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Even in a post-pandemic world, there is still an appetite for [combining different cosmetic procedures](https://aedit.com/aedition/best-aesthetic-procedures-to-combine-to-maximize-appointments) — when possible — in order to achieve optimal results and maximize downtime. One classic pairing that plastic surgeons often recommend due to the harmonious result it creates: [rhinoplasty](https://aedit.com/procedure/nose-shaping-solutions) and [chin augmentation](https://aedit.com/aedition/best-chin-augmentation-enhancement-procedures). Here, we break down the benefits and balance of the common combo.

## **The Benefits of Combining Rhinoplasty & Chin Augmentation** 
As we’ve covered, [facial harmony](https://aedit.com/aedition/facial-harmony-in-aesthetic-medicine) is about proportion, and changing the proportion of the nose can have an impact on the appearance of the chin. So, it should come as no surprise that it’s common to combine [nasal surgery](https://aedit.com/aedition/difference-between-septoplasty-rhinoplasty) with [chin enhancement](https://aedit.com/procedure/chin-enhancement-solutions) procedures — and some patients even tack on a few more things. “Very often, they’re also combined with a little submental liposuction to really define the jawline along its whole length,” says [Dara Liotta, MD](https://www.facialplasticsnyc.com/), a double board certified facial plastic and reconstructive surgeon in New York City. She calls this combination of [rhinoplasty](https://aedit.com/procedure/open-rhinoplasty), [chin implant](https://aedit.com/procedure/alloplastic-chin-implant), and submental liposuction a “profile makeover.” 

Pairing these procedures (in the right patient) helps balance the face and allows the results of the individual procedures to make the greatest impact, Dr. Liotta says. “Combining procedures to achieve a more ideal profile can actually help the results of rhinoplasty look more natural —  like your profile was meant to be like that,” she notes. 

Another benefit? [Minimizing cost and downtime](https://aedit.com/aedition/how-much-cosmetic-surgery-costs). “Combining procedures minimizes downtime and saves a bit of money because there’s one anesthesia and one recovery,” says [Jennifer Levine, MD](https://www.drjenniferlevine.com/), a double board certified facial plastic and reconstructive surgeon in NYC. “Who doesn’t like that?” In addition to the potential cost savings, you also can consolidate your healing time when you safely undergo [more than one procedure](https://aedit.com/aedition/best-surgical-and-non-surgical-cosmetic-procedures-to-combine) at the same time. “With a rhinoplasty, you will have a cast and sometimes stitches for six to seven days,” she explains. “The chin implant has a bandage and stitches for the same amount of time.” 

## **The Best Candidate for Rhinoplasty + Chin Augmentation** 
So, how do you determine if you are an ideal candidate to combine rhinoplasty and chin augmentation? “Someone who has a recessed chin and/or has poor definition in the neck area is a good candidate for these procedures,” says [Edward Kwak, MD](https://aedit.com/provider/edward-kwak-md-74), a double board certified facial plastic and reconstructive surgeon in NYC. “And a good candidate for rhinoplasty is someone who wants to change the [shape of their nose](https://aedit.com/concern/nose-shape), [improve breathing function](https://aedit.com/concern/breathing-issues), or both.”

In some cases, the contour of the chin may be creating an optical illusion of sorts. “Many times, patients may feel that their nose is too large, but really the nose looks bigger because the chin is too small,” Dr. Levine notes. Even so, people don’t always appreciate the [role of the chin](https://aedit.com/aedition/best-chin-augmentation-enhancement-procedures) in balancing the face. “Chin augmentation is often overlooked because most of us look more at the other parts of our face,” she adds, yet a [2010 study](https://pubmed.ncbi.nlm.nih.gov/20115968/) found that as many as 81 percent of patients may see the benefit of pairing rhinoplasty with chin augmentation. 

It should be noted, however, that some patients — specifically, those who have issues with their mandible or maxilla (i.e. jawbones) — may require more advanced treatment. “These patients would need a more extensive procedure for their lower face,” Dr. Levine cautions. Additionally, those with extensive dental concerns may not be a good candidate for these procedures. “If the teeth are not aligned well, it may indicate a bigger issue,” she says. 

## **Performing Rhinoplasty + Chin Augmentation Together**
When combining rhinoplasty, chin augmentation, and liposuction, it’s up to your surgeon to decide what order they will operate in. “I personally like to do the submental liposuction followed by the chin implant and then the rhinoplasty last,” Dr. Liotta says. By doing the nose last, patients can wake up from [anesthesia](https://aedit.com/aedition/everything-you-need-to-know-about-anesthesia) and start icing as soon as possible, which should help minimize [bruising and swelling](https://aedit.com/aedition/how-to-treat-minimize-swelling-after-cosmetic-surgery). “I think it makes for a better, easier, recovery,” she explains.

If they are being performed at the same time, Dr. Levine also places the chin implant first. “It is considered a clean procedure, while the nose itself is less sterile,” she says. But, if the procedures are being performed at separate times, she usually schedules the rhinoplasty first. The reasoning? The nose is typically what bothers the patient the most.

## **Recovering from Rhinoplasty + Chin Augmentation**
Regardless of the procedure(s), Dr. Kwak always stresses the importance of preoperative and postoperative care with his patients. “It is very important to note that one’s final result is determined by this care — no strenuous activity, no touching of any incisions or casts, etc.,” he says. Recovering from any cosmetic surgery requires patience, but rhinoplasty, in particular, takes time. Dr. Kwak notes the healing journey for this pair takes approximately a year.

### **Recovering from Chin Augmentation**
Interestingly enough, Dr. Liotta finds that patients actually have a harder time recovering from the chin implant than the rhinoplasty. “I think people are used to seeing the black eyes and swelling of rhinoplasty recovery, and they’re prepared mentally to wait a full year for final results,” she explains. “But the recovery process after chin implant is much less publicized and written about, so I find that patients have a harder time with the small amount of swelling and tenderness that go along with it.” Feeling like your chin is “huge” after surgery is normal, Dr. Liotta says. The final results of chin implants and submental liposuction are seen around six months post-op. 

Dr. Levine has patients wear a stretchy chin strap and ice the area for the first 48 hours. After that window, the strap is removed. “Bruising is rare but possible, and there will be some generalized swelling in the area for at least a week,” she says. Sleeping with the head elevated for about two weeks is also recommended.

Additionally, chin augmentation patients may require a [soft foods or liquid diet](https://aedit.com/aedition/meal-plans-diet-before-after-cosmetic-surgery) for several days as they heal, as chewing can irritate the newly adjusted tissue and muscle, Dr. Kwak says. [Vigorous activity or exercise](https://aedit.com/aedition/when-to-start-exercising-again-after-cosmetic-surgery-procedures) is discouraged for the first few weeks, but it can soon be resumed — along with a normal work schedule — within about 10 to 14 days, he adds. “Remember that although your fabulous results may be visible right away, they can continue to improve for up to six weeks as your swelling gradually reduces,” he cautions. 

### **Recovering from Rhinoplasty**
Most patients who undergo rhinoplasty surgery (with or without chin augmentation) should be prepared to take two weeks off from work and daily activities. “The early stages of recovery are the most difficult, mostly due to swelling, which leaves you with a stuffy nose,” Dr. Kwak says. Once that step is over, most patients report recovery is easier and less painful than expected. 

You’ll have a small plastic cast on the nose and a few stitches under the nose for about a week. When the cast and stitches are removed, most people only have a tiny bit of residual black eye. “Black eyes fully resolve by around 10 days,” Dr. Liotta shares. Although it does take a full year to enjoy the final results of rhinoplasty, “you can return to normal activity without anyone knowing you did anything” after about a week and half, she says. 

With that said, be prepared to experience residual swelling for 12 months. Dr. Liotta tells patients to expect around 85 percent of the swelling to be gone in a month and 95 percent in six months. All the swelling is generally resolved by the one-year mark.

## **The Takeaway**
Whether your aesthetic concerns center around the shape and [size of your nose](https://aedit.com/concern/nose-size) or the [prominence of your chin](https://aedit.com/concern/chin-shape-and-size), evaluating the proportion of those two facial features before choosing to undergo a cosmetic procedure is important to ensure the most balanced outcome. For some patients, combining a rhinoplasty with a chin augmentation (think: permanent chin implant or [temporary filler](https://aedit.com/procedure/chin-augmentation-with-soft-tissue-fillers)) will be the best way to maximize your time, budget, and results.

Aesthetics

Whether you’re concerned about the size of your nose or the prominence of your chin, evaluating those two features in tandem is the best way to ensure the most optimal result.

Combining Rhinoplasty And Chin Augmentation: Benefits, Candidates, Recovery

The Benefits Of Combining Rhinoplasty And Chin Augmentation

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Septoplasty and rhinoplasty are the two major ways to surgically alter one’s nose. And though the two sound similar and deal with the same basic territory, there are major differences in each procedure. A [rhinoplasty](https://aedit.com/procedure/rhinoplasty-nose-job) addresses cosmetic issues with the nose, such as bridge height, a bulbous or droopy nose tip, or nostril issues, explains [Edward Kwak, MD](https://aedit.com/provider/edward-kwak-md-74), a double board certified facial plastic and reconstructive surgeon in New York City. A [septoplasty](https://aedit.com/aedition/difference-between-cosmetic-rhinoplasty-vs-functional-rhinoplasty), meanwhile, corrects the nasal cartilage for improved breathing. 

In even simpler terms: “A septoplasty is considered a functional surgery because it makes your nose function better, while a rhinoplasty is considered a cosmetic surgery because it can make you look better,” says [Roxanne Grawe, MD](https://www.roxyplasticsurgery.com/), a board certified plastic and reconstructive surgeon at ROXY Plastic Surgery Center in Powell, Ohio. Though disparate, the two procedures are often performed at the same time, depending a patient's needs. 

Ahead, we’ll further explain the similarities and differences between rhinoplasty and septoplasty surgery.

## **What Is Rhinoplasty?**
The most well-known form of nasal surgery, rhinoplasty (a.k.a. nose job) is a surgical procedure that alters the external shape of the nose. Rhinoplasty is “always associated with external contour irregularities,” says [Lee Ann Klausner, MD](https://aedit.com/provider/lee-klausner-md-41), a double board certified facial plastic and reconstructive surgeon in NYC. An accident or breakage caused by trauma to the nose or simply aesthetic preference about how a patient wants their nose to look, may be cause for a rhinoplasty. There’s also a procedure known as a ‘[revision rhinoplasty](https://aedit.com/aedition/what-you-need-to-know-about-revision-rhinoplasty),’ which is a secondary surgery that corrects a previous, unsatisfactory attempt. Since rhinoplasty is a cosmetic procedure, it will most likely not be covered by health insurance.

### **Rhinoplasty Recovery & Results**
The outcome of a rhinoplasty will depend on your vision for a new nose, Dr. Grawe says. “A rhinoplasty can make your [tip more defined](https://aedit.com/concern/nose-shape), remove a [dorsal hump](https://aedit.com/concern/nose-bump), make your [nose smaller](https://aedit.com/concern/nose-size) or shorter or narrower or [tilted](https://aedit.com/concern/nose-angle) differently,” she says. “All your desires should be discussed with your surgeon ahead of time, so you are on the same page prior to surgery.”

On surgery day, you’ll likely be admitted for an outpatient procedure and be able to return home after surgery. The procedure often requires [general anesthesia](https://aedit.com/aedition/everything-you-need-to-know-about-anesthesia), Dr. Grawe notes. As she explains, there are two types of rhinoplasty — [closed rhinoplasty](https://aedit.com/procedure/closed-rhinoplasty), which “requires incisions only on the inside of the nose,” and [open rhinoplasty](https://aedit.com/procedure/open-rhinoplasty), which necessitates a small incision at the bottom of the nose. “The decision between the two has to do with your surgeon’s preference and what needs to be changed with the nose,” she says.

Depending on the goals of the procedure, the surgeon may break your nose, which will leave you with [bruises](https://aedit.com/aedition/how-to-treat-prevent-bruising-after-lasers-filler-botox) below the eyes after surgery. You’ll be sent home with a splint on the outside of your nose that will be removed about five to seven days later.

For six months after surgery, Dr. Kwak advises his patients to avoid strenuous activities, even vigorous nose blowing. You’ll also have to refrain from activities like [smoking](https://aedit.com/aedition/impact-of-cigarette-smoking-vaping-on-skin-hair-teeth-health) and drinking, wearing makeup, tannings, facials, [working out](https://aedit.com/aedition/when-to-start-exercising-again-after-cosmetic-surgery-procedures), and traveling until medically cleared. “Generally, patients look fantastic at the one-month mark (or earlier), although swelling and asymmetries are to be expected until approximately the one year mark,” he says. 

## **What Is Septoplasty?** 
In contrast to rhinoplasty (which can address any number of external nasal issues), septoplasty hones in on the central nasal cartilage — the portion of the nose that separates your nostrils. As Dr. Grawe explains, the septum is like the walls of the house, providing stability to your nose and also allowing for streamlined air movement through the nose. 

For those dealing with [breathing or functional concerns](https://aedit.com/concern/breathing-issues), “a septoplasty opens up airways for improved breathing,” Dr. Kwak says. “This helps patients who suffer from a long list of nasal problems, including nosebleeds, sinus infections, snoring, and migraines.” Since septoplasty is usually considered a medically necessary procedure (read: not cosmetic surgery), it may be [covered by insurance](https://aedit.com/aedition/insurance-coverage-for-plastic-surgery-cosmetic-procedures). 

### **Septoplasty Recovery & Results**
Like rhinoplasty, septoplasty is typically an outpatient procedure. During the surgery, “the cartilage in your nose will be straightened and supported with suture techniques and sometimes cartilage grafting,” Dr. Grawe explains. Depending on your specific needs, “you will have a small incision inside your nose or on the columella (the bottom of your nose),” she adds. Often, the surgeon will end the surgery by placing an internal nasal splint, which helps [decrease swelling](https://aedit.com/aedition/how-to-treat-minimize-swelling-after-cosmetic-surgery). Many providers allow patients to go home the same day. 

After surgery, you can expect “very little” discomfort, Dr. Grawe shares, but there will likely be some swelling around the nose and cheeks. Your breathing should improve within two weeks of the procedure. Since septoplasty often involves straightening the septum, it may, in turn, straighten the nose itself. It should be noted that this is a side effect — not the goal — of this surgery.

## **Which Procedure Is Best for You?**
As with any reconstructive or cosmetic surgery, the most important factor in a successful procedure is proper communication with a [board certified](https://aedit.com/aedition/medical-board-certification-in-plastic-surgery-cosmetic-dermatology) provider. Once a surgeon understands your reasons for seeking nasal surgery and your goals for a modified nose, they can recommend the best course of action (or even share if non-surgical options, like [liquid rhinoplasty](https://aedit.com/procedure/liquid-rhinoplasty), could suit your needs). In the meantime, all you need to do to help decide which procedure — septoplasty or rhinoplasty — is right for you: take a deep breath.

Determining the right nasal surgery for you can come down to one question: Do you have trouble breathing?

Septoplasty vs. Rhinoplasty: What's The Difference?

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In a perfect world, every plastic surgery patient would be thrilled with the outcome of their procedure. In reality, there are an array of both functional and aesthetic reasons why someone [may not be completely satisfied](https://aedit.com/aedition/what-to-do-if-you-are-unhappy-with-your-plastic-surgery-results) with the results. This is especially true of [rhinoplasty](https://aedit.com/aedition/difference-between-cosmetic-rhinoplasty-vs-functional-rhinoplasty) and surgical alterations for the nose. 

Just like there are many reasons why a patient might decide to get a nose job, there are numerous ways to perform rhinoplasty. Due to the complex nature of the procedure, it might not always go as planned. “It is not surprising then that people seeking revisions of their initial rhinoplasty is quite common,” explains [Andrew Frankel, MD](https://aedit.com/provider/andrew-frankel-md-275), a Beverly Hills-based double board certified facial plastic and reconstructive surgeon. “Although the rate of patients who seek out revisions is not published, it is generally accepted that it is around 20 to 25 percent.”

To better understand why a patient might want or need a revision rhinoplasty, we’ve talked to two specialists about the ins and outs of the procedure.

## **What Is Revision Rhinoplasty?**
As its name suggests, [revision rhinoplasty](https://aedit.com/procedure/revision-rhinoplasty) (a.k.a. secondary rhinoplasty) is a corrective surgery that aims to address the function and/or appearance of a nose that has already been operated on. “Revision rhinoplasty is the most difficult of all plastic surgical operations,”  Dr. Frankel says. 

One such reason is because of how rhinoplasty techniques have evolved over time. “Older rhinoplasties were reductive where a lot of cartilage was removed, which decreases support,” explains [Jason Roostaeian, MD](https://aedit.com/provider/jason-roostaeian-md-449), a board certified plastic and reconstructive surgeon at UCLA. “This created less support and can create asymmetry in the shape of the nose.” Another issue? “The procedure used to be very cookie-cutter and may not look natural on all face shapes and sizes,” he says. 

Since revision rhinoplasty requires revisiting a wound created by a previous procedure, there are several factors a plastic surgeon must consider before operating:

- **Scar Tissue**: “There is often a great deal of scar tissue present that has distorted the underlying delicate anatomy to the point of being unrecognizable — if it is not missing entirely,” Dr. Frankel says. 
- **What Lies Beneath**: “Once the anatomy has been uncovered, it needs to be reshaped and there might not be any cartilage left to do this,” he explains. In such cases, grafting is required, but grafted tissues “are not necessarily ideal for the needs each case warrants.”
- **Skin Condition**: Past scarring can impact the skin, too. “The internal lining and skin might be too scarred and may not be able to stretch and re-drape over the structure that cannot be replaced,” Dr. Frankel says. 
- **Functionality**: Needless to say, the nose still needs to function, too. “The airway must always be considered and maintained, which can be challenging in patients who still want a smaller nose but who need additional structure,” he notes. 

To restructure the external shape and internal workings in alignment with the patient’s desires, a precise and individualized procedure plan is needed. 

## **Why Patients May Seek Revision Rhinoplasty** 
When consulting with new patients, plastic surgeons emphasize that [results can take six months to a year](https://aedit.com/aedition/how-long-does-it-takes-to-recover-from-cosmetic-surgery-procedures) (or more) to be fully realized. Rhinoplasty falls into the ‘year or more’ category. But what if you still don’t like the outcome? Or what if there is an underlying complication? These are just a few of the reasons patients may seek a revision rhinoplasty:

- **Complications**: “Rhinoplasty is a delicate and complicated operation and is fraught with potential for asymmetries, irregularities, prolonged swelling and functional problems such as difficulty breathing and runny nose,” Dr. Frankel explains. The anatomy may not heal the way it intended to, which can be an issue moving forward. 
- **Aesthetic Goals**: For some, a change in taste may lead to revision — especially if a patient underwent the procedure as an [adolescent](https://aedit.com/procedure/youthteen-rhinoplasty). “The outcome is highly subjective, and, in our current society, the expectations of patients are increasing due to [social media](https://aedit.com/aedition/march-2020-study-shows-relationship-between-social-media-cosmetic-surgery) and the idealized versions that they are comparing themselves to,” Dr. Frankel says. 
- **Past Experience**: “The patients who are in search of a revision specialist are often fragile due to having prior bad experiences,” he shares. “This makes them wearier with greater scrutiny on every detail.” A previous negative outcome should not deter a patient from seeking out a highly skilled, [board certified](https://aedit.com/aedition/medical-board-certification-in-plastic-surgery-cosmetic-dermatology) provider. 
- **Innovations**: In the rhinoplasty world, there have been [updates to technique and strategy](https://aedit.com/aedition/reinventing-rhinoplasty-whats-different-about-modern-nose-jobs), which may lead some to feel that a secondary experience could yield a more favorable outcome. 

All of these are valid reasons for a patient to consider a revision surgery, though consulting with a board certified plastic surgeon is the best way to determine if you could be a candidate.

## ** The Right Candidate For Revision Rhinoplasty**
Revision rhinoplasty isn’t just about a second procedure. In some cases, patients have already undergone multiple surgeries. “Revisions make up about 30 percent of my practice,” Dr. Roostaeian shares, adding that he has consulted with patients who have had seven or eight previous corrective procedures. Neither of our experts has a specific number of past surgeries that will count a patient out of future work. Instead, they examine the physical state of the nose and the patient's health. [Smoking](https://aedit.com/aedition/impact-of-cigarette-smoking-vaping-on-skin-hair-teeth-health), lifestyle, expectations, and, of course, the internal damage from past surgeries will all factor into a candidate's prospects.   

## **What To Do If You’re Interested in Revision Rhinoplasty** 
You know you’re not happy with the results of your rhinoplasty, but what comes next? Arriving at the decision to undergo a revision may require even more thorough research and vetting than any of your previous procedures. Here are seven things to think about before going under the knife again:

### **1. Consider The Timing**
“There is no specific amount of time any patient must or should wait before having a corrective surgery,” Dr. Frankel says. “This depends on the type of problem.” In fact, you might not even want to wait until the previous procedure is fully healed. “For example, patients who have a bump or irregularity on their dorsum two months following their operation or those who feel their nose is too short are better off having their revision sooner than later because the wound contraction will only make matters worse over time,” he explains. In other cases, patience is necessary. “If the issue is that the nose still looks too wide or big, time will often work in that patient's favor,” he notes. “Things might improve to the point where further surgery is not necessary.” Depending on where you are in the healing process, a conversation with your surgeon can shed some light on what to expect.

### **2. Do Your Research**
A revision rhinoplasty requires a highly skilled aesthetic surgeon to address the issue at hand and will likely cost more than the first rhinoplasty. “[Meet with at least two surgeons](https://aedit.com/aedition/how-i-found-my-plastic-surgeon-its-surgery-not-a-spa-appointment) and try to determine if you are a good fit,” Dr. Frankel encourages. Consider whether or not the provider communicates well, has presented a clear plan, and is upfront about any potential limitations. Another suggestion? Ask to see lots of before and after images from each prospective surgeon, Dr. Roostaeian recommends. At that point, you should be able to assess the risk and determine what is best for your needs and goals.

<RelatedContent
  title={15 Questions To Ask Your Doctor During A Consultation}
  slug={questions-to-ask-your-doctor-during-plastic-surgery-consultation }
/>

### **3. Check Your Medical History** 
If you find a new provider for your revision rhinoplasty, make sure they have all the necessary details about your previous surgery. There are several types of rhinoplasty that a surgeon can perform and, because rhinoplasties of the past were often reductive, Dr. Roostaeian says having this information is advantageous to the new provider. Those who underwent rhinoplasty after an accident or traumatic event should also disclose this information.  

### **4. Know Your Concern** 
Be as specific as possible when consulting with providers for revision rhinoplasty. “Mentally, know what shape, size, and changes you want and verbalize it,” Dr. Roostaeian says. “The more specific you are, the more it helps us.” As he explains, being able to clearly articulate what’s bothering you will allow your surgeon to better understand what they need to do. “We want to be goal-oriented when we operate, so you shouldn’t be ambiguous,” he notes.

### **5. Understand the Risks**
There is risk involved with any surgery, and that’s even more so the case with revision procedures. It’s important to recognize that creating further trauma in the nasal area will leave behind additional scar tissue, and the cumulative scarring may make it difficult to achieve the results a patient desires. There is the added risk of complication as well. 

### **6. Know When to Walk Away**
Depending on the patient’s history, an experienced surgeon will not sugar coat the truth if a patient’s health will not allow for further revision. “I once consulted with a woman who’d undergone 34 prior rhinoplasties. Her skin was in jeopardy of necrosing altogether, so that was the deal breaker,” Dr. Frankel recalls. And it’s not just about physical health. Mental wellbeing must also be taken into account. “The operation becomes more technically challenging with each successive attempt and patients become more and more [frustrated or depressed](https://aedit.com/aedition/treatment-for-post-plastic-surgery-depression-blues-during-recovery), so there is much to consider,” he says.

<RelatedContent
  title={Managing Expectations: Achieving Desired Outcomes Safely}
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/>

### **7. Plan For Recovery** 
Since revision patients have already undergone at least one rhinoplasty, they know what to expect from the [recovery process](https://aedit.com/aedition/preparing-for-a-smooth-recovery-from-plastic-surgery). Generally speaking, [healing from the revision](https://aedit.com/aedition/what-its-really-like-to-get-a-nose-job) will be a familiar experience. With that said, it’s important to follow any pre- or post-op care instructions laid out by your surgeon for best results. 

## **The Takeaway**
Those who are unhappy with the results of a previous rhinoplasty may be good candidates for revision rhinoplasty, but it should be approached with careful consideration and realistic expectations. “There are an infinite number of ways that a nose can become disfigured after a poorly performed rhinoplasty, and there is an unlimited number of nuanced techniques for handling them,” Dr. Frankel concludes. “It comes down to the artistry and creativity of the revision specialist and their commitment to rendering the best possible outcome.”

Rhinoplasty may not always yield desired results, which is where revision surgery comes into play. The experts weigh in on what to know about going back for another procedure.

Revision Rhinoplasty: Guide To Safety, Surgery, Recovery

Considering Revision Rhinoplasty? Here’s What You Need To Know

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Since the time of the ancient Greeks, mathematicians, philosophers, and scientists have been searching for an elusive secret: What makes someone beautiful? Whether its Fibonacci’s Golden Ratio, to Leonardo da Vinci’s Vitruvian Man, or Charles Darwin’s competing theories of selection, we’ve long been obsessed with pinpointing the precise formula that makes one person’s face more aesthetically pleasing than another.

Enter [artificial intelligence (AI)](https://aedit.com/aedition/artificial-intelligence-in-healthcare-doctors-offices-operating-rooms). The science-fiction staple is now our modern reality, and researchers have been employing the technology — essentially a genius-level, one-track mind — in everything from rideshare apps to Alexa and, now, aesthetics.

## **The Study: Machine Learning, Rhinoplasty, & Aging**
Led by associate professor [Jason Roostaeian, MD](https://aedit.com/provider/jason-roostaeian-md-449), researchers in the Department of Plastic and Reconstructive Surgery at UCLA recently completed a study that brings us one step closer to objectively quantifying what defines beauty.

Why is that so significant? The answer lies in matching art with science. “As plastic surgeons, we try to be as science-based as possible to be certain everything is working for our patients,” Dr. Jason explains. “We can think we’re creating beauty. But without a way to measure that objectively, we’re not really using the scientific method.”

The UCLA researchers, including plastic surgery residents Sean Saadat, MD, and Robert Dorfman, MD, set out to test whether or not existing machine learning technology (which forms complex calculations based on a set of test images) could accurately recognize what humans consider beautiful. While the initial results showed promise, they quickly realized the high degree of subjectivity would require a greater quantity of images to get objective results.

So, they shifted focus — instead honing in on just one of the many facets of beauty: youth. The surgeons used established AI technology capable of detecting a person’s age more precisely than the human eye to an accuracy within four months. “If you gave me a hundred photos could I guess virtually their exact age? No,” Dr. Jason says. “This proves that the computer is figuring out something that we simply cannot. It’s incredible.”

For the test subjects, researchers passed over the obvious options like [facelift](https://aedit.com/procedure/smas-facelift) and [brow lift](https://aedit.com/procedure/endoscopic-brow-lift) patients (we already know those procedures reduce apparent age), instead choosing a sampling of Dr. Jason’s most common clients: 100 female [rhinoplasty patients](https://aedit.com/aedition/what-its-really-like-to-get-a-nose-job), ranging in age from 16 to 72 years old. The results were eye-opening. In patient after patient, the machine returned a postoperative age that was, on average, three years younger than the preoperative age.

## **The Results: Objectivity in a Subjective Field**
Surgeons have long suspected that certain changes to the nose (like refining and rotating the tip, for example) make patients seem younger. “Conceptually, we’ve known for awhile that a droopy tip is associated with facial aging,” Dr. Jason shares, adding that the study, [recently published in the Aesthetic Surgery Journal](https://academic.oup.com/asj/advance-article-abstract/doi/10.1093/asj/sjz259/5648144?redirectedFrom=fulltext), represents “the first time rhinoplasty has been proven to show a decrease in age.” 

While textbooks and journal articles rarely (if ever) correlate facial rejuvenation and rhinoplasty, Dr. Saadat says it should come as no surprise that the popular cosmetic surgery procedure has such an impact. 

When the nose is out of balance with the rest of the face, it draws undo attention to itself, Dr. Saadat explains. A rhinoplasty aims to [manipulate the angles of the nose](https://aedit.com/aedition/reinventing-rhinoplasty-whats-different-about-modern-nose-jobs) — the highlights and shadows — to bring it into better harmony with the surrounding facial features. Refining the nose opens up the face, highlighting the lips and eyes. “Bright, open eyes are a key indicator of youth,” he says. “In youth, facial harmony is optimized. You look more awake, more alive.”

Long term, Dr. Saadat foresees the study’s findings being a critical component of evaluating facial rejuvenation patients. “Of course, [not every aging patient needs a rhinoplasty](https://aedit.com/aedition/difference-between-cosmetic-rhinoplasty-vs-functional-rhinoplasty), but it’s an important piece of the puzzle, particularly when we’re fat grafting the mid-face,” he explains. “In some patients, maybe we balance it with a rhinoplasty to keep everything in proper proportion for the most natural results.”

## **The Future of AI in Aesthetics**
So, what do these findings mean for the future of aesthetic medicine more broadly? According to Dr. Saadat, figuring out how beautiful a person is on a scale of one to 10 misses the point. The focus instead is on using AI data — symmetry, proportion, and shape — as a tool to complement our more subjective sense of beauty. “It’s about asking: ‘What would this individual look like were they to be improved in their objective aesthetic harmony,’” he says.

The technology may prove particularly useful in facial reconstruction cases, allowing surgeons to “reverse engineer” what changes would yield the most pleasing outcome for the patient. “Artificial intelligence could provide a roadmap for reconstruction, rather than having to rely solely on what’s in the mind of the plastic surgeon,” Dr. Saadat says. 

Down the road, plastic surgeons may even be able to pinpoint the subtle differences in technique that create the most ‘beautiful’ result. “Over time, if we run enough numbers and enough people use this technology, we may be able to potentially figure out those differences” Dr. Jason says.

On the flip side, machine learning may also help patients in their search for the perfect plastic surgeon. “We may be able to get an objective score for a surgeon’s quality of work,” he adds, while conceding there will always be an element of subjectivity. “Whether you agree with it or not, that’s a question everyone will have to answer for themselves,” he shares.

## **The Takeaway** 
No matter how close we come to objectively cracking the beauty code, subjectivity will always remain. After all, it’s humans who have to tell the technology what is beautiful in the first place. “You feed the machine a bunch of photos, and the computer gets smarter and smarter,” says Dr. Jason. “But, absolutely, the input affects the output.” Given human nature, it’s unlikely that we’ll abandon our own individual sense of beauty, even when faced with quantifiable AI data. Beauty — for now — remains in the eye of the beholder.

Now Trending

A new study is using artificial intelligence to bring us one step closer to objectively quantifying what defines beauty. So, what does it mean for the future of aesthetic medicine?

New Study Shows How Artificial Intelligence Is Bringing Objectivity To Aesthetics

How Artificial Intelligence Is Bringing Objectivity To Aesthetics

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We all have that friend who, according to their doctor, “needed” a [nose job](https://aedit.com/procedure/open-rhinoplasty), and then we have friends who simply wanted one. So, what’s the difference?

One of the few procedures that are common among men and women and performed from [teenage years](https://aedit.com/procedure/youthteen-rhinoplasty) through [adulthood](https://aedit.com/procedure/rejuvenation-rhinoplasty), rhinoplasty (a.k.a. nose job, nose surgery, nasal surgery) can be classified as both a medically necessary plastic surgery procedure and an elective cosmetic surgery depending on how and why it is performed.

Generally speaking, your friend who “needed” the procedure likely had what is called a ‘functional’ rhinoplasty, during which a surgeon worked to resolve internal structural issues — in addition to potentially making aesthetic changes. Because the surgery was performed for medical reasons, it very well may have been covered by insurance (typical of plastic and reconstructive procedures but not cosmetic ones).

Your friend who wanted to change the shape, size, or appearance of her nose without an underlying medical condition, meanwhile, probably underwent what is known as a ‘cosmetic’ [rhinoplasty](https://aedit.com/procedure/ultrasonic-rhinoplasty). The cosmetic surgery procedure focuses exclusively on the external bone structure and usually requires patients to pay out of pocket.

[According to the American Society of Plastic Surgeons](https://www.plasticsurgery.org/documents/News/Statistics/2018/plastic-surgery-statistics-full-report-2018.pdf), there were some 215,000 rhinoplasties performed in the U.S. in 2018 alone, and that statistic accounts for both functional and cosmetic procedures. If you’ve been considering a nasal surgery, here is a guide to the two classifications.

## **What Is a Functional Rhinoplasty?**
First things first, a functional rhinoplasty is a medically necessary procedure that is used to [correct breathing problems](https://aedit.com/procedure/endoscopic-rhinoplasty) and sinus concerns. While we may not be able to see the inside of the nose, there can be structural issues that pose medical risks. 

“The nose is the organ of breathing,” says [Oren Friedman, MD](https://aedit.com/provider/oren-friedman-md-1609), a Philadelphia-based board certified facial plastic surgeon and director of facial plastic surgery at the University of Pennsylvania. “We are meant to breathe through the nose and not the mouth.”

As Dr. Friedman explains, the most common reason a patient seeks a functional rhinoplasty is to improve breathing. Patients who have a deviated septum (i.e. a narrow or crooked nasal passage caused by genetics, accident, or trauma), for example, may require a septoplasty to straighten or repair the septum. Beyond correcting a deviated septum, a rhinoplasty can “strengthen the sidewalls of the nose, so that the nasal sidewalls do not collapse and, therefore, obstruct airflow when the patients breathe in,” he shares. For cases of congenital abnormalities of nasal anatomy (think: cleft lip nasal deformities), meanwhile, Dr. Friedman says “highly specialized surgical care of the nasal tip cartilages and skin” is required.

For patients dealing with intense allergies or sinus infections that cause the turbinates (i.e. small structures inside the nose that clean and humidify air that passes through) to swell, nasal surgery may be able provide relief. 

There are three pairs of turbinates in each nose, and, when the lower set (read: inferior turbinates) become swollen, they can cause nasal obstruction and make it more difficult to breathe. To fix the structural issues, doctors may recommend a turbinate reduction. While non-surgical treatments, like radiofrequency, can sometimes do the trick, surgery might be needed.

“Some patients require septum straightening surgery as well as turbinate reductions, however, we generally advise against removing significant portions of nasal turbinate tissue,” Dr. Friedman warns. “Turbinate tissue is vital to the function of the nose — namely, humidifying, warming, and filtering the air are enhanced by the presence of turbinate tissue. Removal of too much turbinate tissue will lead to irreversible nasal problems. Ask your surgeon to not remove much or any turbinate tissue when you undergo nasal surgery.”

Whether performed individually or in tandem, both a septoplasty and turbinate reduction take six months to a year to heal. While improved breathing can be expected, turbinates will grow back in time and the septum may never be perfectly straight.

## **What Is a Cosmetic Rhinoplasty?**
Cosmetic rhinoplasties, on the other hand, focus on the outside of the nose (i.e. the part of the nose you can visibly see). Typically, patients that undergo the cosmetic procedure are dissatisfied with the appearance of their nose. A rhinoplasty can be used to:

- [Reshape and resize the nose](https://aedit.com/procedure/ethnic-rhinoplasty)
- [Address crookedness and asymmetries](https://aedit.com/procedure/revision-rhinoplasty)
- Change the base or bridge of the nose (or both!)
- Conceal a hump or bump
- Correct a pinched or bulbous nasal tip 

“The most common structural reasons for which patients seek cosmetic rhinoplasty include a prominent hump or bump along the bridge of the nose that they wish to be reduced, prominent and bulbous tip cartilages of the nose that they wish to be made smaller and triangulated, and a crooked nose that a person may wish to straighten out,” Dr. Friedman says. “The structural components that most often need to be altered, therefore, include the nasal bones as well as the tip cartilages.”

While the surgery is limited to the nose, the results can help to balance the entire face. At the end of the day, cosmetic rhinoplasty surgery isn’t a medical necessity, but it can boost confidence and make patients more comfortable with their appearance. 

## **Comparing Rhinoplasties** 
There are plenty of differences between a functional rhinoplasty and a cosmetic rhinoplasty, but at least one thing is true of each: the procedure improves a patient’s quality of life. While it may be easy to classify one as purely aesthetic and the other as medical, many rhinoplasty surgeries end up being a combination of the two.

“This is one of the most common procedures for specialized nasal surgeons, and it gives an opportunity for the surgeon to enhance a patient's quality of life on two different levels,” Dr. Friedman says of the combination surgery. “First, we are able to improve their quality of life through improvements to their appearance, and secondly we are able to improve their quality of life through improved nasal breathing.”

Regardless of the reasoning behind the rhinoplasty, the recovery and healing processes are similar — though there are subtle differences. “If the nasal bones need to be contoured in a cosmetic procedure, there will likely be some external bruising which would not be present if only internal nasal surgery was being performed,” Dr. Friedman notes. “Other than the slight bruising that might occur, the internal swelling of the nose generally resolved in one week for each of the different types of nasal surgery.”

At the end of the day, most people enjoy the results of their procedure by the six-month mark, but it can take up to a year for the nose to fully heal. Additionally, it is important to discuss with your surgeon whether or not your procedure is purely functional, purely cosmetic, or a hybrid because it will impact whether your insurance provider covers some part of the cost.

## **The Takeaway**
Regardless of which type of rhinoplasty you’re after, the procedure is best performed under the care and guidance of a specialized surgeon to avoid complications and the need for revisions down the road. 


“Excellence in outcomes for these types of nasal surgeries relies on the surgeon's expertise in this highly sub-specialized field,” Dr. Friedman explains. “In order to avoid the need for revision rhinoplasty due to failure of the first operation, it is very important the patient make the extra effort to identify a plastic surgeon who specializes in both internal and external nasal surgery.”

Some people need a rhinoplasty for medical reasons, while other people want one due to aesthetic concerns. Here, a guide to the two classifications and what it means for patients.  

Difference Between Cosmetic Rhinoplasty and Functional Rhinoplasty

Cosmetic Rhinoplasty vs. Functional Rhinoplasty: What’s The Difference?

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_Finding the right plastic surgeon is a lot like dating. You’ll likely have to consult with a few doctors — and maybe meet a frog or two along the way — before you find the best one for your cosmetic surgery._

_So, how do you know when you've found The One? There are a few important factors. For starters, he or she must be board certified by the [American Board of Plastic Surgery](https://www.abplasticsurgery.org/), must have attended an accredited medical school, and must perform all procedures in an accredited or state-licensed surgical facility and operating room. What makes them the right doctor for you beyond professional accreditation is a bit more subjective. In this series, we ask real patients to share their surgeon-selection stories to help guide — and safeguard — your own cosmetic surgeon search._

_The below interview has been edited for length and clarity._


## **Elizabeth, 52**


My two aesthetic plastic surgery experiences were at two extremes: the worst and the best.

The first time I had surgery was more than 12 years ago. I wanted my [nose reshaped](https://aedit.com/procedure/rhinoplasty-nose-job) and, during the consultation, was convinced by the doctor that I should also have a [chin implant](https://aedit.com/procedure/alloplastic-chin-implant) and some [liposuction](https://aedit.com/procedure/liposuction). The surgeon I chose was older — probably in his sixties at the time — and I figured he’d had lots of experience. He’d also appeared on _Oprah!_, which, in 2005, was a big deal. The first time I went to the surgeon's office, I took a friend from the beauty industry with me, and we were both impressed. Maybe less by him and more by his art-filled Upper East Side office and name-dropping, but I felt that if he’d had a successful practice for years, I’d be safe in his hands. Now, more than a decade later, I can see the red flags I missed.

### **The Immediate Warning Signs**

For starters, he smoked a cigar throughout our consultation. Seriously. He also talked at me the entire visit, bragging about his accomplishments and not really taking any time to get to know me or understand my concerns. He (successfully) upsold me on more surgery procedures — that chin implant and lipo — when I’d only come in about my nose. He never showed me his operating room, which was in the same building as his office. I also dismissed negative reviews I’d read online. At the time, chat rooms and community boards were relatively new and, while I did look at them, I didn't take them seriously. They were littered with negative comments about him, mostly referring to the fact that he had a terrible bedside manner. I should have paid closer attention. 

I could write a book about my negative plastic surgery story, but one detail sums up the experience: I woke up in the middle of my surgery to the doctor banging on my nose. That was emblematic of everything that followed. He botched my nose job, taking too much off the end and making my nostrils look over-exposed. He also left stitches inside my nose that caused an infection. He put in a chin implant that was too large and he overdid the liposuction, causing the skin in my stomach to permanently tighten and twist. In the end, he accepted no responsibility for anything and, while I did try to pursue legal action, my lawyer told me to save my money and put it toward reconstructive surgery. 

### **Second Time Around**

It was during the pursuit of corrective surgery for my nose that I found the [best surgeon](https://aedit.com/aedition/finding-the-right-plastic-surgeon-dermatologist-or-cosmetic-dentist). I first met him when I developed the infection in my nose. I’d been treated so poorly by the first doctor that, when the pain started, I didn’t trust him to take care of it. So, I searched online for the type of procedure I wanted and board certified plastic surgeons who had rave reviews when it came to nose jobs. I called the one whose name came up most often. I was desperate and scared. I explained my story to the nurse on the phone, which she communicated to him, and told me that even though he was done seeing patients for the day, he would wait at the office for me until I could get there. I was so thankful. He immediately put me on antibiotics and followed up with me until the infection was gone. 

He also helped outline the surgical procedures he thought would help me and explained that I would have to allow my nose to fully heal and wait a year before I could go under the knife again. In our follow-up meetings, he took the time to understand what I wanted and even asked me to draw a picture of what I wanted my nose to look like. He was an excellent communicator and clearly explained the kind of result I could realistically expect from these new plastic surgery procedures. He seemed to both understand what I wanted and be capable of creating it for me. I trusted his artistic skill as much as his medical acumen. I did wait a year until the second surgeon could do my corrective surgery. He restored my nose and removed the oversized chin implant. 

### **Lessons Learned**

I learned a lot during those two years of surgery and recovery. First, don’t dismiss what you read online. The negative reviews are good cautionary tales, but the positive ones are also important. People are more apt to pound out angry comments, but when someone takes the time to write about exemplary work, that’s just as telling. I also believe you should trust your gut. There were warning signs with the first doctor — the smoking, the over-talking, the disinterest in me — that made me wary, but I repressed that anxiety because of this doctor’s fancy office and television appearance. Always listen to your inner voice. Beware of any doctor who goes overboard telling you everything they think is "wrong" about you and all the additional cosmetic procedures they think you "need." If you go in for a nose job, that’s what you should be discussing. Finally, consider a surgeon with a specialty in the specific procedure you want. The second surgeon I chose is known for nose jobs — it’s what he does the most often. That turned out to be one of the most important things for me.

Patient Perspective

Finding the right plastic surgeon is a lot like dating. You’ll likely have to consult with a few doctors — and maybe meet a frog or two along the way — before you find the best one for your cosmetic surgery.

How I Found My Plastic Surgeon: Trust Your Gut

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With nearly eight million subscribers and 3.5 million [Instagram](https://www.instagram.com/gabi/?hl=en) followers, YouTube personality Gabi DeMartino is no stranger to scrutiny. What’s surprising, however, is that for years, the criticism came not from her fans, but from herself. We spoke to the social media sensation about the influence of family, friends, and Internet fame on her quest to finally become comfortable in her own skin.
 
“I wasn’t happy with my face for forever,” says Gabi, 24, the host of YouTube's wildly popular [Fancy Vlogs by Gab](https://www.youtube.com/channel/UCLGe0PxyRFWmXVGJKq_gGvw) and [Niki and Gabi](https://www.youtube.com/channel/UCuVHOs0H5hvAHGr8O4yIBNQ). She spent much of her early teens fantasizing about fixing the features she found so unpleasant. “I didn’t even know what surgery was, and I was in seventh grade saying, ‘Mom and dad, let me [change my nose](https://aedit.com/procedure/youthteen-rhinoplasty)’, and they were like, ‘What?’”

Despite her insecurities, Gabi started creating makeup tutorials for YouTube alongside her identical twin sister Niki when the two were just 17. She was enamored by the transformative power of makeup, yet frustrated with herself as a model. “I didn’t have that makeup face,” Gabi explains. “I didn’t have lips to put lipstick on. I didn’t have a tiny, cute little fairy nose that makes everything look proportionate when you do makeup. I had a bulbous nose, thin lips, and tiny teeth. The only feature I was actually not ashamed of was my eyes, so if you look at my older makeup videos, everything is about the eyes.”

Becoming a successful beauty vlogger may have magnified Gabi’s dissatisfaction with her appearance, but it also inspired her to do something about it. “People might think it would make me feel more insecure, but it actually made me feel empowered to follow what I want to do with my life.” It also afforded Gabi the money she needed to make those cosmetic changes she’d been longing for all through high school.

As soon as she turned 18, Gabi used the money she’d saved to get [lip filler](https://aedit.com/procedure/temporary-lip-fillers) (without realizing it required periodic upkeep) and [dental veneers](https://aedit.com/procedure/veneers), but the YouTube star was afraid to go under the knife because of the risks and the stigma associated with plastic surgery. Her parents, both well-known dentists in their small Pennsylvania town, were adamantly against it. “I think they were insecure about looking like bad parents," she says, "and I feel like my mom has wanted to change her nose for her entire life, but felt she couldn’t.”

Gabi also experienced blowback from some of her friends, even the ones who’d expressed interest in having their own cosmetic procedures. “There were friends I knew wanted to get their lips done, but told me I'd changed and I was full of myself," she says. "I told them I just modified something that I never liked and that doesn’t change me. I did lose some friendships over it.”

And in a candid episode of Niki and Gabi last year called [The Truth about Gabi's Face Transformation](https://www.youtube.com/watch?v=vu9TNw8i25A), the twins talk openly about the profound effect Gabi's non-surgical cosmetic procedures have had on their relationship as identical twins. Niki "has the same insecurities as me," Gabi says, but she's become more accepting now that she's started to get cosmetic procedures too.

The more Gabi's look changed, the more some began to accuse the YouTube star of trying to look like Ariana Grande, her pop idol. Online, she was labeled Ariana's doppelgänger by some and her stalker by others. When Gabi made a parody video entitled [i lived like ariana grande for a day](https://www.youtube.com/watch?v=BX41qvpKbBs), it inadvertently set off a Twitter feud between [@gabcake](https://twitter.com/gabcake?ref_src=twsrc%5Egoogle%7Ctwcamp%5Eserp%7Ctwgr%5Eauthor) and [@ArianaGrande](https://twitter.com/ArianaGrande?ref_src=twsrc%5Egoogle%7Ctwcamp%5Eserp%7Ctwgr%5Eauthor) that was ultimately cleared up amicably. Grande apparently held no grudge, inviting Gabi to be in her Thank U, Next music video. Gabi later gushed on YouTube, "She looks like a Snapchat filter, I look like when you take the Snapchat filter off." 

It was a very public reference to Gabi's continuing insecurity about the one thing she hadn’t crossed off her cosmetic wish list: her nose. “I was getting [non-surgical nose jobs](https://aedit.com/procedure/liquid-rhinoplasty) for the last two years, but no matter what we did with it, I was still completely miserable with the nose I had.”

<a href="https://www.instagram.com/p/Bs6zmsgFs9G/" class="embedly-card" data-card-width="80%" data-card-controls="1">Embedded content: https://www.instagram.com/p/Bs6zmsgFs9G/</a>

Last fall, Gabi had an epiphany. “I remember thinking, do I want to go through another Christmas with this nose? Do I want to go through more birthday pictures with this nose? Do I want to go through more screenshots from fans with this nose?’” She finally realized that although approval from her friends and family was important, it was also holding her back. “My parents aren’t the ones putting themselves out there for eight million followers to see. They’re not the ones doing what I’m doing. It’s so easy for them to say it’s not a big deal, get over it, don’t be vain. But they’re not the ones trying to deal with something that makes them very upset.” 

Gabi confided in her injector, who recommended she make an appointment with board certified plastic surgeon [Jason Bloom, MD](https://aedit.com/provider/jason-bloom-md-2248). She’d already been to six consultations with surgeons in New York, Los Angeles, Miami, and beyond, but none of them felt right. That changed, however, once she met Dr. Bloom. “First, I made sure that I found a doctor that I felt comfortable with to put me under anesthesia and cut open my face," she says. "Second, I found someone who could make my nose look like it was mine, like I was born with it.” 

During the consultation, Gabi looked through before-and-after photos of patients who had a similar anatomy and aesthetic goal to hers. “What I try to do in a consultation is to show patients particular pictures which are going to match what their needs are," says Dr. Bloom. "Once they see that I can do something that they’re interested in, then it’s a match.” He also provided Gabi with 3D imaging of her nose, which allowed her to see just how she’d look post-surgery. “3D imaging really lets the patient see what their nose is going to look like in all dimensions,” he says. “The main reason I do it is so that my patient and I are both headed towards the same goal."

For Gabi, seeing how Dr. Bloom's 3D images matched with the post-surgical results is what sold her. “That gave me so much confidence," she says. "If he’s able to do this 3D imaging in a consultation and then actually make your nose look like what he showed you at your consultation, then this is the guy.’”

Gabi scheduled her surgery immediately, but was sidelined for four months due to  pneumonia. It was worth the wait. “It was the most painless, comfortable, and easy thing I’ve ever done,” she gushes. "Lip injections hurt more than a [nose job](https://aedit.com/procedure/open-rhinoplasty) did. I had absolutely no pain, barely any bruising, and no swelling.” 

Dr. Bloom attributes Gabi’s smooth recovery to his [endonasal](https://aedit.com/procedure/endoscopic-rhinoplasty) surgical approach, which causes less nasal trauma, and therefore less swelling, than an open rhinoplasty. The day before the surgery, Dr. Bloom dissolved the filler in Gabi’s nose so that he could accurately gauge her anatomy. He determined Gabi's nose "was overall wide, flat, lacked a little bit of definition, and her bridge was a little bit higher than she wanted it. So I brought the bridge down, both the bone and a little bit of the cartilage,” he recounts. “I shaped the tip cartilages to make it a bit more defined, and I did some tip suturing to give some projection and support to the tip. I narrowed the nasal bones and lastly, I did internal nostril base reductions to bring the nostrils more toward the midline.”

Gabi credits her post-procedure comfort level, both physical and emotional, to her years of experience in the public eye (“ I was used to being stared at,” she says) and to Dr. Bloom’s expertise. “I didn’t take any painkillers, because I felt no pain at all,” she says. Dr. Bloom also sent Gabi home with OcuMend arnica pads to help with healing. “Those patches saved my life,” she exclaims. "I’d seen those videos of people with big eggplant-colored bruises around their eyes. I was so fortunate to have those patches because the only bruising I had was for the first two days and it was very minor.”

<a href="https://www.instagram.com/p/BsykOxjlFUp/" class="embedly-card" data-card-width="80%" data-card-controls="0">Embedded content: https://www.instagram.com/p/BsykOxjlFUp/</a>

Throughout her entire rhinoplasty process, Gabi was completely forthcoming, walking fans through her surgery plans in a YouTube video called [i lied to you all of 2018 NOT clickbait](https://www.youtube.com/watch?v=uEkWBh71sDU) and chronicling the procedure in another called [I just got a nose job. my entire nose job experience (so fun)](https://www.youtube.com/watch?v=xwTY2YnwaGk). Gabi also posted pics, cast and all, to Instagram, including a video of herself at a store listening to an Ariana Grande song, which the superstar reposted to her own account. “She thought it was really funny,” explains Gabi. “Ariana even asked me about my [nose job](https://aedit.com/aedition/reinventing-rhinoplasty-whats-different-about-modern-nose-jobs ) process and how I was doing. She was really sweet about it.”

The public response to Gabi’s nose job has been overwhelmingly positive. “I really haven’t gotten any bad comments,” she reveals. “The only negative comments I got in the past were before I owned up to my lip injections.” The lesson wasn’t lost on Gabi. She feels a moral obligation to be honest about everything she’s changed. “I think people are cowards when they try to hide it,” she says, “especially when they’re public figures. They could really be helping people by sharing their experience.”

Now that Gabi’s family and friends have seen how happy she is after her rhinoplasty procedure, they’re more accepting. She hopes to dispel the belief that cosmetic surgery is all about vanity. “A lot of people look at the vanity and not the internal happiness aspect of it,” she muses. “I finally found peace within myself the moment I changed my nose. Yes, it's a lot of money, but at the same time, it’s on your face – something you wear everywhere, every day, and it’s something that will make you feel so good about yourself if that’s what you truly want.”

We spoke to the social media sensation about the influence of family, friends and Internet fame on her quest to finally become comfortable in her own skin.

Why YouTube Star Gabi DeMartino Got A Nose Job

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Are you looking to improve the contour of your nose without going under the knife? You’re not alone. Non-surgical nose jobs, also known as a [liquid rhinoplasty](https://aedit.com/procedure/liquid-rhinoplasty), have become a sensation in recent years, with increasing numbers of patients seeking to solve their dorsal dilemmas with no downtime. Technically speaking, the procedure isn’t a [rhinoplasty](https://aedit.com/procedure/open-rhinoplasty) at all; it’s dermal filler (usually hyaluronic acid) non-surgically injected into the nose. The implicit promise in this procedure is a seemingly easy fix for a very common cosmetic complaint. 
 
According to Los Angeles-based board certified plastic surgeon [Jason Roostaeian, MD](https://aedit.com/provider/jason-roostaeian-md-449), requests for non-surgical rhinoplasties are on the rise due to increased exposure on social media. “As more people talk about it and see it posted, of course everyone becomes interested,” he says. “If they think they can get a good result without committing to a full surgery, then it’s enticing.” 

## **Liquid Rhinoplasty vs. Traditional Rhinoplasty** 
Non-surgical rhinoplasty procedures involve strategically injecting filler into the nasal valleys and curves to create the illusion of a smoother contour. To determine whether a person is a good candidate for the procedure, board certified Beverly Hills plastic surgeon [John Layke, MD](https://aedit.com/provider/john-layke-645), looks for several factors. Liquid nose jobs, he says, are performed “to correct a dorsal hump, to raise a drooping tip, to fill in contour irregularities (usually from a previous rhinoplasty)” and to correct minor nasal asymmetries or crookedness. For patients who are considering surgery but aren’t prepared to take the plunge, Dr. Layke says nasal filler allows you “to see the effects of improving the overall appearance of your nose without permanency. This way patients can try out their new nose to see if they like it.” 
 
Patients with functional concerns, however, are not good candidates for nasal filler. As Dr. Layke explains, “Breathing issues cannot be corrected without surgery.” Dr. Jason adds that a non-surgical rhinoplasty is also not ideal for those seeking dramatic or permanent changes, looking to fix a severely crooked nose, or hoping to correct a wide nasal base.
 
## **Potential Risks and Complications** 
According to Dr. Jason, this treatment that’s taking the aesthetic business by storm has some other serious drawbacks. It has both limited potential to produce pleasing results and a serious set of risks. “With filler, we can only add – we have to make the nose larger,” he says. “It’s physically impossible to shrink a nose with [filler](https://aedit.com/aedition/reinventing-rhinoplasty-whats-different-about-modern-nose-jobs).” For this reason, Dr. Jason cautions people to look critically at the size of the nose in before-and-after pictures. “It’s common for injectors to use photo trickery, where the ‘before’ is a closeup and the ‘after’ is taken a bit farther away to create an illusion that’s not actually achievable.” 
 
Using [injectable filler](https://aedit.com/aedition/8-new-and-unexpected-uses-for-injectables) to alter the nose can also create an inconsistent result, says Dr. Jason, because “it dissolves all the time, so you’re chasing your tail trying to maintain it. The nose is very structural – it doesn’t make a lot of sense to add a gooey gel and expect it to look right.” This is especially true when addressing the nasal tip, he explains, because there, “the cartilage should be close to the skin. Pleasant looking noses have a bit of that underlying structure lending it substance visually.” Adding filler to the tip can sometimes result in simply exchanging a droopy appearance for a puffy one. 
 
More concerning, however, are the potential complications associated with injecting filler into the nose since it has a high concentration of blood vessels. According to Dr. Jason, it’s crucial for people to seek out a highly trained injector, ideally a board certified plastic surgeon, to perform any kind of dermal filler cosmetic procedure. If filler is inadvertently administered into a vessel that leads to the eyes, irreversible blindness can occur without warning. More commonly, nasal filler carries a risk of skin death (known as necrosis), which happens when tiny blood vessels, like those along the sides or tip of the nose, become blocked with gel. According to Dr. Jason, the warning signs are usually immediately apparent and include skin discoloration or a blotchy, mottled appearance that’s distinctly different from typical bruising. “While you may safely see a slight purple elevation right where you were injected, seeing splotchy color away from the injection site isn’t good,” he says. A lack of color near the surface of the skin is also concerning. “When you press on normal skin, it turns white,” he explains, “and then when you release the pressure, it quickly turns pink again. You should be able to see that redness coming back right away.”
 
Because of the potential complications and the limited aesthetic potential, Dr. Jason performs non-surgical nose jobs infrequently. For those patients committed to avoiding rhinoplasty surgery for health or other reasons, he recommends dermal filler to correct a mild hump as long as the patient isn’t concerned about nasal width. Injecting filler “can make the hump look smaller,” he points out. “It’s an optical illusion: If you add filler in the valley, the mountain doesn’t look as big.”

## **Additional Factors To Consider When Choosing Liquid Rhinoplasty** 
A non-surgical rhinoplasty typically costs around $1,000 to $2,000 and takes about 10 to 15 minutes to complete. About 20 minutes before the procedure begins, the surgeons apply a topical numbing cream to make patients more comfortable. Dr. Layke usually starts with adjustments to the nasal tip (if applicable) before addressing the bridge of the nose, and Dr. Jason uses the same “top down” approach he does during his surgical rhinoplasties. 

While patients may experience minor bruising and swelling at the injection sites for a couple of days, cold compresses help minimize their appearance. Dr. Jason encourages patients to avoid both strenuous exercise (which elevates blood pressure) and blood thinners like ibuprofen, aspirin, or alcohol for 24 to 48 hours after receiving dermal filler injections. Everyone metabolizes filler differently, so results last about one year, but may begin to diminish as early as six months. If a patient is unhappy with their non-surgical rhinoplasty, Dr. Layke says that “Hyaluronidase can be injected to dissolve the product and return them to their pre-injected state.”

## **The Takeaway**
Whether you opt for a traditional or a non-surgical rhinoplasty, Dr. Layke urges patients to confirm that their surgeon is board certified by the American Board of Plastic Surgery or the American Board of Facial Plastic Surgery. “Make sure you feel comfortable with that surgeon, as they must be able to manage potential complications,” he says. “Look at their results to ensure that their ‘aesthetic eye’ matches yours.” 

Dr. Jason agrees, adding that it is important to look at before-and-after photos from as many angles as possible. “Be diligent about examining standardized before-and-after photos. Those patient selfies aren’t accurate – what you can do with lighting and makeup completely changes the apparent result,” he warns. “What may look fine from one perspective could look terrible from every other view. When you're evaluating a plastic surgeon’s work, make sure that the result looks good from every angle."

Liquid rhinoplasty is the buzziest treatment in beauty, but it may not be for everyone. We spoke to Drs. Jason Roostaeian and John Layke to find out what you need to know about the non-surgical nose job. 

What You Need To Know About Liquid Rhinoplasty

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In recent years, both the art and science of [rhinoplasty](https://aedit.com/procedure/open-rhinoplasty) have been experiencing an evolution. Innovative surgical techniques, combined with inventive new technologies, are generating greater options for both [surgeons](https://aedit.com/aedition/finding-the-right-plastic-surgeon-dermatologist-or-cosmetic-dentist) and patients alike. For people seeking nose surgery, this means that the days of cookie-cutter, overly done noses are disappearing, replaced by a custom approach that respects each patient’s unique aesthetic and anatomy. 
 
According to board certified UCLA Associate Professor of Plastic Surgery, [Dr. Jason Roostaeian](https://aedit.com/provider/jason-roostaeian-md-449), “The biggest difference between historical surgical technique and modern rhinoplasty technique is the shift from a reductive to a structural approach.” In the past, facial plastic surgeons focused primarily on removing tissue to reduce the size and/or change the proportions of the nose, a technique that often led to too much tissue being discarded. Reductive nose reshaping could eventually form scar tissue, which often warped whatever cartilage remained and tightened the soft tissue, creating both breathing issues as well as the sloped, saddle nose and pinched nasal tip we often associate with [nose jobs](https://aedit.com/aedition/what-its-really-like-to-get-a-nose-job). That has all changed. “With structural rhinoplasty,” Dr. Jason says, “We utilize what’s already there – the nasal bones and internal cartilaginous framework – but rearrange and sculpt it so that we end up with a more stable and predictable result that stands the test of time.”
 
## **A Tailor-Made Nose Job**

“Think about the nose as a two-story house, with the skin being the roof and exterior siding, and the cartilage and soft tissue inside are the wooden framework and the drywall," says plastic surgery resident Dr. Sean Saadat. "In the old days, surgeons would go in, demolish the second floor, and put the roof back on. Now, we take the whole house down to the studs, redesigning and fortifying it when necessary, before we cover it back up.”
 
Practically speaking, this translates into a more harmonious result that better blends with a patient’s existing facial proportions. It also means that patients are less likely to be faced with complicated revisions. When they are, cosmetic surgeons now have a better understanding of how to correct a previous nose job. However, correcting mistakes made during prior rhinoplasties is no easy task. “Not every plastic surgeon does revision rhinoplasty,” says Dr. Jason. “It requires considerably more thinking, planning and creativity than primary procedures because you never know what you’re going to get. To use the construction analogy, it’s like coming in after the demo and trying to figure out what we’re going to use to rebuild and how we’re going to use it.” 
 
Achieving these more natural, lasting results takes time. Surgery times for rhinoplasty have increased from an average of one or two hours to sometimes five hours or longer, particularly in revision cases. According to Dr. Saadat, this is due in part to the more targeted approach. “There is a better understanding that ideally, you disrupt the internal nasal structure as little as possible," he says. "Injury leads to inflammation, which leads to scarring, which can cause both functional and aesthetic problems down the road.” 
 
## **The Role of Technological Advancements**

Even though rhinoplasty patients are spending more time under general anesthesia, technological advances are allowing them to heal more quickly and comfortably and see results that better match their expectations. Historically, surgeons packed the nose full of gauze in the operating room, which led to considerable patient discomfort for a week following surgery. These days, doctors can instead insert hollow silicone stents inside each nostril, which allow patients to breathe properly from the moment they wake from anesthesia. To protect the exterior of the nose, Dr. Jason also uses new splint technology from MirrorMe3D. “Traditional splints are essentially casts applied to the patient after surgery, but this transparent device is completely custom molded to each individual via 3D imaging," he says. "It provides a superior level of protection from post-operative swelling, and also allows patients a sneak peek at their healing nose.” 
 
While all of this innovation is impressive, Dr. Jason discourages patients from relying exclusively on bells and whistles when choosing their rhinoplasty surgeon. “Computer software that simulates a patient’s potential result is certainly useful, but generating the images is time-consuming and limited by your surgeon’s skill with Photoshop," he says. Dr. Jason encourages patients who are researching rhinoplasty doctors to study their prospective surgeon’s before-and-after photographs to get a strong sense of their skill and aesthetic. Dr. Saadat, who chose his primary nose surgeon solely on the basis of the 3D technology the doctor used, has since reconsidered its importance. “3D technology can show you the vision your plastic surgeon has for you, but their before-and-after photos demonstrate their ability to execute that vision. It’s a fine balance.”
 
Fortunately, an increasing number of modern rhinoplasty procedure patients are able to benefit from that balance and it's a trend that will continue as long as plastic surgeons continue matching skill with science. “Technology is clearly crucial to modern rhinoplasty," says Dr. Jason. "It comes down to taking advantage of the advances in technique and technology and to whether or not your plastic surgeon is able to really utilize those advances to provide a superior experience.”

The days of cookie-cutter, overly-done nose jobs are disappearing. We spoke with Dr. Jason Roostaeian about how innovative surgical techniques and new technologies are changing what we can expect from a rhinoplasty.

The AEDITION

Rhinoplasty