Rhinoplasty

Quick Facts About Rhinoplasty

Procedure Time: 1-3 hours
In/Outpatient: Usually outpatient
Anesthesia: General or local with sedation
Recovery Time: 10-14 days; strenuous activity in 3-6 weeks
Duration of Results: Long-lasting
Average Nose Job Cost: $3,500-$14,000
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What you should know

What Is A Nose Job

Rhinoplasty, commonly called a “nose job,” is a plastic surgery procedure for reshaping the nose by enhancing or reducing its size or shape. Nose reshaping is also becoming a popular age reversal procedure to correct common issues associated with aging like a droopy nose tip, uneven cartilage, which causes humps and bumps, and/or structurally supporting the nose bridge to fix or avoid sagging.

A Droopy Tip

A drooping tip can lead to a harsh and aged appearance. “When the nose is pointed up, it creates a much softer look,” says Los Angeles plastic surgeon Geoffrey Keyes, MD. A droopy tip can also cause the area between the end of the nose and the upper lip to look short—small, thin lips are common of an aged look.

Three Causes of a Droopy Tip:

  1. Muscle movement & loss of volume: The force of gravity pulls the tissue of the nose down, causing it to droop which is often accompanied by a loss of volume. Your nose may appear larger with age because, as volume is lost from the face, the cheeks lose definition, in turn making the nose look disproportionate or even hooked.
  2. Inadequate support: “As support is lost in the nose, the tip begins to sag and point downwards,” says Scottsdale, AZ, facial plastic surgeon David Hecht, MD, adding that it’s more common in those with thick skin, which weighs down the underlying supporting cartilage.
  3. Facial expressions: Constant smiling compels the tip of the nose to move downward and droop as a result of years of muscle contraction. There is a muscle between the nose and upper lip that can become overactive with time. “We can weaken that muscle, but it needs to be done conservatively. If too much of the muscle is weakened, it can potentially change the smile,” says Dr. David Hecht. 

How to fix it:

The only way to permanently correct an aging nose is with surgery, and it’s important that your age be taken into consideration—the nose of a 70-year-old should not look like the nose of a 27-year-old. “In older patients, the tip shouldn’t be as high,” says West Palm Beach, FL, facial plastic surgeon Michael Schwartz, MD. “By elevating a drooping tip to the appropriate position and adding support, we can bring the tip back up and prevent it from dropping back down. Other changes to the nose may be necessary, too,” says Chevy Chase, MD, facial plastic surgeon Shervin Naderi, MD. In some cases, injectables may be used to lift the tip of the nose. “Botox-like injections help to stop movement of the muscles that pull the tip down. They are also good for someone who has a gummy smile because it raises the tip and makes the lip look longer,” says Cleveland, OH, plastic surgeon Bahman Guyuron, MD.

Humps and Bumps

Most people with nasal humps and bumps, which are related to uneven amounts of cartilage, have always had them to some degree. Even if your nose developed with a bump, and it was always there, it may become more noticeable with age as support from the tissue and cartilage is lost. Others notice nasal humps and bumps later on in life that virtually didn’t exist before.

Nasal humps and bumps can create an imbalanced look. Plus, as fat is lost from the surrounding areas and the bumps become more prominent, features like the cheeks can look less defined.

Two Ways to Fix Them:

Surgery: The most conventional way for your doctor to correct bumps and humps. By filing down the bone and/or cartilage, the bump is smoothed out and the nose appears in better proportion. One thing to consider is that if the tip isn’t addressed, and just the humps and bumps are evened out, the outcome can be end up looking overdone or unbalanced. The various parts of the nose should be balanced to look natural.

In order to ensure the best results, it’s always important to seek treatment with a board-certified plastic or facial plastic surgeon who is experienced in this field of surgery.

Fillers: Using hyaluronic acid fillers, like Restylane, or even thicker and longer-lasting injectables, such as Perlane or Radiesse, your plastic surgeon or dermatologist will inject the areas that you’re wishing to correct to camouflage any concerns. “There are a number of fillers used, but this technique can only correct minor problems,” says Los Angeles plastic surgeon Geoffrey Keyes, MD. The filler acts as a spackle of sorts to soften the appearance of any dents, bumps and humps. In less than 30 minutes, the results are seen (there may be some swelling, redness or bruising, which will subside over a few days). Keep in mind that your nose will physically be larger—although it may not look any bigger—than it was pre-injection since the filler eliminates unwanted bumps by adding volume.

“Using injectables to produce minor nose alterations is unquestionably easier than surgery. In fact, temporary injections are producing longer-term effects than expected because reactive tissue fills in the minor depressions. Therefore, the results can be more enduring, although not as long as what is achieved with surgery. In the future, we’ll see even more extensive use of fillers to correct minor nose flaws, says Cleveland, OH, plastic surgeon Bahman Guyuron, MD.

A Low, Wide Bridge

Visible from the side, a nose with a low bridge sits too close to the face. When you look at a nose from the front, a wide bridge makes the nose look out of proportion with the rest of the face. The nose may appear too short or bottom heavy, and the eyes may appear set too far apart. This flaw draws attention away from the eyes toward the nose.

How surgery fixes it: To raise the bridge, volume is added with cartilage from another part of the nose. If there is no cartilage available, it can be taken from the ear or rib. When a bridge is too wide, the bones of the nose may need to be broken in order to make them narrower.

How injectables fix it: Radiesse can be injected along the bone that runs the length of the nose to make it appear higher, with results lasting from one to two years, depending on the patient. 

A High Bridge

With a high bridge, both the nasal bones and the cartilage sit too high on the face. A nose with a high bridge looks too prominent and makes the eyes look too close together.

To remedy this problem, it’s essential to lower the nasal bones by cutting or filing them down. The bones will always need to be manipulated to lower the bridge, and as your surgeon gives the bridge a nice round shape, care is taken to support the cartilage that makes up the side walls. 

A Crooked Nose

 A crooked nose attracts attention, and exaggerates otherwise normal asymmetries that most of us have. These cosmetic issues are often accompanied by breathing problems caused by the same structural damage.

A crooked nose bends to one side or the other, lacking a straight bridge. These noses can have either a curved or bumpy appearance, and can also be too big or too small.

A crooked nose can be caused by a deviated septum or an injury that has broken the bones. To straighten the nose, the bones need to be moved into a better position and are often reduced before being reshaped. 

A Bulbous Tip

According to St. Augustine, FL, facial plastic surgeon Deirdre Leake, MD, “Tip rhinoplasty is among the most technically difficult surgery we perform. After changing the framework of the nose, the skin may or may not take the new shape, making it hard to anticipate the final result.”

Having a bulbous tip means it looks like your nose has a ball on the end. This can be due to the shape of the underlying structure, or just thick skin, but regardless of the cause, this nose type looks bottom heavy and draws attention away from the eyes.

To refine the tip of the nose, the cartilage is narrowed. Rhinoplasty relies less on removing cartilage and more on strengthening existing cartilage or adding additional cartilage for support in order to improve definition.

Wide Nostrils

When looking at the nose from below, the tip should be shaped like a triangle, and although nostril shape varies by ethnicity, the nostrils should be symmetrical.

Nostrils that are overly wide attract attention and take focus away from the eyes and the rest of the face. To make the nostrils smaller, portions of the surrounding tissue are removed through incisions beneath and inside the nose so there are no obvious scars.

Who It Is For

Anyone seeking to to improve the appearance of their nose for a more symmetircal look by correcting a droopy or bulbous tip, humos and bumps, a low wide or high bridge and/or wide nostrils should consider the benefits of rhinoplasty.

An injectable nosejob is an option for those who want to test-drive potential rhinoplasty results or those who have minor indentations, bumps, hollows, low bridges or asymmetry. It also works well to build up a flat bridge or to upturn a droopy tip.“Injectables can help to temporarily fix some problems as well as post-surgery irregularities that do not necessitate additional surgery,” says West Palm Beach, FL, facial plastic surgeon Michael Schwartz, MD.

Who It Is Not For

Rhinoplasty is not for anyone who is satisfied with the appearance of their nose.

An injectable nose job is not for anyone with major nasal deformities or anyone seeking a smaller nose.

Balance Your Features

Those seeking a well-balanced and youthful face should aim for a nose that’s symmetrical within itself, as well as overall facial symmetry. Other misaligned features may be accentuated by a nose that is askew.

No face is perfectly symmetrical, but certain asymmetrical features, like the nose, tend to be more obvious. “The nose is a bilateral structure, so you want both the left and right sides to match so that the nose looks the same from the front and side views,” says West Palm Beach, FL, facial plastic surgeon Michael Schwartz, MD. “Symmetry is crucial when dealing with the nose because, when the nose is in balance, it blends better with the face and creates a more harmonious look, as if everything fits together just right,” says Los Angeles plastic surgeon Geoffrey Keyes, MD.

How your nose can make other features look older:

The nose is what most people first notice about the face. “It can provide facial balance and a cohesive blending between features, but the nose can distract from some features and throw off the harmony of the face if it’s too large or too small,” says Chevy Chase, MD, facial plastic surgeon Shervin Naderi, MD. Because the nose is central to the face, it affects how the other features are integrated, and if they are not symmetrical as a whole, it could create the illusion of an aged appearance. “Ideally, the nose should not distract attention away from the eyes or lips but rather draw interest to those features and fade into the background of the face.”

A Youthful Nose

Your nose will look more youthful and defy an aged appearance, if it:

 1.  Points up ever so slightly

Noses that point up just a bit are associated with a younger look, but you don’t want too much nostril to show.

 2. Is smooth and refined

The bridge of the nose should be straight and smooth so that the profile view matches the front view. It shouldn’t lack projection, otherwise it will lack depth.

3. Is the right width for your face

When the nose is too wide, it can detract from other features, like the cheeks. If the width of the nose encompasses too much space, other features can look poorly defined.

Why Other Facial Features Matter

Thin lips: If the nose is too droopy, it can mask the smile and hide part of the upper lip, making it look thin and limp.

Recessed chin: If your nose has too much projection, it can create the illusion of a recessed chin and weak cheeks. With age, the chin area can become saggy and appear set back, contributing to a poorly defined jawline. If the cheeks are not delineated, they can make the face look gaunt and sunken.

Poorly defined cheeks: If your nose is too long, it can cause your cheeks to look weak and ill defined. Flat cheeks that lack volume and definition are common with age.

Post-Treatment Care

You will wake up after rhinoplasty with a splint covering your nose and small tubes may be placed in your nose for a short time to prevent draining fluid from being swallowed. It's also possible that you may have packing to support the nose internally as it heals. When it comes to stitches, dissolving sutures are used internally, and dissolving or removable sutures close any external incisions. No matter how cumbersome or uncomfortable, you shouldn't remove any splints or packing without your surgeon's permission.

Added Post-Care Considerations:

  • Someone must drive you home and stay with you for at least the first 24 hours.
  • If you have a drip pad to catch any drainage, you'll need help changing it so you're clean and comfortable.
  • Expect to be swollen, bruised in the eye and cheek region and stuffed up.
  • No nose-blowing allowed.
  • A diet of soft food is recommended for a the few days after surgery as you may also have a mild headache and your cheeks and jaw might be sore
  • Keep your head elevated even while you sleep.
  • Cool compresses and anti-inflammatory medications can make you more comfortable and keep swelling down.
  • You may also experience mouth dryness because you'll be breathing through your mouth until the nasal swelling subsides. Sucking candies and drinking extra liquids can help.
  • Contact lenses can be used once swelling diminishes.
  • You should be back to your normal routine within a week and back to regular exercise within three to six weeks.
  • Wear appropriate protection if you are involved in any sport or activity that may cause injury to your nose.
  • Be sure to protect your skin and nose from sun exposure.

Risks

Cosmetic surgery has its risks. Not choosing a board-certified plastic surgeon puts you at a higher risk for revision surgery, since surgery performed by an unqualified surgeon can end in major complications and the possibility of disfigurement.

One of the biggest risks with rhinoplasty surgery is that you may not like the end result—undergoing a rhinoplasty revision procedure may be necessary to achieve your ultimate goal.

“Revision surgery is performed to improve the quality of a surgical outcome or to address changes that are necessary to ‘fine-tune’ your results,” says Eugene, OR, plastic surgeon Mark Jewell, MD.

Other nose job risks:

  • Nosebleeds or ruptures of small blood nasal vessels are common after rhinoplasty. Visible vessels can be corrected with a laser, cautery or sclerotherapy.
  • An infection could be accompanied by severe headache, fever and thick mucus.
  • The normal risks of anesthesia accompany any surgical procedure.
  • Excess scar tissue can develop but is rare. This might impair breathing and, in some cases, can be treated with steroid injections. If bone is grafted or altered, minor irregularities may develop and occasionally be felt or seen.

Unpredictable results are possible. The aesthetic outcome of rhinoplasty cannot always be foreseen. Bones may dislodge, and cartilage and soft tissue may change in shape over time. In addition, results may not develop as you had hoped, and asymmetry is possible. Secondary procedures may occasionally be required to refine your results to achieve your original goal. 

Inside Tips

We've all heard the myth that the nose must be broken during rhinoplasty. The truth is that a broken nose is one that suffered accidental trauma. In nose surgery today, the smallest possible instruments are used to cut and shape structures of the nose, including the bone. Nothing is broken, per se.

Here are a few additional things to consider about rhinoplasty:

  • During rhinoplasty, your surgeon may make an internal incision in the bones and move them with a “controlled break” in order to alter the appearance of your nose. This is not like breaking an arm or a leg.
    • Rhinoplasty is performed either as an open or a closed procedure.
    • An open procedure requires an additional incision across the narrow strip of tissue that separates the nostrils.
    • In a closed procedure, incisions are hidden within the nose, though some surgeons feel that this can limit the extent of a rhinoplasty.
    • Whether open or closed, the best approach for you is determined by the structural changes to be made to your nose and by your surgeon's preference.
  • When selecting a plastic surgeon for rhinoplasty, Dallas plastic surgeon Jack Gunter, MD, emphasizes the importance of selecting an experienced doctor who specializes in the procedure or at least performs it frequently, and, he adds, “The best time to get it right is the first time.”
  • Though many people associate rhinoplasty with teenagers, the fact is that more than half of all nasal procedures are performed on those over the age of 35, according to the American Society for Aesthetic Plastic Surgery (ASAPS).

According to Dr. Jack Gunter, it is a fallacy that the nose gets larger with age. The nose may look larger because of the effects of gravity. Rhinoplasty can offer dramatic results for older patients looking to rejuvenate their appearance by moving the tissues back to where they once were.

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