What is Rhinoplasty - Your Expert Plastic Surgery Guide to Nose Jobs in 2023
Rhinoplasty is a common nose surgery that alters the shape of a person’s nose. While this surgery is usually performed to help the individual breathe easier, such as in cases of having a deviated septum, sometimes rhinoplasties are performed to change the appearance of a nose, either to make it smaller or slimmer.
Whether you’re contemplating getting a rhinoplasty for cosmetic reasons or to help improve your quality of life, here’s an extensive guide on what you should expect if you choose to move forward with this procedure.
History of Rhinoplasty
Believe it or not, rhinoplasty actually dates back to 3000 B.C. Typically performed for reconstructive purposes, it wasn’t until the late 1800s that the first rhinoplasty was performed for cosmetic purposes by Dr. John Orlando Roe - now credited as the “Father of Aesthetic Rhinoplasty.”
What made this procedure notable was not only the fact that it was performed on someone who suffered from agoraphobia due to the awkward appearance of his nose, but that it was performed fully inside the nose in what’s now known as a closed rhinoplasty.
The procedure laid the groundwork for the rhinoplasties offered today.
Reasons for Rhinoplasty
There are many reasons, both aesthetically and functionally, why people go under the knife for this procedure.
Here’s an overview of the most common reasons to get a functional rhinoplasty:
Repairing a Deviated Septum
Correcting a deviated septum is one of the most common reasons for undergoing rhinoplasty for reconstructive purposes. A deviated septum is when the wall between your nasal passages is dislodged and off to one side, constricting airflow and making it more difficult to breathe.
Correcting a deviated septum can improve breathing and can get rid of serious sleep disorders such as sleep apnea.
Alleviating Chronic Sinus Conditions
If you dread the spring season because of allergies and serious sinus congestion, then you may want to undergo a rhinoplasty.
Sinus conditions such as chronic congestion, allergies, and infections can be difficult to live with. With this procedure, your surgeon will be able to alter the structure of your nose and open your nasal airways to not only help you breathe easier but lower your risk of sinus infections and allergies, as well.
Repairing a Broken Nose
If your nose was broken, you will usually have to undergo a rhinoplasty to repair it. A broken nose may make it more difficult to breathe, as well as alter the appearance of your nose which make it look more crooked. A rhinoplasty can address these issues, realigning your nose so it looks the way it did before your injury.
Correcting Birth Defects
A cleft lip/palette is the result of a baby’s lip and mouth not forming correctly in utero. After birth, the child may undergo rhinoplasty to correct the birth defect by reshaping the nose and increasing the size of nasal passages so the child can breathe better.
While this surgery is usually performed during the child’s first six to nine months of life, it can be done anytime within the first 18 months.
Correcting Enlarged Turbinates
Severe allergy sufferers may suffer from enlarged turbinates. When exposed to allergens, the tissues inside your nasal passage can swell, causing the passages to become obstructed. A rhinoplasty can remove parts of your turbinates, so you no longer have to live with this condition.
Rhinoplasties performed for medical reasons are there to offer some sort of relief to the individual who’s suffering, as well as improve their overall quality of life, such as when a child is born with a cleft palate and has difficulty eating.
However, since this procedure can also be done for cosmetic purposes, you may want to get this surgery for the following reasons:
Slimming Down the Bridge of Your Nose
The width of your nasal bridge is determined by your nasal bone. This is affected by genetics, which is why everyone’s nose looks different. If you believe the bridge of your nose is too wide, a rhinoplasty can help slim it down. This is typically done by breaking the bones inside your nose and reshaping them so they give off a slimmer appearance.
Reshaping Your Nose
Do you think your nose is too big for your face? Is it too bulbous? Do you think it’s too small compared to your other facial features? If you answered yes to any of these, you may want to undergo rhinoplasty to reshape your nose.
In most cases, this is done by adding or removing cartilage to reshape your nose, so it looks smaller, slimmer, or more proportionate to your face.
Narrowing Your Nostrils
You might feel like your nostrils are too large or misshapen. One option for adjusting this is to have your nostrils narrowed. This is a procedure called alarplasty.
This procedure is performed by a surgeon making an incision where the face and nostril meet, removing part of the nostril, and then having it sewn shut for healing. This will help your nose appear narrower and smaller.
As with any cosmetic procedure, a rhinoplasty can be done to boost confidence by improving your overall appearance.
If you simply don’t like the look or shape of your nose and it’s causing self-esteem issues, getting rhinoplasty is a great way to make you feel more confident.
Changing the Angle Between The Nose and Upper Lip
Sometimes the angle between the nose tip and the upper lip doesn’t quite look right. This is a consideration most doctors have to look at when making any sort of adjustment to the nose.
To correct this, there are several different adjustments that can occur depending on the angle. These usually include either grafts or trimming different parts of the nose, including the septum, depending on how the angle needs to be adjusted.
Types of Rhinoplasty Procedures
The most common type of rhinoplasty is either an open or closed procedure, and both are performed as an outpatient surgery. A closed rhinoplasty is when all of the incisions are done inside the nostril, whereas an open procedure leaves a small scar that will fade over time. In most cases, the procedure will last anywhere from 2-4 hours. In both instances you'll typically be put under general anesthesia as opposed to local anesthesia.
Here’s an overview of the different types of rhinoplasty procedures currently available and an overview of how they are each performed:
A closed rhinoplasty is typically preferred among patients because it doesn’t leave a scar the way an open rhinoplasty would. During this procedure, the surgeon makes a small incision inside the nostrils before separating your skin from the cartilage.
Once these are separated, your surgeon will either add on or shave off cartilage to reshape your nose. In some cases, your surgeon may need to perform a bone graft to add bone to your nose as part of the reshaping process. After this is all complete, the surgeon will add stitches and a nose splint. In most cases, you’ll only have to wear this splint for a week.
Like all procedures, it does carry some risk, most notably nosebleeds, prolonged bruising, and numbness.
Unlike a closed rhinoplasty, an open rhinoplasty is performed on the outside of your nose and usually leaves a scar. Despite the probability of some slight scarring (that will eventually fade over time), there are many benefits to this open approach, most notably the surgeon having greater visibility.
During an open rhinoplasty, your surgeon will make a small incision on the bottom of your nose in between your nostrils, also known as the columella. Once the Z-shaped incision is made, the skin that covers your bone and cartilage will be slightly raised so it can be reshaped.
Like the closed rhinoplasty, your surgeon will either add or remove cartilage to create your ideal nose shape. Once satisfied with the reshaping, your surgeon will pull down the skin and add sutures. You'll have splints placed inside your nose that will be removed a week after your rhinoplasty/
Because of where the incision is made, it usually takes longer for the swelling associated with an open rhinoplasty to go down - up to several months. However, in some cases, it may be swollen for up to a year. Though you will see some gradual changes in the weeks and months after surgery, you may not see full results until 12 months (or longer) after your procedure is performed.
Liquid Rhinoplasty (Non-Surgical Rhinoplasty)
If the surgical route isn’t for you, you may want to take advantage of a liquid rhinoplasty instead. Also sometimes referred to as a “liquid nose job,” a liquid rhinoplasty uses dermal fillers to temporarily alter the shape of your nose.
Dermal fillers, which usually contain hyaluronic acid, are used to enhance facial features. Most commonly, they’re used to smooth out wrinkles, lessen the appearance of scars, and plump lips. However, they’re also commonly used for “nose jobs.”
When you go in for the appointment, your doctor will inject these dermal fillers into your nose. From start to finish, the process only takes about 15-20 minutes and you’ll typically see results immediately. Since it’s not a surgical procedure, keep in mind that you will be awake for these injections and you will experience some mild discomfort. However, before the injections are given, your doctor will apply a numbing cream to the area to minimize the pain.
Dermal fillers can correct drooping nasal tips and unevenness, and smooth out lumps and bumps. Once the procedure is complete, you may experience some swelling and bruising at the injection site for up to two weeks. You can expect your results to last anywhere between 6-12 months.
Septoplasty and Septorhinoplasty
A septoplasty is typically performed on patients suffering from a deviated septum. A deviated septum is when your nasal septum between your nasal passages is off-center. Individuals living with a deviated septum often have difficulty breathing and encounter nosebleeds more often than the average person.
Though many people can live full and active lives with a deviated septum, it can be challenging to live with, especially because it could create lasting congestion and sleep interruptions from not being able to breathe easily. The good news is that all of these issues can be corrected through septoplasty..
During the procedure, your surgeon will make an incision in the lining of your nose, also known as the mucosa. Your cartilage and bone inside the septum are then lifted, and any cartilage that causes the septum to be off-center will be removed. Once it is, everything will be put back into place.
Depending on the details of your procedure, your surgeon may have to break and reset your nasal bones to correct the shape and appearance of your nose at the same time they’re addressing the deviated septum. Typically when combining a septoplasty with cosmetic changes, the procedure is referred to as a septorhinoplasty. Though you can return to your normal activities three weeks after your surgery, it will take one to two months to fully heal.
A tip plasty is a type of cosmetic procedure that reshapes the tip of your nose, usually to make it appear thinner, slimmer, or smaller. Because it’s not addressing your entire nose, a tip plasty only takes about 45 minutes to complete.
This procedure involves your surgeon making a small incision between your nostrils. The steps taken depend on what goal you’re trying to achieve with your tip plasty. For example, a tip plasty can make your nostrils more symmetrical, or remove bumps on the bridge of your nose.
Regardless of what your end goal is, a tip plasty usually removes cartilage to reshape the end of your nose. Furthermore, it’s usually always performed as an open rhinoplasty.
A revision rhinoplasty only occurs if you are unhappy with the results of your surgical rhinoplasty. Usually, more cartilage is required with this type of surgery to provide structural support to the bridge of the nose and/or tip of the nose. In most cases, this additional cartilage is either removed from the rib or ear.
Revision rhinoplasties can be a bit more complex than the other procedures mentioned on this list. Like other rhinoplasties, they generally take anywhere between 2-4 hours to complete. It’s important to keep in mind that revision rhinoplasties may not offer as much alteration as your original nose job. Instead, they tend to address minor problems like curvatures and any existing functional problems.
Once the revision is complete, you can expect your healing process to take anywhere between two and three weeks.
Average Cost of Rhinoplasty
The cost of rhinoplasty varies throughout the United States, ranging between $3,096- $15,995.
Generally speaking, whether or not a rhinoplasty will be covered by your insurance depends on the circumstance. For example, if you’re injured in an accident and suffer a broken nose, then it’s likely your insurance carrier will cover at least some portion of the surgery.
However, rhinoplasties that are performed for cosmetic purposes will typically not be covered, as they’re considered to be elective surgeries. In other words, you don’t need the surgery for medical reasons.
Benefits of Rhinoplasty
There are many benefits to getting a rhinoplasty, especially if you’re having difficulty breathing or living with a deviated septum. Likewise, if you’re undergoing rhinoplasty for cosmetic reasons, the big benefit is liking the way your nose and face look once the surgery is completed, as well as having higher self-esteem and confidence.
Here are the benefits of a rhinoplasty:
Helps achieve facial harmony by adjusting the proportions of your nose
Corrects sinus issues
Corrects broken noses and other injuries
Remedies birth injuries, such as cleft palettes and undeveloped noses
Makes it easier to exercise
These are just a few of the wonderful mental and physical benefits a rhinoplasty can offer, regardless of whether you’re getting one for cosmetic or reconstructive reasons.
Risks of Rhinoplasty
However, just like with any other medical procedure, there are risks associated with rhinoplasties, most typically:
Permanent scarring on your nose
Ongoing pain and/or discoloration
Not getting your expected results
Potentially needing revision surgery
Before agreeing to move forward with a rhinoplasty, it’s important to consider the risks and determine whether or not the benefits outweigh them.
Even though surgeons have perfected their skills over the years, not every surgical procedure has the same outcome. Only you know what you’re comfortable with, and that includes the associated risks
Consultation and Preparation
Now that you’ve decided to move forward with rhinoplasty, let’s go over what you should expect at your initial consultation.
Just like any surgical consultation, this is your time to ask your plastic surgeon any questions you have. It’s a good idea to create a list of questions and goals of surgery before your consultation so you don’t forget anything.
However, just in case you’re not sure what to ask, we’ve created a sample list of questions below:
Am I a good candidate for rhinoplasty? Why or why not?
How many rhinoplasties have you performed so far?
What can I expect from the recovery process? How long before I can return to work and/or school?
Are there any physical activities I should avoid while recovering?
Is it safe to continue taking my prescriptions or antidepressants while I recover?
What kind of results should I expect from this procedure?
Do you have before and after photos I can see?
How much does this procedure cost? Do you offer financing?
What if I’m not happy with the outcome? Do you offer rhinoplasty revisions?
How long have you been a plastic surgeon? What are your credentials?
Where is their surgical facility located?
While this is not an exhaustive list, these are just a few examples of the types of questions you should ask your plastic surgeon during your rhinoplasty consultation. It’s recommended that you meet with several plastic surgeons before making a final decision.
In addition to asking these questions, you’ll also want to discuss your goals for getting a rhinoplasty and the reasons behind them. Don’t be afraid to be candid. Once these conversations are out of the way, your rhinoplasty surgeon will ask you about your medical history to ensure you’re eligible for surgery, as well as inspect your nose and take digital photos.
These photos will be uploaded to a computer and then altered to show you a 3D rendering of what your new nose will look like based on the information you provided.
In the weeks leading up to your surgery, you’ll want to stop smoking and consuming alcohol. Things like nicotine, for example, actually constrict your blood vessels, which can negatively affect the outcome of your surgery and healing process, as well as put you at a higher risk of infection.
Alcohol, on the other hand, is a natural blood thinner, which could lead to increased and uncontrollable bleeding during the procedure. This is also why you should stop taking blood thinners like Warfarin if you’re routinely prescribed them.
On the night before surgery, make sure to remove all cosmetics and hair products and avoid eating or drinking after midnight. Depending on the time of your procedure, your surgeon may request you avoid food and drink earlier than midnight, but this is on a case-by-case basis.
Anatomy of the Nose
The nose is the star of your face, which is why if you’re uncomfortable with how it looks, you may be eager to move forward with this type of procedure.
That being said, it’s a good idea to go over the structure of the nose so you know what parts you may want to have surgically altered, as well as the areas your surgeon will be working on.
As part of your respiratory system, your nose is what allows you to breathe. And, fun fact, the nerve cells found inside your nose are also primarily responsible for your ability to taste. Without our sense of smell, we would only be able to taste foods that were sour, bitter, salty, savory, and sweet. But enough about that!
Your nose has nine main components:
Nose bone - Your nose bone, or nasal bone, is responsible for binding the cartilage together that defines the shape of your nose. Each person has two nasal bones located between the upper jaw that make up the bridge of the nose.
Sinuses - There are four pairs of sinuses connected to your nasal cavities - frontal, ethmoid, sphenoid, and maxillary. These sinuses are located between your ears, behind the nasal cavity and cheekbone, and in the middle of your forehead, and all drain into the nose. These not only keep your nose moist, but they humidify the air you inhale before it reaches your lungs, as breathing in cold air can cause shortness of breath.
Nostrils - Located at the bottom of your nose, these openings filter out allergens and other particles from the air you breathe. Your nostrils are also responsible for providing your body’s sense of smell.
Septum - Separating your nasal passages, the septum, which is made out of bone and cartilage, is responsible for forcing the air we breathe through our nostrils and into our lungs.
Nasal cavities - Your nasal cavities, which are located inside your nose and above the bone that forms the roof of your mouth, filters and moves air to make it moist enough to pass into your lungs.
Turbinates - Surrounded by vascular tissue, the turbinates inside your nose are responsible for cleaning and humidifying the air that passes through from your nostrils. This process ensures that the air is clean before it enters your lungs.
Nerve cells - Your nerve cells are responsible for trapping odor and transmitting the information to the brain, so it can process what the smell is and how it is experienced. Without your nerve cells, you wouldn’t be able to distinguish between good and bad smells.
Hair/nares - The hair inside your nose is responsible for trapping and filtering out dust, allergens, and other particles so they don’t enter your lungs. These particles are dislodged when you sneeze.
Lateral walls - Located on the lateral (side) of your nasal cavity, the lateral walls are responsible for filtering all of the air we breathe.
If you’re interested in getting a rhinoplasty, but don’t feel comfortable with surgery, you may be able to take advantage of non-surgical options.
Known as a non-surgical rhinoplasty or liquid nose job, this cosmetic procedure uses dermal fillers, which usually contain hyaluronic acid, to temporarily alter the shape of the nose. Because liquid nose jobs only use dermal fillers, they can’t physically reduce the size of your nose or narrow the bridge. It can only alter its shape and in some cases, temporarily smooth out unwanted bumps.
After getting a non-surgical rhinoplasty, you may have a little bruising and swelling, but your symptoms should subside in a few days.
Liquid nose jobs aren’t your only option, either. While it’s certainly one of the most popular and common non-surgical options available, you could ask your provider about a thread-embedding rhinoplasty.
This technique involves the insertion of threads beneath the skin to increase collagen, which can make your nose appear flatter. Keep in mind that even though this technique does exist, it’s more popular in Asia than it is in the United States.
Recovery and Aftercare
Nasal splints will be placed immediately following the procedure. However, they will come off one week after surgery. Up until they’re removed, and for a little time after, your surgeon will want you to use sterile saline nose rinses to clean out your nose. They may also prescribe you an antibiotic cream to use on your incision site and sutures.
In the days after surgery, you can expect minor bleeding, as well as an expulsion of mucus and some swelling. Keeping your head elevated can help minimize the swelling. Depending on the circumstances, your surgeon may place a small piece of gauze beneath your nose to serve as a drip pad. If so, this will have to be changed out regularly. By month 4, most of your swelling should be gone.
You will also experience bruising. Typically, the bruising is at its worst at the 72-hour mark after surgery, but it slowly starts to get better after that.
You should also take great care to avoid strenuous physical activity, laughing, and even smiling, as these can all be painful. Likewise, don’t wear glasses or sunglasses for at least a month after the procedure. You should also use a good silicone-based scar gel and minimize sun exposure to the scar.
Full recovery can take up to a year because the swelling (especially in the tip of the nose) tends to linger. Though you may see minor changes in the months following your procedure, it could take up to a year to see the final results of your rhinoplasty.
Realistic Expectations of a Rhinoplasty
If you’re going under the knife for facial plastic surgery, the most important thing you can do is be realistic about the results:
Realize That Surgery Does Have Limitations
If you’re planning a rhinoplasty surgery, chances are, you’ve been dreaming about what your new nose will look like. And while most surgeons will be able to bring your vision to life, it’s important to remember that medical interventions do have limitations.
For example, a rhinoplasty can’t completely change the structure of your nose, nor can it predict how the shape of your nose will change as you age. Likewise, a rhinoplasty can’t change anything about your skin, so if you have redness around your nose, don’t expect this to be fixed with this kind of procedure.
Remember, you need to be honest with your doctor about what you truly want your nose to look like and be mindful that medical interventions can only do so much. While many clients are happy with their new nose after surgery, that’s not the case for everyone. The only way to combat this is by explaining what you want to your surgeon in explicit detail, so everyone is on the same page.
Though revision rhinoplasties are always a viable option if you’re dissatisfied, they may not always be possible due to financial constraints or time available to take off work.
Realize Your Nose is Going to be Swollen for Months
Even though rhinoplasty is a relatively short procedure, it takes time until the nose is fully healed. So, if you’re planning on moving forward with this procedure, you have to be patient when it comes to seeing the final results.
As briefly mentioned above, swelling can take several months to go down. Rhinoplasties typically have three stages of the healing process:
Inflammatory Phase (1-7 days after surgery): You will experience the most swelling during the inflammatory phase because your body is exhibiting its natural response to injury. During this phase, your body’s blood vessels will dilate so white blood cells, nutrients, and other essential cells reach the injury site. This phase is when your body starts the healing process.
Proliferative Phase (1-6 weeks after surgery): During this phase, your body will work on building up scar tissue around your nose, so you may notice that your incision site is a bit thicker than it was in the days/weeks prior. This is also the time when nerve function at the incision site begins again, so you may experience some mild discomfort during this phase, too.
Remodeling Phase (6-12 months after surgery): This is the body’s final phase of the healing journey. During this phase, scar tissue will start to break down, so the scar you see will turn from red to white. You'll typically see the final results one year after the surgery.
Realize That You Will Have to Make Lifestyle Changes
After a rhinoplasty, you will likely have to make a few short-term lifestyle changes, such as:
Avoiding blowing your nose for 3-4 weeks
Avoiding sexual activity for 3 weeks
Not lifting weights or engaging in rigorous exercise for 6-12 weeks
Not swimming for 6 weeks
Avoiding contact sports for 4-6 months
Not smoking or drinking alcohol for 3 weeks
Not eating crunchy, chewy, or hard foods for 1 week
Be Prepared That Your Nose Won’t Yield Immediate Results
We briefly touched on this above, but it’s important you don’t expect immediate results after your rhinoplasty. Because of the healing processes mentioned above, it may be an entire year before you see the results you want. It’s hard to wait, but the best thing you can do is give it time and practice patience.
That being said, there are a few things you can do to help ease your mind while you’re waiting for the final results of your rhinoplasty:
Stop checking your reflection: Compulsively checking your reflection can harm your mental health.
Follow the doctor’s orders: Though this may involve taking it easy for a short period, following your doctor’s orders regarding relaxation, medication, and treatment can ensure that you’ll get the results you want in due time.
Develop a mantra: In times of stress or upheaval, it’s easy to obsess over what’s going on and the outcome. But, when you’re recovering from rhinoplasty, you have to remember that the nose you see in the mirror right now is not the nose you’re going to see a week from now, two months from now, or a year from now. Your nose will constantly be changing so developing a mantra to repeat when you’re not loving your reflection can help you remember that this is only temporary. Your dream nose is only a few months away.
Emotional Considerations with Plastic Surgery
Even if you’re not undergoing a surgical procedure for cosmetic reasons, rhinoplasty can still take an emotional toll on you because, at the end of the day, your face is going to look different.
A report published by the National Library of Medicine found that half of the people in the study who were undergoing a rhinoplasty were also suffering from psychological ailments. Though surgeons should always do their due diligence to make sure a patient is seeking surgical intervention for the right reasons and is of sound mind, it’s important to do this analysis for yourself, too.
Take the time to find out the motivations for wanting a rhinoplasty. If it is for self-esteem issues, consider the possibility that your self-esteem could still be suffering even after your nose is altered. How will you handle the possibility that your results aren’t exactly what you expected?
As with any cosmetic procedure, it’s important to reflect inward to determine whether you truly want this, or are using it as a bandaid to temporarily heal more significant trauma.
It’s because of this that many surgeons and those in the medical field recommend those seeking plastic surgery meet with a therapist first. In doing so, you may be able to address any underlying issues that ultimately won’t be fixed by a medical procedure.
Schedule a Rhinoplasty Consultation With Dr. Troell Today!
If you’re contemplating moving forward with a rhinoplasty and want a natural looking nose, schedule your complimentary consultation with Dr. Troell. Dr. Troell is board-certified facial plastic surgeon specializing in both functional and cosmetic rhinoplasty. He's developed his own techniques to achieve highly natural results for his patients over the years.