Rhinoplasty (Nose Job)

Rhinoplasty, which may be better known as a "nose job," is one of the most popular cosmetic procedures available. Both non-surgical and surgical rhinoplasty procedures exist, with the aim of the nose-reshaping process either focusing on correcting an injury or birth defect, improving the patient's breathing, purely cosmetic reasons to enhance the appearance of the nose, or a combination of similar reasons.

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Medically Reviewed by Dr. William A. Kennedy III, MDLast Reviewed 01.24.2019

Summary

Rhinoplasty, according to the American Society of Plastic Surgeons, can create a new shape to a patient's nose in proportion to their face. Rhinoplasty surgery can enhance the appearance of the nose size or shape by straightening a crooked nose, shaving nasal bones that create a bump on the nasal bridge, or by fixing the nasal tip.

Rhinoplasty was the third most common plastic surgery procedure in 2017. According to the 2017 Plastic Surgery Statistics Report by the American Society of Plastic Surgeons, 218,927 nose reshaping surgeries were performed in 2017, which is slightly less than the 223,018 rhinoplasty surgeries performed in 2016.

The Many Different Types of Rhinoplasty

A nose job can create a new shape for a person's nose or correct breathing problems by using many different methods. During certain rhinoplasties, the nose surgery is an actual invasive surgical procedure that corrects the functionality of the nose as well as the appearance. Other non-surgical methods of rhinoplasty are non-invasive and focus more on the aesthetics of the facial focal point.

In the following sections, you will learn about traditional nasal surgery options such as a septoplasty, which is cosmetic surgery often done in conjunction with a rhinoplasty to fix a deviated septum and help the patient breathe better by ridding them of any nasal obstruction discovered.

We will also cover the variety of additional advanced techniques that a facial plastic surgeon has in his or her arsenal these days. A plastic surgeon generally performs open rhinoplasty or closed rhinoplasty, with the open surgery featuring an incision in the soft tissue that separates the nostrils, while the closed surgery keeps all incisions contained inside the nose.

There is another option called endoscopic surgery, wherein a nasal endoscope helps the surgeon perform surgery entirely inside the nose without cutting the face or nose from the outside.

Advances in nose surgeries have helped reduce pain levels and have shortened recovery times. From ethnic nose jobs to revision rhinoplasty to fillers injected into the nasal bridge, rhinoplasty surgery offers many options, including non-surgical ways to update the look of the nose.

Open Rhinoplasty Open rhinoplasty surgery is a surgical method that "opens" the nose in a broad way, giving the facial plastic surgeon open access to the nasal area. An incision is made underneath the nose in an inconspicuous location between the nostrils to help the surgeon expose the cartilage and nasal bone during nose surgery.

With open rhinoplasty, the flaps of nasal skin are lifted up and off the nose to help the surgeon work freely. Prior to the nose surgery, local anesthesia is injected into the incision site, as well as the nasal septum, the thin wall of nasal bone and cartilage that divides the nostrils. The surgeon then performs specific work on the nose based upon individual needs. Common reasons for rhinoplasty include nasal tip reshaping, straightening a deviated nasal bridge or nasal septum, removing a “dorsal hump”, and other nasal repairs.

A septoplasty, according to the American Academy of Otolaryngology-Head and Neck Surgery, is the preferred method of fixing a deviated septum, which occurs when the midline of the nasal septum "deviates" to one side and is off-center. Nasal tip improvements, meanwhile, can affect everything from the way the nose tip projects, lifts, falls, or is shaped. Open rhinoplasty may also require a surgeon to shave down bumps on the nose bridge or break the nasal bones in order to restructure them.

Closed Rhinoplasty The surgical rhinoplasty known as closed rhinoplasty doesn't leave scars that can be seen, because the incisions are made inside the nose as the nasal bone, cartilage, or septum is operated on. Usually, closed rhinoplasty results in less swelling after the procedure.

Closed rhinoplasty may also be called “finesse” or endonasal surgery, because the surgeon works through the nostrils to correct issues within the nose. With closed rhinoplasty surgery, the surgeon makes cuts in the nostril lining that allows him or her to access the bone structure underneath in a manner that is not as invasive as open rhinoplasty. However, closed rhinoplasty surgery has limitations and requires the nasal skin to be stretched greatly, but places limits on how much the nasal tip and skin can be reshaped. Closed rhinoplasties are not recommended for patients looking to have a revision rhinoplasty.

Although closed rhinoplasty may come with the benefits of less post-surgery swelling and no visible scars, Randal Digby Haworth, M.D., F.A.C.S., a top Beverly Hills nasal surgery expert, argues that a closed rhinoplasty procedure usually produces results that aren't as excellent as the open method of nasal surgery. That’s because with open rhinoplasty, the surgeon is offered full exposure and visuals of the nose structure.

Endoscopic Rhinoplasty The surgical rhinoplasty called endoscopic rhinoplasty involves the surgeon using an endoscope, which is a tube with a camera and light attached to it, that helps the surgeon see inside the nose as he or she works to correct the issue at hand.

Used in conjunction with the closed rhinoplasty surgery, endoscopic rhinoplasty is a cosmetic procedure that usually results in less swelling than an open rhinoplasty procedure. However, critics of the so-called 3D high definition endoscopic rhinoplasty question whether or not the technique provides better results than the open rhinoplasty procedure, or if the terminology is more marketing directed.

According to Edward J. Domanskis, MD, patients should verify that their surgeons are certified by the American Board of Plastic Surgery and beware of those promoting new techniques that aren't widely used. Francis R. Palmer, III, MD seconds that notion, writing that 3D high-definition endoscopic surgery "sounds more like marketing hype than reality." Dr. Palmer noted that improving the aesthetic nose shape generally works best when the nose is directly seen, not by viewing it through a remote camera.

Ethnic Rhinoplasty Ethnic rhinoplasty is the name given to facial plastic surgery procedures whose aim is to provide a more "Western" look to the nose. Many times undergone by Asian Americans, African Americans, and those of Middle Eastern or Jewish heritage - or any other ethnic group that doesn't always possess an overall slimmer and pointier "Western" nose appearance - ethnic rhinoplasty alters the facial features of the person seeking the surgery usually by changing the nose's profile and making it narrower or lifted higher.

Such a procedure generally includes extracting cartilage from an individual's ribcage or ear to build up the nasal bridge and help garner the additional nose height or the nasal projection desired. Plastic surgeons can use open rhinoplasty or closed rhinoplasty to perform ethnic rhinoplasty. Nearly 3,000 posts on Instagram are tagged with the #EthnicRhinoplasty label, some of which feature photos and videos displaying the results of the surgery.

Revision Rhinoplasty Revision rhinoplasties are surgeries for patients who have already undergone at least one rhinoplasty procedure in the past and need the previous work revised or corrected via the open or closed method. As can be seen on TV shows like Botched, patients oftentimes seek a second or third or 19th chance to get the nose job results they have always wanted via revision rhinoplasty. According to Dr. Paul S. Nassif of Los Angeles, there are thousands of nasal surgeries performed each year, with a portion of those being performed by facial plastic surgeons with discounted rates and disastrous results.

When a patient is not satisfied with the outcome of a prior rhinoplasty surgery, they may be able to seek revision rhinoplasty to correct any asymmetry, continual breathing problems or the general look of their cosmetic surgery, if they are the right candidate for repeat rhinoplasty.

Also called "secondary rhinoplasty," revision rhinoplasty usually works to correct problems by transferring cartilage from other parts of the body, such as from the ribs, the ear, or the nasal septum in order to improve upon the original surgery. When receiving a revision rhinoplasty, it is recommended that your plastic surgeon use the open rhinoplasty technique in order to better expose nasal deformities.

Youth or Teen Rhinoplasty Nasal surgeries aren't just for adults, but rhinoplasty isn't necessarily a common surgical procedure enjoyed by young children, since their nose bones are still growing along with the rest of their bodies. In the case of rhinoplasty for a child or teenager who is younger than 18 years of age, a parent or legal guardian has to give consent for the procedure. Rhinoplasties are generally considered safe once a nose has reached adult size: age 13 or 14 for girls and 15 or 16 years for boys.

The 2017 Plastic Surgery Statistics Report by the American Society of Plastic Surgeons notes that teenagers from ages 13 to 19 comprised only 1% of the patients receiving cosmetic surgery procedures in 2017, but nose reshaping was the most common procedure for teens. The report indicates that 30,681 nose reshaping surgeries were performed on teens from 13 to 19 years of age in 2017.

Open or closed rhinoplasty can be performed on a youth or teenager, preferably when the young adult's bones have generally stopped growing or have greatly slowed in the rate of growth. For girls, that means approximately one year after the menstrual cycle begins. For boys, that may mean when they have not gotten taller in the year prior to the planned surgery.

Rejuvenation Rhinoplasty Rejuvenation rhinoplasty is a specific type of nose job that handles issues that can accompany getting older. For example, if the nasal tip of a person has drooped with age, a rejuvenation rhinoplasty procedure can correct and lift it by rotating the tip of the nose upward. Additionally, the nose can be rejuvenated via the cosmetic procedure by refining a tip that has grown too large or by shaving the bridge of the nose that the patient wants trimmed.

Although certain portions of the body cease to grow as people age, such as the bones, other parts of the body do not. Cartilage in the ears and nose keeps growing until death, reports Arthur Perry, MD, F.A.C.S. Therefore, rejuvenation rhinoplasty can cut down on the extra cartilage that may cause a bulbous nose, which is a nose that has a rounded nasal tip.

Liquid Rhinoplasty with Dermal Fillers Liquid rhinoplasty is the name given to non-surgical nose jobs that use injectable dermal fillers to change the shape of the nose. Liquid rhinoplasties do not use scalpels to change the appearance of the nose. The dermal fillers commonly used include Restylane, Perlane, Juvederm, and Radiesse. Once injected into the nose these fillers instantly change the nose’s shape and appearance. The former three fillers are comprised of hyaluronic acid, a natural compound found in the body that tends to reduce with age. Radiesse is made up of a synthetic biocompatible substance that is more difficult to shape but is longer lasting.

During liquid rhinoplasty, a patient who seeks a more prominent profile may have injectable fillers placed in the bridge of the nose to give it a bit more definition or height. Based on the desired effect, the individual may have up to 1 cc of filler injected into their nose with a needle during the minimally invasive procedure to fill depressions or indentations or to create height when desired.

The benefits of liquid rhinoplasty include the fact that the nose shape is immediately changed, without waiting for the nose shape to form over time like during nasal surgeries. However, the instant results with liquid rhinoplasty are not permanent.

Muscle Paralysis Rhinoplasty: Botox Shots In and Around the Nose Botox is known as a substance that is mainly used to relax facial muscles to help reduce wrinkles and fine lines. Muscle paralysis rhinoplasty employs the use of Botox to reduce wrinkles surrounding the nose, which can in turn have an effect upon how the size and shape of the nose is perceived via the effects of shadows and light.

Botox injections are placed within targeted facial muscles or even in the nasal tip in order to lift it. According to Juvea Medical and Aesthetics, the depressor septi muscle fibers lower the nasal tip and constrict the nostrils, but two to three units of the botulinum toxin that is Botox can relax the area and lift the tip. Botox shots can also control nasal flare and lessen the "bunny lines" that appear when a person crinkles their nose in an upward motion, such as when smelling a scent.

Rhinoplasty Cost

Rhinoplasty costs may be as little as $100 to $1,000 for the Botox muscle paralysis type of nose job. For "liquid rhinoplasty," the cost can vary from approximately $1,000 to $2,000, based on the type of filler used. However, according to RealSelf, injectable filler non-surgical nose jobs average $1,025 in cost. Unlike rhinoplasty surgery that may only be needed once throughout a person's entire life, the filler type of nose jobs are temporary, so the cost of future injections should be calculated into the cost.

The minimum cost ranges from $3,000 for open, closed, endoscopic, ethnic, youth, and rejuvenation rhinoplasty, up to $15,000. Revision rhinoplasty may cost anywhere from $8,000 to $20,000, depending on the complexity of the mission. RealSelf places the average rhinoplasty cost at $7,475.

Who is a Good Candidate for Rhinoplasty and Who is Not?

Ideal candidates for open rhinoplasty may include:

  • Patients with extremely crooked noses
  • People with several factors that make up the reason for the deformed nose
  • One who needs an intensive cartilage graft
  • A nasal tip correction needed that requires excellent visuals, such as during revision rhinoplasties

Optimal closed rhinoplasty patients may include:

  • Those with minor nasal problems or deformities
  • Individuals who don't need much cartilage grafting and nasal tip work

Endoscopic rhinoplasty ideal candidates might include:

  • Patients who do not want any visible scars
  • Individuals with chronic sinus problems

Liquid and muscle paralysis nose job ideal candidates may include:

  • Individuals who desire a non-surgical way to enhance their noses
  • Patients with minor issues that might benefit from Botox or filler injections

Rhinoplasty isn't recommended for the following candidates:

  • Anyone not healthy enough to undergo surgery, such as individuals with cardiac and pulmonary health concerns who may be at risk when going under with anesthesia

  • Patients with allergies to injections or Botox in the case of liquid nose jobs, potentially including nursing and pregnant women

  • People under the age of 18, although the aptitude for surgery is deemed suitable on a case-by-case basis, especially in the case of injury or a birth defect

  • All forms of rhinoplasty aren't recommended for people who are not physically, mentally, or psychologically ready for the procedure

Rhinoplasty Recovery

After undergoing open rhinoplasty, the patient is usually left with a splint outside of their nose for about 7 days post-surgery to protect and support the updated nasal framework as it heals. Usually there is bruising and swelling around the eyes, which should dissipate in the month following the procedure. The lips and teeth might also be numb, but will return to their normal state within approximately two weeks following surgery.

When the cast is taken off, the patient can resume wearing makeup, but the nose will keep healing for the next year to 18 months. In general, invasive rhinoplasty surgery comes along with a two- to four-week recovery period, although patients should be mindful of not returning to certain strenuous activities too soon in the wake of cosmetic surgery.

A closed rhinoplasty surgery patient should experience much shorter recovery times, with the ability to return to their normal activities about two or three days after surgery, and the choice to return to work in approximately 5 to 7 days. Less swelling and bruising should be evident.

Liquid rhinoplasty patients can often resume their regular activities right away, although there might be evidence of injection marks, swelling and bruising. There is generally no recovery time needed for a muscle paralysis nose job.

Before and After Rhinoplasty

Prior to a rhinoplasty procedure, the patient should be evaluated for specific reasons:

  • To determine allergies
  • To learn their motivation for wanting a nose job
  • To monitor the usage of any drugs, prescribed or otherwise
  • To find out which type of rhinoplasty would benefit the patient best, based upon his or her individual needs

Before rhinoplasty:

  • The patient may be instructed to avoid ibuprofen, aspirin, naproxen, and specific supplements or blood thinners two weeks before surgery
  • The individual should stop smoking
  • Patients should avoid sun burns
  • Patients should buy Vaseline, saline nasal spray, and a stool softener for use in recovery
  • Patients should ask their surgeon if general anesthesia will be used during their procedure, local anesthesia with IV sedation, or a topical agent

After rhinoplasty:

  • Patients who have undergone open, closed, or endoscopic rhinoplasty may experience nasal drainage and be forced to change their dressing until it ceases
  • Gentle sniffing is encouraged, but those who have had actual nasal surgery should refrain from blowing the nose for 14 days
  • Sneeze with the mouth opened
  • Ice packs can be applied to the cheeks and eyes the first two days post surgery
  • Moisten the nose with saline nasal spray and Vaseline applied with a Q-tip
  • Elevate the head for 48 hours after surgery to reduce swelling
  • Try not to move the face a lot, like with excessive chewing
  • Use soft toothbrushes to gently brush the teeth
  • Don't move the upper lip often in order to help the nose rest and heal
  • Stay away from strenuous activities like exercise and sex to lessen bleeding
  • Keep glasses off the bridge of the nose after rhinoplasty surgery

The Pros and Cons of Rhinoplasty

Rhinoplasty can bring many advantages to a patient who has suffered with a nasal problem that has had a negative effect upon their outlook on life. Open rhinoplasty surgery may especially provide great results in the hands of an experienced and well qualified facial plastic surgeon, because the nature of the permanent surgery offers more precise surgical manipulation. However, the open method may include visible scarring and a longer recovery period.

Closed rhinoplasty has the advantage of no scarring and a faster recovery time, but it might not be suitable for those who need extensive nasal work.

All in all, a successful rhinoplasty surgery can help increase the self confidence of the patient, although drawbacks to ethnic nose jobs may be accompanied by ethnic identity issues. For nose jobs attained when a person is a young age, the benefits can arise by improving the patient's self image, but the youthful age may mean that a revision surgery might be needed in the future.

Liquid and Botox nose jobs offer instant results and little downtime, but they are not permanent. A liquid rhinoplasty is also are not recommended for anyone seeking to make any part of their nose smaller such as the nasal tip or bridge.

Rhinoplasty can be a very rewarding but serious surgery, which comes with risks often associated with other cosmetic surgeries, including possible permanent nerve damage and blood vessel bursting. Therefore, make sure to use the American Society of Plastic Surgeons to find the best board-certified plastic surgeon for you.

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