Real Rhinoplasty Patients Sound Off: What They Wish They Knew Before Getting a Nose Job

In the last five to ten years, social media has democratized and, in many ways, glamorized aesthetic medicine. You used to find plastic surgeons through a localized web search and/or word of mouth. Today, providers are increasingly going digital to showcase their work, while patients are more open than ever about what they are getting done.

Some of the most dramatic and popular before and afters on Instagram, TikTok, and even YouTube are of rhinoplasty (a.k.a. nose jobs), which has increased interest in the already top procedure. According to the American Society of Plastic Surgeons (ASPS), some 45,000 nose reshaping surgeries were performed in the United States in 2022 – that’s up 37 percent from pre-pandemic (2019) levels.

The great thing about social media is that it puts an abundance of information right at your fingertips. A quick search of ‘nose job’ on just about any platform will pull up millions – if not billions – of seemingly picture perfect results. But are they too good to be true?

Ideally, every plastic surgery patient would be thrilled with the outcome of their procedure. In reality, there are an array of both functional and cosmetic reasons why someone may not be completely satisfied with the results. While revision statistics are hard to come by, revision rhinoplasty is more common than social media may have you believe.

That’s why I’ve asked revision rhinoplasty candidates from all over the world to share their patient perspective. We asked them about what they wish they knew prior to their primary surgery and whether or not they would have gone forward with the procedure knowing what they know now – and let’s just say their answers may surprise you.

To be clear, this article is by no means meant to dissuade you from getting a nose job. Instead, it’s designed to arm you with everything you need to make the most informed decision for yourself.

Rhinoplasty 101

Here’s the thing: You don’t need to earn a medical degree prior to beginning the rhinoplasty consultation process, but there is no such thing as knowing too much. Perhaps that is why one of the most common refrains we heard from revision rhinoplasty patients was:

Patient Perspective: “RESEARCH!! I thought I was prepared but I really knew nothing about this surgery.”

For starters, you should know what rhinoplasty is. In the simplest terms, rhinoplasty is “an operation designed to change the shape of the nose based on the current aesthetic standard while improving or preserving nasal breathing,” says Ari Hyman, MD, a double board certified facial plastic and reconstructive surgeon in Los Angeles. “The result of that rhinoplasty should also be long lasting.”

There are, however, limitations to that shaping. “A common misconception is that rhinoplasty can achieve anything in terms of shape,” Dr. Hyman says. As he explained, currently accepted rhinoplasty techniques can address either the two-dimensional or three-dimensional features of the nose:

Two-Dimensional Features: These include “how far the nose sticks out from the profile at the tip, the height of the bridge, as well as nasal tip rotation,” Dr. Hyman shares. Three-Dimensional Features: These encompass the “front view – shadows and highlights,” he adds.

This means that rhinoplasty generally isn't capable of “creating abstract shapes,” Dr. Hyman explains, like “putting a hump back when it was removed, creating natural roundness of the tip that was removed with previous surgery, or creating an hourglass front view that can occur with some natural bridges.”

Open vs. Closed Rhinoplasty

In regards to technique, there are two main types of rhinoplasty: closed rhinoplasty and open rhinoplasty. “It comes down to surgeon comfort and preference,” Dr. Hyman shares. “Closed rhinoplasty spares a columellar scar, but both techniques require surgery.” If you are looking for a primer, here you go:

Closed Rhinoplasty: Externally scarless; surgery performed through small nostril incision; may cause significant internal scar tissue if performed incorrectly Open Rhinoplasty: External incision at the base of the nose (columella); may require longer healing and recovery time

Do not make the mistake of choosing a surgeon who isn't the right fit for you because you don’t want a columella scar. Not everyone is a candidate for closed rhinoplasty. For instance, if your nose requires extensive modifications and/or grafting, open rhinoplasty is likely the more suitable option. The best analogy I heard during one of my many consultations was:

“Compare this procedure to working on the engine of your car. Would you rather have the hood open or closed?”

Many surgeons prefer open rhinoplasty because it gives them greater access to the internal structure of the nose, ensuring the most precise outcome.

Not So Frequently Asked Questions

If you’re like us, you don’t exactly have an encyclopedic knowledge of your high school anatomy class. If you are interested in rhinoplasty, however, now is the time to brush up on your knowledge – plus, the medical terminology that specifically relates to the procedure.

Here are a few of the questions revision patients wish they would have considered and/or discussed more extensively before their primary surgery:

Do you feel like you are able to describe the parts of your nose you wish to maintain and/or change effectively? (e.g. “I had no idea what a columella or infratip lobule was before my primary, and I was ineffective in explaining that I wished to keep mine.”) Are you familiar with the different techniques used to achieve different outcomes?

Is your surgeon using outdated techniques and/or grafts? What does ‘botched’ actually mean? Over-resection, inverted V deformity, nasal tip pinching, open-roof deformity, saddle nose, and pollybeak are just a few examples of being ‘botched’ cosmetically, but something like over-resection could also impact your breathing and quality of life.

Revision seekers overwhelmingly told us that while they initially knew very little of the above, they now know as many of the terms and techniques as the surgeons they consult with because of the extensiveness of their secondary research.

Revision Rhinoplasty

The rate of patients who seek out revision rhinoplasty (a.k.a. secondary rhinoplasty) is not officially reported, but plastic surgeons say it is generally accepted to be around 20 to 25 percent. That is significantly higher than the 10 to 15 percent figures you will likely find online. A couple of reasons for this:

Just because someone needs a revision doesn’t mean they will get one. Cost and fear hinder people from moving forward with a second procedure. Revision patients will often opt for a different surgeon from their primary, thus manipulating that primary surgeon’s revision rates.

Revision procedures are almost always more costly than primary ones. Prices can range from $15,000 to $50,000 (or more), but that’s not all. The surgery is more complicated, and the recovery process tends to be more involved. In some cases, poor outcomes stem from improper technique. In others, the body/healing process simply doesn’t cooperate. And then there is the age factor. Even beautiful results will be subjected to the aging process and may need revision down the line. This is especially true for younger patients.

Perhaps that is why we heard some version of this from many patients:

Patient Perspective: “I wish I knew the costs of revision vs. primary and joined the revision support groups as part of my research to see what it entailed if something should go wrong. I may have never gotten surgery in the first place.”

While secondary rhinoplasty may be unavoidable for some, there are certain things that can mitigate the risk. “Choose a surgeon who commonly performs rhinoplasty,” Dr. Hyman emphasizes. “While not used by every surgeon, I think it is important to use computer imaging to align aesthetic preferences between the patient and their surgeon. This can help ensure both the patient and surgeon are on the same page regarding what changes should occur during one's rhinoplasty.”

Harvested Materials

Another part of the revision – and primary – rhinoplasty surgery that patients are often unaware of? The need for harvested materials to correct deformities. "Rhinoplasty is a surgery for changing the shape of the nose – that has to be done somehow," Dr. Hyman shares. "It is often not enough to simply cut things away and suture them into submission to create the perfect nasal shape, so surgeons need materials."

Specifically, surgeons need cartilage. While that can come from the nose itself, (mainly the nasal septum, Dr. Hyman notes), the septal cartilage is often gone, damaged, or in short supply in a revision rhinoplasty patient. "There are generally two other places surgeons will go for cartilage: the ear or the rib," Dr. Hyman says.

Both have pros and cons. "Ear cartilage, while more accessible, is generally soft, thick, irregular in shape, and low in volume," he explains. "These qualities make it less ideal for revision surgery." Rib cartilage, Dr. Hyman's view, is more ideal for revision cases. "It's harvested through a small incision (1.5 cm or less in my practice), takes around 15 minutes to harvest, is low in terms of risks, and gives excellent quality and quantity of cartilage to fix most any nasal deformity," he explains.

Patients may also require "soft tissue coverage” to “camouflage the nasal framework” or “fill in dents and dings,” Dr. Hyman says. “In these cases, fascia (connective tissue) from the scalp or from the abdominal muscle (through the rib harvest incision) can be used.”

All of these materials “are very commonly used” in Dr. Hyman’s practice and others that perform a high volume of revision rhinoplasty. Some surgeons, however, may employ artificial materials, like silicone, for these purposes. Understanding the risks and rewards of these techniques is an important component of the research process.

Finding a Rhinoplasty Provider

That brings us to perhaps the most important part of the rhinoplasty discovery process: finding the right provider. Much like Goldilocks, it requires some trial and error to find someone who is just right.

The consultation process is designed for you to get to know the background, aesthetic, and bedside manner of the surgeons you are considering, in addition to offering a chance to ask all the questions you have. “Have a minimum of two but ideally three consultations to ensure a good sample size of opinions,” says William A. Kennedy, III, MD, a board certified Head & Neck Surgeon, fellowship trained in facial plastic and reconstructive surgery and founder of AEDIT.

This is a good time to play your cards close to the vest. “It is important that the patient not divulge they are seeking other opinions or who the other surgeons are,” Dr. Kennedy shares. “This information, if divulged, will almost certainly skew the doctor’s response and could provoke a biased recommendation.” With that in mind, he recommends asking every physician these three questions:

How many times a year do you repeat a rhinoplasty on your patients? Have you ever been sued by a rhinoplasty patient? (“In California, medical malpractice lawsuits are only published and available to the public if the surgeon has accumulated 3 or more lawsuits over a 5-year period,” Dr. Kennedy notes.) How often do you refer post-op rhinoplasty patients to other plastic surgeons for further work?

As Dr. Kennedy explained, “the best questions for a patient to ask a plastic surgeon are often the hardest or most uncomfortable questions for them to answer.” Additionally, revision rhinoplasty patients offered us some vetting tips of their own:

Patient Perspective: “Proximity doesn’t mean they’re a good choice for you.” You may want to consider traveling for the right surgeon. Revision patients often have limited options of experts willing to take on their cases and wind up traveling outside of their state. The same can be applied to primary surgery. If you don't have suitable options in your area, consider broadening your search.

Patient Perspective: “Traveling abroad for rhinoplasty – while cost effective – comes with its own set of risks.” First of all, there are different standards for medical care in different countries, which can complicate the surgery and recovery process. Furthermore, some regions are known for an aesthetic that may not be what’s best for you (e.g. eastern European surgeons and patients often prefer more dramatic results).

Patient Perspective: “I didn’t know rhinoplasty was a ‘complicated’ procedure, and I didn’t know there were ‘specialists.’” You’ll want to seek a rhinoplasty specialist who has experience working on noses similar to yours – whether that is ethnicity or skin thickness. A thorough consultation will determine whether they are the right fit for your needs.

Patient Perspective: “Spend the money the first time you have surgery – even if that means you’ll have to save and wait.” Don’t try to find a ‘good deal’ from a ‘great’ surgeon. It doesn’t exist. Expertise has its costs.

Patient Perspective: “Just because a surgeon has a good PR team doesn’t mean they have the clinical skills and artistry to give their patient a desirable outcome.” Do not fall for marketing traps and stop your research there. Be diligent in obtaining as much information as possible before, during, and after the consultation.

Patient Perspective: “Patient reviews may be a useful resource while conducting research, but take each with a grain of salt.” Any cosmetic surgery takes time to fully heal, with rhinoplasty taking at least 12 months. Reviews written too soon after surgery can be misleading due to the fact that the recovery process is not complete and results change over time. Additionally, review sites are not always the most reliable way to vet providers, as a number of factors can influence a physician’s ratings. If a surgeon has no negative reviews, it is likely too good to be true.

Patient Perspective: “Realize that surgeons are human beings, not wizards.”
Even world-renowned surgeons have failed cases. Run the other direction if your doctor claims to only have happy patients. This is not possible and, sadly, NDAs are passed out freely in this industry.

Facial Morphing & Imagery

While plastic surgeons are trained in the same general techniques, their personal views on aesthetics influence their work. Asking a surgeon to move out of their comfort zone will not lead to desirable outcomes. But how can you confirm that your aesthetics align?

Technology has come a long way and we no longer have to rely solely on trust when explaining our ideal nose to surgeons. Many practices now offer facial imaging, but there are also at-home tools – like AEDIT’s AI Plastic Surgeon – that can jump start the process. “The technology now has the potential to overtake even real doctors in terms of precision of facial measurements and analysis,” Dr. Kennedy explains. “It has the powerful ability to provide a general insight and view into potential results a patient can expect to receive after a procedure.”

This is not meant to replace a consultation with a board certified provider but rather complement it. “Although it can provide a ballpark view, plastic surgery is an art and surgeons are artists,” Dr. Kennedy shares. “Finer aspects of results are ultimately determined by an individual patient's desires and a surgeon's aesthetic opinion.”

Rhinoplasty Recovery & Results

Part of the equation of having a satisfactory rhinoplasty result is having the right mindset going into it. The patients we spoke to emphasized recovery, expectations, mental health, and results as some of the key elements to consider and below is some of their unfiltered advice:

Recovery

Patient Perspective: “Your nose will not look good when the cast comes off. It shouldn’t even look good seven days post-op. Be careful of doctors marketing these results only.” Besides being able to promote themselves to a much broader audience, social media has allowed plastic surgeons to easily share their before-and-after photos like never before.

The most effectively presented before-and-afters will use the same lighting and background. The patient should be in the same position with the same (minimal) expression. Filtered, patient-documented photos are not an accurate representation of surgical outcomes.

Be weary of photos that do not show the final result. If a nose looks good a week after surgery, that is not a clear indication of the ultimate outcome. Swelling will reduce dramatically in the first eight weeks and continue to gradually improve over the course of 12 to 18 months. Areas like the tip can take the longest to show results, as the thickness of the skin impacts the healing process.

Realistic Expectations

Patient Perspective: “You will not end up with a Kardashian nose. There are so many gorgeous people out there who have imperfect noses and we’d never notice it just like they would never notice it about us.” Comparison is the thief of joy and you do not know what a person has done to achieve what you are seeing online – especially through the social media lens.

Patient Perspective: “Set expectations for yourself and know that no nose is perfect, not even prior to undergoing surgery.” The human body is asymmetrical and that includes the nose. These natural variations may still be present after surgery. In the case of a revision surgery, expectations should be set accordingly, as the nose has now already undergone alterations both cosmetically and functionally.

Mental Health

Patient Perspective: “In the event that something does go wrong – and sometimes when it goes right – the effect of surgery on mental health can be huge and crippling. Identity loss, even after a great result, is a potential side effect that no one really talks about.” Rhinoplasty involves making permanent changes to your face. If you have a less than satisfactory result, it will take at least one year to revise and you will never get back to exactly what you started with. Even if you love your result, it will take time to get used to your new appearance. Are you mentally prepared for the best and worst case scenario?

Patient Perspective: “Rhinoplasty is a surgery of millimeters. Minor tweaks and enhancements bear the most risk.” Minor adjustments are actually the most difficult types of rhinoplasty. If you are looking for an extremely subtle change, you may not be a good candidate for rhinoplasty. Identity loss is very common post-op, and there is no such thing as a small change mentally. Proceed with caution and find a surgeon who understands what you are looking for.

Relative Results

Patient Perspective: “Changing your nose size and shape may impact the way you see your other facial features.” Understanding facial harmony is another skill of exceptional surgeons. Lacking the proper artistic experience may leave you with an unbalanced result.

For example, deprojection may change the appearance of your eyes and make the front of the nose look wider and flatter. Lifting a tip, meanwhile, can elongate your philtrum. Re-shaping a hump will change all angles of the nose and, interestingly enough, 75 percent of the revision seekers I talked to regretted hump removal.

Your smile may also change temporarily after rhinoplasty, but should return during the course of your healing.

The Takeaway

There is a lot that is fun, glamorous, and transformative about aesthetic medicine, and it has the ability to help people look and feel their best. At the same time, it involves complex surgical and non-surgical procedures that come with inherent risk. Rhinoplasty is a great example of this. If I had a do-over, I’d proceed with a different surgeon and the arsenal of information I have now. It would lead to a very different experience and result. The idea is to do all the necessary research before your first surgery, so you are set up for success down the line.