Rhinoplasty refers to reshaping of the nose, often referred to as a “nose job.” This can be done for the functional purpose of improving the ability to breathe through the nose, or for the cosmetic purpose of bringing the size and shape of the nose into better balance and harmony with the other facial features. Each nose is different and presents a unique challenge to the surgeon, which is why an individualized approach for each patient is critical to achieving an excellent outcome. Read below to learn more.
What type of anesthesia is used for a rhinoplasty?
Prior to surgery, our patients are given medication to help them relax. They are then taken to the operating room where our board-certified anesthesiologists administer the anesthesia to make the patient sleep through surgery. In some cases, we perform rhinoplasty under total general anesthesia, but in most cases, patients are under a deep IV sedation. In either case, patients are asleep throughout the entire procedure, feel no pain, are comfortable throughout, and have no memory of the surgery. The advantage of IV sedation over true general anesthesia is that patients bounce back from surgery much faster, recover quickly, and have far fewer issues with post-operative nausea, vomiting, fatigue, etc.
How is a rhinoplasty performed? What happens during a nose job?
Rhinoplasty surgery is typically performed by making small incisions within the nose, and depending on the deformities to be addressed, a small incision may be made on the columella, which is the portion of skin and soft tissue that runs between the two nostrils. This allows the skin envelope to be carefully lifted off of the underlying cartilage and bone, which gives the nose its shape. This cartilage and bone is then carefully reshaped to obtain the desired results. Cartilage taken from the patient’s own nose or ear may be used to help provide support and correct any deficiencies in the shape or function of the nose. Occasionally, for severe deformities, cartilage from the rib or small implants may be necessary to provide the desired result.
What is the difference between an open and closed rhinoplasty? Is a closed rhinoplasty better than an open rhinoplasty?
In reality, there is very little difference between an open and closed rhinoplasty procedure. In an open rhinoplasty, a very small incision is made across the lower part of the columella (the central piece of the base of the nose between the nostrils). All other incisions are made within the nose, similar to a closed rhinoplasty. The only difference between the two techniques is the placement of these very small incisions. The columellar incision heals very quickly, and is very difficult to find within a few weeks after surgery. Open rhinoplasty surgery allows the surgeon to see the nasal structures clearly and perform precise surgical maneuvers without obstruction. While we do perform some closed rhinoplasty surgeries, we find that most surgeons (ourselves included) achieve better results with the open approach, and recommend this techniques for most of our patients. While you may read about faster healing with the closed technique, healing is similar between the two approaches, and the benefits of better visualization during surgery generally outweigh any small benefits of slightly reduced initial postop swelling.
What are the risks of rhinoplasty? What are the potential complications from nose surgery?
Every procedure has risks, including rhinoplasty. The main risk to be aware of is the risk of bleeding, so we give patients very specific instructions described below in the recovery section to help avoid bleeding. In addition to the risk of a nose bleed, other risks of rhinoplasty surgery include internal or external scarring, nasal airway obstruction that causes difficulty breathing, lack of improvement, dissatisfaction with the cosmetic result, septal perforation, numbness of the skin or postoperative nasal pain, asymmetry, and the potential need for future additional revision surgeries. Very rare complications are unlikely but also possible, including anesthesia complications, spinal fluid leak, and infection. Any additional surgical procedures that are involved may require additional surgeon, anesthesia, or facility fees as well.
How much does a rhinoplasty cost? Is a nose job expensive?
Rhinoplasty costs will vary widely from one surgeon, geographic area, and patient to another. In some cases, minor changes are all that are needed and costs may vary because of this. Patients can expect to pay from $7,000 – $10,000 for most cosmetic rhinoplasty surgeries, and maybe much more in some cases. Revision rhinoplasty surgeries may be more expensive because they are more challenging and risky. We will provide you with a custom quote during your private consultation.
How long does a rhinoplasty last?
Rhinoplasty results are permanent. Patients may see subtle changes to their nose, particularly in the skin (thinning or thickening) over many years, but the underlying structure should stay in place. There is a risk of warping of cartilage over long periods of time, but this is a rare occurrence.
Who is a good candidate for a rhinoplasty surgery? Am I a candidate for a nose job?
Patients who are wanting to have a rhinoplasty should be healthy without any major medical issues, particularly issues related to the heart, lungs, kidneys, history of heart attack or stroke, etc. In almost all cases, a rhinoplasty is an elective procedure, and patients should be healthy before proceeding with elective surgery, especially for cosmetic purposes.
Is rhinoplasty performed only for cosmetic reasons? If I cannot breathe through my nose, do I need a rhinoplasty?
Rhinoplasty is commonly performed for cosmetic reasons only, functional reasons only (not being able to breathe through the nose), or in many cases, BOTH cosmetic and functional problems. Dr. Cain and Dr. Richardson are rhinoplasty experts who perform many rhinoplasty surgeries for both functional and cosmetic issues. Keep in mind that any changes to the outside of the nose are almost always considered cosmetic unless they are the result of recent trauma. CLICK HERE to learn more about nasal surgery for breathing problems such as a deviated septum, enlarged turbinates, or nasal valve collapse/obstruction.
Who is qualified to perform a rhinoplasty?
Rhinoplasty surgery should be performed by a board-certified surgeon who performs many rhinoplasty surgeries. In most cases, facial plastic surgeons are very well-trained and highly-specialized to perform rhinoplasty surgeries. There are some general plastic surgeons who also perform many rhinoplasty surgeries and may also be highly-skilled in rhinoplasty surgery. Keep in mind that most facial plastic surgeons have performed hundreds of nasal surgeries before even leaving their residency programs, and as such, are very experienced in nasal anatomy and nasal surgery.
Rhinoplasty is a highly-technical procedure that requires years of experience and specialized training. Some oral-maxillofacial surgeons, general surgeons, or dermatologists may profess to perform rhinoplasty surgeon as well, but may not be well-versed in rhinoplasty surgery and are not likely to have the experience needed for excellent rhinoplasty results. Be sure to ask your surgeon to see before and after photos of their patients, ask about their surgical techniques, and ask how often they perform rhinoplasty surgery.
What is revision rhinoplasty?
Revision rhinoplasty is rhinoplasty surgery performed in a patient with a history of prior rhinoplasty surgery. Revision rhinoplasty is more complicated and higher risk than primary rhinoplasty. Dr. Richardson and Dr. Cain frequently perform revision rhinoplasty surgery, but will counsel patients on reasonable and realistic expectations regarding revision surgery. In many cases, revision surgery may require addition of other tissue from the patient (like ear cartilage or temporalis fascia), tissue from a tissue bank (like rib cartilage), or even implant material in some select cases.
Can I have a rhinoplasty if I have had a non-surgical nose job or liquid rhinoplasty in the past?
In general, patients can safely have a rhinoplasty surgery if they have had filler in the nose in the past. This is most true for patients whose filler was hyaluronic-acid based, such as the products in the Restylane and Juvederm families of fillers. Silicone injections, calcium-based products, and other materials injected in the nose might have caused permanent scarring or may be very difficult to remove. We recommend that patients avoid any filler injections in the nose within 12 months prior to planned surgery if possible. Depending on the patient, we may also recommend a pre-operative visit in the weeks leading up to surgery in order to attempt to dissolve and filler that may be present in the nose.
What are the alternatives to a rhinoplasty?
Alternatives to rhinoplasty surgery include avoiding surgery or having a non-surgical nose job, also known as a liquid rhinoplasty, non-surgical rhinoplasty, or liquid nose job. CLICK HERE to learn more about a non-surgical nose job.
What is the difference between a rhinoplasty surgery and a liquid rhinoplasty? Is a non-surgical nose job better than a surgical nose job?
With rhinoplasty surgery, we are able to make permanent changes to the underlying bone and cartilage of the nose. We are able to make the nose smaller, reduce a dorsal hump, and alter the basic structure of the nose through surgical techniques. With a non-surgical rhinoplasty, we are only able to add injectable fillers into certain areas of the nose in order to improve the nasal shape. This makes a liquid rhinoplasty more of an augmentation procedure (we are only able to ADD to certain areas). In many cases, we can achieve similar results with both techniques, but while we may reduce a dorsal hump on the nose surgically, we are forced to add filler around the dorsal hump non-surgically in order to achieve a similar (but still different) cosmetic outcome. CLICK HERE to learn more about a non-surgical nose job.
How long does it take to recover from a rhinoplasty? What is the down time after a nose job? What can I expect during rhinoplasty recovery?
In general, rhinoplasty recovery takes about six weeks. During the first week, patients will have a cast on the outside of the nose, and small splints on the inside of the nose. Both of these are removed in clinic one week after surgery and allow the nose to heal straight and prevent internal scar tissue. The nose will feel very stuffy and possibly completely blocked during this time. We instruct our patients to avoid any strenuous activity, exercise, heavy lifting, straining, or lowering the head below the heart for two weeks after surgery in order to prevent nasal bleeding. Patients must be careful about getting hit or bumped in the nose for at least six weeks after surgery while the nasal bones are healing. Patients must avoid nose-blowing for 6 weeks after surgery as well.
During the first few weeks after surgery, the nose, especially the tip of the nose, will get progressively more stiff. At around one month postop, the nose will feel quite stiff to the touch, but will then begin to soften. By two months after surgery, most patients are feeling like the nose is almost back to normal.
Patients are given specific instructions on how to care for the nose, which generally just involves simply nasal saline sprays, gels, and ointments to keep the inside of the nose clean and allow healing to occur. In ALL cases, it takes a FULL ONE YEAR for the nose to mature after a rhinoplasty surgery and to be able to see the final results. Small amounts of swelling will linger for many months after surgery. In most cases, patients will see about 80% of the rhinoplasty results within approximately 3 months after surgery.
Dr. Cain and Dr. Richardson have both undergone extensive specialized training in rhinoplasty surgery, including complex revision rhinoplasty for patients who have new or persistent deformities following prior rhinoplasty surgery and will guide you through your consultation and surgery.
EMAIL US today or call us at (469) 362-6975 to schedule a consultation and find out more about how we can help you look your best.
CLICK HERE to see more Rhinoplasty Before and After Photos