Nose Job (Rhinoplasty)

There are two primary types of surgical rhinoplasty. Let’s take a look at each:

Open rhinoplasty: The surgeon makes a tiny incision between the nostrils, to obtain a full view of all nasal structures and maximum control of the nose.

Closed rhinoplasty: All adjustments are made through the inside of the nose, without an external incision.

An open rhinoplasty gives a surgeon more visibility, allowing them to stabilize structural elements of the nose and perform the most detailed work. However, this technique may slightly increase recovery time and leave a small scar (though it is most often undetectable). A closed rhinoplasty avoids an external incision but gives surgeons less visibility.

The choice of procedure depends on your specific concerns and the surgeon’s preference. Major tip refinements or nose revision surgery often require open rhinoplasty, while bridge work (hump correction) and subtle tip refinements may be done with both approaches.

In the past few years, rhinoplasty surgeons have also started performing “preservation rhinoplasty,” which addresses the bridge of the nose from within (i.e., septal cartilage internal to the nose), rather than shaving or filing down the outside of the nose. This can help preserve the nose’s natural structure and contour and minimize irregularities.

Non-surgical rhinoplasty, also known as “liquid rhinoplasty,” involves altering the shape of your nose by using injectable fillers. While its results are not permanent, it offers a quick and non-invasive alternative to surgery, especially for modifying the bridge of the nose.

Although liquid rhinoplasty is less invasive, that does not mean that it is risk-free; in rare circumstances, potential risks include vascular occlusion, skin necrosis, and the formation of irregularities or nodules, even when performed properly by an experienced provider.

You should discuss the risks of surgical and non-surgical rhinoplasty with your surgeon and make sure they have extensive experience in these complex procedures.

Rhinoplasty is a powerful tool in the world of cosmetic surgery. It can correct a range of concerns like a bulbous tip, a hump on the bridge, crooked alignment, or a flat appearance. But a rhinoplasty surgery is not just about the tip or bridge of your nose. It can help with overall shape, structure, and nostril size, improving breathing issues and blending functionality with aesthetic enhancement.

The septum is the “internal wall” dividing your nostrils. If the septum is crooked it can cause breathing issues. A “septoplasty” is a corrective surgical procedure that straightens a deviated septum and is often performed along with a rhinoplasty. The nostrils can also be reshaped, in a procedure called “alar base reduction,” helping achieve a balanced and pleasing appearance.

Everyone’s rhinoplasty journey is unique, just like their results. This means, among other things, that your ethnicity may be a consideration as you discuss desired outcomes with your surgeon. This important aspect of our identity can be connected to the shape of the nose. For instance, if you have a dorsal hump characteristic of your ethnicity, the decision to adjust its appearance through ethnic rhinoplasty can be deeply personal.

In general, it’s important to remember that a successful surgery will use a customized approach that considers your unique features. There is no one-size-fits-all perfect nose job or “cookie cutter” solution.

Communicate your concerns with your surgeon, expressing what you hope to retain about your nose and what changes you are seeking. Together, you can craft a surgical plan that meets your aesthetic goals without leading to any unwanted outcomes.

Before you go

Before surgery, you and your physician should have a conversation about your goals and desired outcomes. Together, you’ll review your medical history and discuss any additional tests that are required. You’ll be provided with an opportunity to learn more about the surgery, its advantages, potential risks, strategies for pain management, available alternatives, and a comprehensive overview of what to anticipate both during and after the procedure.

Photographs are very important in a rhinoplasty. Using visual aids is a great way to show your surgeon your aesthetic preferences. Your surgeon will also take extensive photos of your nose for before-and-after views and to use as a reference during surgery.

Some surgeons utilize advanced computer morphing software as a visual aid and educational tool during the consultation process. This technology allows you to see potential outcomes and be sure you and your surgeon have a shared understanding in terms of aesthetic goals. While the final surgical results may differ from the simulations, this technology serves as a valuable communication tool, allowing for an open dialogue about possibilities and expectations.

During the procedure

Rhinoplasty is usually performed under general anesthesia, so you will be comfortable and pain-free. The procedure is typically performed at an outpatient facility, so you can expect to go home the same day. You will need someone to drive you home and spend the first few nights after surgery with you.

You will likely have an external splint, or cast, applied over the bridge of your nose to protect and immobilize the area during the healing process. Taping is used below the cast to help reduce swelling and stabilize the nasal skin. While nasal “packing” was once a standard practice, most surgeons now avoid this method due to the discomfort. Many surgeons prefer to use a temporary internal silicone sheet to improve nasal airflow and keep the septum in place.

Nose Job Aftercare 

Post-procedure, you should expect some swelling and bruising, which peaks two to three days after surgery and gradually subsides over the next several weeks.

Discomfort can generally be managed with over-the-counter acetaminophen (Tylenol) and a very limited amount of prescribed pain medication. You should avoid aspirin, ibuprofen and other non-steroidal anti-inflammatory drugs (NSAIDs), as they may increase bleeding and bruising risks.

Your surgeon will usually give you an irrigation system that you may start using a few days after surgery to keep the inside of your nose clean and to help with crusting. Antibiotic ointment is also recommended by most surgeons, both on the incisions and inside the nostrils to prevent superficial infections and help keep the area moist. Cold compresses should be used in the first 72 hours to help with recovery and bruising.

After about a week, any external stitches and splints are removed. In most instances, you should be able to return to work in one to two weeks and return to full activity in three to four weeks.

The initial swelling begins to subside during the first three months, but it can take one to three years after the rhinoplasty procedure to fully appreciate the final, refined nasal contours. The duration and extent of the healing process largely depend on the complexity of the surgery and the thickness of your skin. Patients with more extensive reshaping or thicker skin may require longer for residual swelling to resolve, before the ultimate results are fully revealed.