Rhinoplasty, commonly referred to as a “nose job” was the fifth most common cosmetic procedure performed in the US in 2014. Close to 150,000 people chose to have the appearance of their noses altered with surgery in that calendar year. This surgery is one that I truly enjoy because it is technically challenging and yet it also allows me to utilize my artistic side. In this article I am going to provide information that will explain my philosophy and techniques regarding this procedure, and hopefully clear up some common misperceptions.

Rhinoplasty is designed to re-shape the nose in a variety of ways. My desired approach to this procedure is to attempt to provide the patient with their desired outcome, but to preserve a normal appearing nose that does not look obviously surgically altered. Not all plastic surgeons share this approach. Some prefer to create noses that are obviously not the nose the patient was born with. Either approach is acceptable, but it is important that you select a surgeon whose philosophies match your own. You should query any plastic surgeon you consult with about their desired outcomes. Look closely at their photo galleries and decide if the majority of their results are aesthetically pleasing to you before committing to surgery.

Rhinoplasty is performed under general anesthesia as an out-patient and generally takes between one and three hours depending on the complexity of the patient’s situation. I perform open rhinoplasty, meaning I make a small incision in the skin between the nostrils so that I can see the entire cartilage and bone structure. In my opinion, this allows me to more precisely re-shape the nose. This small scar fades beautifully and is difficult to see once completely healed. Some surgeons still perform closed rhinoplasty in which the incisions are all inside the nose, but no surgeon would deny that the visibility of the tissues being operated is much poorer with this approach.

During rhinoplasty, the bony portion of the nose can be reduced in size or narrowed, and the tip cartilages can be re-shaped. This is done with a combination of cartilage and bone removal and placing stitches in the cartilage. Occasionally, cartilage is harvested from inside the nose to be used as grafts, adding additional tissue for re-shaping. Some surgeons will use implants in the nose, but I do not because of higher complication rates. Once the bone and cartilages are re-shaped, the bones can be shifted inward to narrow the upper portion of the nose if desired.

Some patients have obstructed breathing and or a crooked nose from a deviated septum. This occurs when the cartilage between the two nostrils is curved, bent, warped, or fractured. Straightening or re-positioning a deviated septum can be done in combination with cosmetic rhinoplasty. Crooked noses can be very difficult to straighten completely, and appropriate expectations should be addressed by the surgeon prior to undertaking such a procedure.

It is surprising to many people, but it is rare for rhinoplasty patients to complain of pain during the post-operative period. I rarely use packing or internal nasal splints which can be uncomfortable. An external splint is worn for ten days post-operatively to protect the nose. Bruising and swelling are present for two to three weeks. All athletic activities or strenuous physical activity is prohibited for three weeks. Most patients return to work at one to two weeks post-operatively.

Insurance does not pay for cosmetic rhinoplasty but will cover septoplasty if documented nasal obstruction is present. Fees for cosmetic rhinoplasty can range from five-thousand to fifteen thousand dollars depending on the complexity of the case. It is important to seek out a board certified plastic or facial plastic surgeon with a lot of experience if you are considering this procedure. Plan to be patient about your results. Even as early as ten days post-operatively when the splint is removed, you will generally notice some nice changes in your nose, however, the final results can take about one year to reveal themselves.

I have many happy patients on whom I have performed this procedure. I hope you will visit my photo gallery at www.pattiflintmd.com and review some of the pre and post-operative photos there. If you are interested in a consultation, I would be happy to meet with you to discuss the possibilities.

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