Rhinoplasty (Nose Job)

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. Before 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 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 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, 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.

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. 3D high-definition endoscopic surgery can be used as a marketing ploy, which is why it is important to know that the plastic surgeon administrating this procedure is certifed. It should also be 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 often seek a second or third or 19th chance to get the nose job results they have always wanted via revision rhinoplasty. 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 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 to improve upon the original surgery. When receiving a revision rhinoplasty, it is recommended that your plastic surgeon use the open rhinoplasty technique 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 children or teenagers, 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 before 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 to be 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 will keep growing until death. 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 affect how the size and shape of the nose are perceived via the effects of shadows and light.

Botox® injections are placed within targeted facial muscles or even in the nasal tip to lift it. 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.