For the past few decades, rhinoplasty has always been one of the most sought-after surgeries within the cosmetic world. From elective procedures designed to make patients happier with their appearance to medical ones to improve nasal obstruction, there’s a wide range of reasons for getting a nose job. No matter what camp you’re in, it’s important to know what to expect if you’re considering rhinoplasty. For this very reason, NewBeauty sat down with San Francisco facial plastic surgeon David W. Kim, MD about his approach to reconstruction and what readers should know about getting a new nose.
NewBeauty: Why do you think so many people are interested in rhinoplasty?
Dr. Kim: So much of the way we see ourselves is through our faces. The face is basically our social interface with the rest of the world. It is interesting because the nose is in the center of the face, yet we generally don’t want it to be the point of focus. After all, eye contact is one of the most universal social norms across every culture. If the nose has features which draw attention or are distracting, it may create negative or unpleasant emotions. For this reason, I believe rhinoplasty goes beyond purely “beauty” or “vanity” and helps people feel like they can reach a normal and comfortable sense of self identity.
NewBeauty: What do you consider to be an ideal outcome?
Dr. Kim: The best outcome is the one which makes the patient happy. In my experience, I have found that this is a nose which looks natural and attractive. This does not always have to be the same for each person—in fact I believe it is important to create outcomes which fit individual features, ethnicities, and most of all, personal preferences. But there are certain traits common among attractive, natural noses: smooth contour, symmetry, and a normal shape, which is some version of a rounded triangle.
NewBeauty: Many consider rhinoplasty to be one of the more difficult procedures. Why is that?
Dr. Kim: There are several reasons. First, the anatomy is highly variable which means the same technique cannot be used in the same way for every case. Because end goals are also different from person to person, rhinoplasty cannot be considered as just one maneuver. There are hundreds of possible techniques used in limitless combinations to create an ideal outcome. Second, the central location of the nose on the face and its three-dimensional nature makes it easy to see imperfection. The margins are smaller for error before imperfections can be visualized. Finally, the structures which form the nose are delicate. Techniques which leave the structures of the nose weaker will lead to unpredictable changes which can happen well after surgery. For this reason, I adhere to a structural approach to rhinoplasty, in which changes are made by adding support and strength to the anatomical areas, rather than through reduction and weakening. By seeking treatment by an experienced rhinoplasty surgeon who performs a high volume of nasal surgery, these challenges can be overcome.
NewBeauty: What advice can you give a prospective rhinoplasty patient on whether or not they should do it?
Dr. Kim: I believe that the key question patients should ask themselves is if rhinoplasty is likely to feel worth it to them. What are the pros and cons? On the negative side, there is downtime, risk, possibility of complication or revision, and cost (more on these items later). On the positive side, there is the potential that the outcome could have significant benefit to their self-esteem, sense of self, or happiness. For many, the cons are easy to understand as they are more concrete and tangible. The pros are always very personal and require careful consideration.
NewBeauty: If someone wants to change their nose, but are unsure of what they’d like it to look like, how does the consultation process work?
Dr. Kim: It’s common that a patient knows that they don’t like their nose, but are not sure about what specifically they would like to change. This is where digital renderings are helpful. Morphing software helps me visually demonstrate possible rhinoplasty outcomes to patients with rendered photos of their noses. With the help of these images, most patients are able to hone down what would appeal to them.
NewBeauty: What are the risks associated with the procedure?
Dr. Kim: Like with any surgery, bleeding or infection can occur following the procedure. In my practice, infection occurs about 1-percent of the time and can present up to a few weeks post-operation. Infection would manifest as increasing redness and pain and swelling within the nose. Post-operative infections are easily treated by resuming antibiotic treatment. It’s important to note that a small amount of bleeding is normal after surgery. This is typically mild dripping from the nostrils which tapers after one to two days. However, a severe bout of bleeding requiring urgent attention, although occuring very infrequently (less than .2-percent in my practice, but may vary by practitioner) is possible. In such cases, immediate treatment through a pressure pack placed inside the nose is required. Fortunately, these complications are very uncommon, and the vast majority of patients have a smooth, uneventful recovery.
NewBeauty: What can a patient expect in terms of the recovery process?
Dr. Kim: During the first week following rhinoplasty, the patient will have a plastic splint over the nose. There may be swelling or bruising under the eyes and there will some discomfort and pressure within in the nose. Antibiotics are generally prescribed to reduce the risk of infection and pain medicine is prescribed to use as needed. Most patients can stop the prescribed pain meds within a few days of surgery and can switch to Tylenol. This is ideal as the narcotic medication can cause side effects like nausea or constipation. The splint and sutures are removed at about one-week post-op. After that time, patients can get back to work or school, but the nose will still be swollen. The swelling takes months to a year to fully recede, but it generally does not cause the nose to look abnormal. I encourage patients to get back to normal life as soon as possible rather than waiting for the swelling to fully disappear.
NewBeauty: After the procedure, is there any reason a patient would need to come back for a touch-up or follow-up surgery?
Dr. Kim: There are always imperfections after rhinoplasty, but in most cases, these are small and either not noticeable or bothersome to the patient, particularly when there has been significant improvement. If there is an imperfection which simply bothers a patient to the point that they feel it would be worth addressing with another procedure, an in-office or surgical touch up is possible. For very small imperfections, most patients don’t feel it is worth the trouble to pursue further treatment. Rarely is there a more significant imperfection which would need to be addressed with a formal revision rhinoplasty. These usually occur in more difficult, complicated procedures, such as revision rhinoplasty of a badly damaged nose. In all cases, the pros and cons of additional surgery are discussed and the decision whether or not to treat made carefully and thoughtfully.
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