgery.
In addition to being board-certified, the surgeon you choose should have a current membership in one or more of the following organizations:
- American Academy of Facial Plastic and Reconstructive Surgery
- American Society of Plastic Surgeons
- American Board of Plastic Surgery
While membership in any of these organizations does not guarantee a successful outcome, you can be confident that surgeons who hold membership in one or more of these organizations has undergone extensive surgical training and has consistently high-quality surgical outcomes.
Contact an experienced plastic surgeon or facial plastic surgeon near you!
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