Nose “Definition” is very subjective and there are limitations to what can be done with each nose during a rhinoplasty.  The thicker the skin, the less “definition” is possible but regardless, each and every nose that “needs improvement” usually can be improved with a rhinoplasty.  Definition is all about the way light reflects off of the structure of the nose, namely the tip and the bridge and the way shadows are created along the side of the nose.  Definition can be achieved be suturing methods to bend the cartilage into a better shape or by removing or adding cartilage or by breaking the nasal bones or by grafts.  Everything that is done during a rhinoplasty is meant to give the nose a better shape and contour and definition although there are limitations.

There are some plastic surgeons who do every rhinoplasty open and some plastic surgeons do every rhinoplasty closed.  I decide which procedure is best for my patient’s particular unique nose and do the rhinoplasty either open or closed based on various factors.  The desire of the patient is important but if I think an open rhinoplasty will give a much better result for a particular patient’s unique nose and she insists that she wants it closed then I would try to educate and guide her to the pros and cons or benefits and disadvantages of open vs closed rhinoplasty and help her understand why a particular type of rhinoplasty approach may work better for her nose.  Conversely, there are patients who have been told by other plastic surgeons that they need an open rhinoplasty and I may advise them to get a closed rhinoplasty.  Each nose is unique and different.

A nose bump or hump is fairly common and it is excess bone and cartilage usually.  During rhinoplasty, the excess bone is rasped and the excess cartilage is shaved until the proper nose bridge or dorsal contour is achieved by the plastic surgeon doing your nose job.

Different cartilages have different characteristics in rhinoplasty.  Septal cartilage, ear cartilage and rib (costal) cartilage are all very different and used differently in Revision Rhinoplasty.

Unfortunately many plastic surgeons create very fake over resected noses and this is very common in California, Beverly Hills and Hollywood.  A bad nose job like that can be corrected with a revision rhinoplasty to replace cartilage and structure back to the nose.

Not true.  It just depends on how extensive your primary rhinoplasty was and how much work is necessary during your revision corrective rhinoplasty.

A revision rhinoplasty can change your nose and improve it but I would have to see and examine you to see what changes may or may not be possible to your nose.

Your plastic surgeon either missed the fact that your nose tip was droopy before and didn’t fix it so now you notice it more or he did not support your nose tip properly and the tip dropped with scar tissue and healing forces.  Sometimes even in the best plastic surgery hands the tip position can be a bit too low or too high due to variations in healing.  A droopy tip can be lifted and fixed with a revision rhinoplasty.

Insurance can and does often cover the septoplasty or functional portion of the rhinoplasty surgery but it is not a guarantee and each insurance carrier has different guidelines for covering or paying for a septoplasty.

The nose can certainly be sensitive or tender after a nose hump removal or breaking of the nasal bones but pain is usually not a major complaint after my Rhinoplasties. 

Nose bleed during or after a rhinoplasty depends on the patient’s genetics and the surgeon’s technique.  Operating with meticulous technique in the correct surgical plane minimizes bleeding and therefore no nose packing is required after the rhinoplasty.

I have to see you and examine you.  Depends on the graft.  If it is cartilage then it can be shaved or repositioned but if it is an implant then it would have to be removed and replaced with cartilage.

Definitely! The nose is not a solid structure. A block of granite can be carved into any sculpture but your nose is made up of thin sheets of cartilage and bone with unique skin thickness and then add healing and scar tissue to the mix! Beautiful improvements can be achieved but there are limitations and computer imaging and a top rhinoplasty expert can discuss these with you. See before and after photos of rhinoplasty.

Absolutely.  But I would have to see and examine your nose and take pictures to be able to discuss your options with you with the aid of computer imaging as a discussion and dialogue tool so that you can get a good idea of what may be possible and what are the limitations of any rhinoplasty. Egyptian and Middle Eastern nose jobs are very common and nice results are very achievable.

Swelling and scar tissue can obliterate some of the results that you will eventually see over time as swelling resolves and scar tissue matures and dissolves. The tip of the nose should continue to get smaller and shrink wrap for many years. Even after 1, 2 or 5 years you should continue to see the nose, especially at the tip and even the bridge, get slimmer.

I would have to see your nose and examine it.  Many times you won’t know for certain unless the surgeon who did the surgery is the one evaluating it.  Often times you have to open the nose to be able to tell with certainty.  But most of the time the hard bump will be a cartilage edge or a cartilage graft that can be shaved down and improved by your Plastic Surgeon.

I would have to examine you and see if there is anything that can be done to help you breathe better.  It may be something simple and minor like a turbinate reduction or it may be much more involved and require major revision rhinoplasty.

Nostrils may be able to be reduced if it is not simply a very thick nostril skin issue.  Thick nostril skin is very difficult to improve.  Uneven nostrils can also be improved on most occasions but perfect symmetry is often unrealistic.  All rhinoplasty is complex and should be left to plastic or facial plastic surgeons that specialize in nose reshaping.

Not all nose job patients are candidates for nonsurgical rhinoplasty but for those who are, it works great.  Benefits are a better nose without surgery and less downtime but risks are bruising and infection and allergic reaction and scar tissue.  However, you need to treat a nonsurgical rhinoplasty like an actual rhinoplasty and see a plastic surgeon that does nose jobs who understands the nose and not let a Dermatologist or family doctor just randomly inject filler into your nose.

Each nose is unique.  There are some characteristics that are common to each race and ethnicity but ultimately each nose is unique.  For example while most Asian rhinoplasty patients need their nose bridges built up with cartilage, some Asian rhinoplasty patients actually have humps similar to Middle Eastern patients and need that reduced.  See more here: http://www.rhinoplastyspecialistsurgeon.com/ethnic-rhinoplasty/asian-rhinoplasty/.

If your nose fits your face then you should not “lose your ethnicity.”  But more importantly you need to see a plastic surgeon who routinely performs computer imaging so you can somewhat visualize yourself with the new nose and the new changes and do you can decide for yourself if you like your new face or if you think the rhinoplasty changes your ethnicity.  I have never had anyone complain of that after their nose job but I have seen Hispanic patients who had aggressive rhinoplasty elsewhere and then complain of looking too Asian with their new noses.  See ethnic rhinoplasty before and after photos here.

Ala are the nostril margins so alar base reduction is the same as nostril narrowing.  Alar base reduction is done when the nostrils are wide or flared and often are necessary in African American noses although many other cultures and races need nostril narrowing as well.

Not all Hispanic patients have thick some.  Some have thin oily skin and others have thick sebaceous skin.  Many Hispanics have weak lower lateral tip cartilages and underprojected nose tips.  There are many factors that need to be taken into consideration with a Latina or Latino or Mestizo Rhinoplasty.  See below: http://www.rhinoplastyspecialistsurgeon.com/ethnic-rhinoplasty/hispanic/.

You cannot do any surgery without ending up with scar tissue. Scar tissue develops with any surgery and a nose job is no exception. But too much scar tissue is bad. If your surgeon lifts your nose skin in the wrong plane and if you have very thick skin then you may get more scar tissue. Steroid injections can melt some of the scar tissue thereby avoiding a revision rhinoplasty. Scar tissue makes elevation of the skin and penetration of your nose more time consuming as opposed to a primary rhinoplasty nose which had no scar tissue.

The tip cartilages called the Lower Lateral Cartilages would need to get trimmed and/or reshaped in order to refine the bulbous or ball like tip.  See the anatomy below:

http://www.rhinoplastyspecialistsurgeon.com/choosing-a-rhinoplasty-specialist-surgeon/nasal-analysis-anatomy-2/

I have had patients come to me who have had 3, 5 or even more previous poorly executed rhinoplasties and a revision rhinoplasty can improve many of the problems with their nose.  I also see patients who have had 1 or more previous rhinoplasties elsewhere who are still unhappy with their nose but I talk them OUT of another surgery if I think another revision rhinoplasty will not help them.  I would have to see you and examine your nose in order to tell you if you should or should not undergo another rhinoplasty. See photos of revision rhinoplasty at:

http://www.virginiarhinoplasty.com/Photogallery.html#revisionrhino.

Almost all of my patients for primary rhinoplasty or revision rhinoplasty take only one week off from work.  When the nose job is done pristinely without too much bruising and swelling and without packing, most patients recover quickly and are back to work in one week after their nasal reshaping plastic surgery.

The majority of my patients do not need ANY pain medicine.  If your plastic surgeon does your revision rhinoplasty meticulously without much trauma and without packing your nose, you should not need any major pain medicine other than maybe a few Tylenols.  Packing the nose is what really hurts and I do not like to routinely pack the nose after a rhinoplasty.  However, I still give my patients Vicodin or Celebrex for those who are going to experience a bit more discomfort since pain is truly subjective.

Septum is the structure on the inside of the nose that separates the left side from the right side. If you have a deviated septum then a septoplasty can be done to improve the deviation and improve your breathing. That can be done without rhinoplasty but if you want to change the shape of the nose as well then combining the two surgeries makes the most sense and doing one without the other may complicate things.

If the nostrils are wide the width can be reduced but if the skin is thick there are no great options for reducing the skin thickness without giving you noticeable unsightly scars. I do Middle Eastern Rhinoplasties all the time and I can tell you what is and what is not possible after I see you in person in my Virginia or Maryland offices and examine you.

Revision is more complex than primary and there are limitations and ALL problems may not be fixable but significant improvements can be made. Do not panic! I see patients like you all the time. In a Revision Rhinoplasty I can correct the errors of omission or Errors of Comission of another plastic surgeon who either took too much tissue out of your nose or did not do the proper rhinoplasty in the first place but you have to wait about 12 months from your last rhinoplasty before I can do a revision nose job for you. It would be good if you can get your operative report from your original plastic surgeon and bring it with you as well as pictures of your nose before your surgery.

Absolutely. Do not panic! I see patients like you all the time. In a Revision Rhinoplasty I can correct the errors of omission or Errors of Comission of another plastic surgeon who either took too much tissue out of your nose or did not do the proper rhinoplasty in the first place but you have to wait about 12 months from your last rhinoplasty before I can do a revision nose job for you. It would be good if you can get your operative report from your original plastic surgeon and bring it with you as well as pictures of your nose before your surgery.

Fillers may improve the nostrils using a non surgical rhinoplasty but many times an actual revision needs to be done to correct asymmetric nostrils and there are limitations to how much symmetry can be achieved.

No two noses are the same but most black patients require tip narrowing, tip elevation or a droopy tip, support of the tip, narrowing of wide nostrils and elevation of the bridge to give it more height. I often need rib or costal cartilage for such changes and I do this all the time with great results. But not all African American patients need the same maneuvers.

There are a series of maneuvers that are used to increase more projection. The involve reshaping or suturing your lower lateral cartilages or repositioning them on the caudal septum or using grafts such as columellar struts and tip grafts and cap grafts. 

Use of fascia is just one of many techniques and tools of rhinoplasty. Fascia is the covering of muscle and temporalis muscle fascia is the most commonly used followed by rib perichondrium which is the lining of rib cartilage. Alloderm is also an option.

You can do a non surgical revision rhinoplasty with Restylane to temporarily fill in certain areas until you get an actual revision rhinoplasty or perhaps just continue with annual yearly injections for a non surgical nose job revision but I would suggest you wait a few weeks to a few months for the nose to take its shape and not do it immediately.  See your own plastic surgeon and see what he suggests.

Nose cartilage can swell up with pregnancy. Finish your breast feeding and then you can consider a nice rhinoplasty to improve your nose and make it fit your face better.

There is no way of improving it now other than possible steroid injections to bring down swelling and scar tissue but you should see your own plastic surgeon for that. I can see you closer to the one year point to discuss revision rhinoplasty IF you need it. Time will improve the nose but you may need a revision. You also may be forced to accept limitations of rhinoplasty because some patients nose tips will look round due to their skin and cartilage anatomy but the tip can look smaller if the surgery is done right.

Swelling is typically less and fades quicker after a closed rhinoplasty but often less is done with a closed rhinoplasty and that is also a part of it. If you need major tip work then open would be the method of choice and you will have more swelling from the open rhinoplasty but also from the amount of extra work done on your tip rhinoplasty.

Thick skin rhinoplasty is very different than think skin and each type of skin has its own unique techniques during rhinoplasty. I routinely have both thick skin and thin skin rhinoplasty patients and both types can expect very nice improvements but there are some limitations. What you may be experiencing may be swelling, or scar tissue or excess cartilage or a combination of these. Swelling and scar tissue can improve with time and with steroid injections. Extra cartilage needs to be shaved down with a revision. If your original plastic surgeon is too rough with your skin or elevates the skin in the wrong plane, your body will create tons of extra scar tissue. 

Most people think that hump reduction is a simple procedure.  I can’t tell you the number of times I’v heard patients come to see me for revision rhinoplasty say “it was just a simple hump removal and look at what happened!?”  The fact is hump reduction is fairly simple for a rhinoplasty specialist but most plastic surgeons doing nose jobs aren’t focusing or specializing in rhinoplasty and even in the hands of the best rhinoplasty specialists in the United States, the nose still has to heal and it may not heal perfectly.  If your nose is wide then osteotomies may not have been done or perhaps this is the narrowest your nose can get safely.  I will have to see your nose before I can tell you what you can do for revision rhinoplasty at this point.

You have to be very careful not to end up with breathing problems if your nostrils are small but wide on the side.  Most likely your skin is thick and it makes your nostrils look wide.  There is a procedure that can make your nostrils appear less wide while maintaining the internal diameter of your airway but not all plastic surgeons in Maryland or Virginia are aware of this method for nostril width reduction.

A nice closed rhinoplasty can improve your profile potentially but I have to see your nose and examine it before I tell you what can be achieved with a rhinoplasty for your Middle Eastern nose.

Hard to say without seeing you and without having seen your nose prior to your nosejob.  If your septum is deviated or your turbinates are large or your internal valve is narrow then they may require repair but other complications such as internal scar tissue known as cicatricial scarring or even septal perforation could have occurred with your previous rhinoplasty and you should see your plastic surgeon to be examined first.

This is not a question I can answer in a few words online! There are chapters and textbooks dedicated to the under projected nasal tip.  Essentially the lower lateral cartilages must be altered to improve the projection.  This may involve any series of rhinoplasty maneuvers from least to most invasive.  Columellar strut, tip grafts, cap grafts, vertical dome division, Simons or Goldman’s tip, lateral crural steal are just a few of the rhinoplasty techniques that can be used to increase nasal tip projection.

I have used computer imaging in 99% of my rhinoplasty and revision rhinoplasty patients for many years now.  I use the digital computer imaging as a discussion and dialogue tool so that the patient and I can communicate the changes they are seeking and the changes that can be realistically achieved with a rhinoplasty.  It is important to realize the computer imaging is not a guarantee of results and that the actual rhinoplasty results will vary somewhat from the computer imaging pictures and that is due to multiple factors, with healing being a large part of the uncertainty and variability.

When the septum on the inside of the nose has to be straightened it is called a septoplasty.  When a septoplasty is combined with a rhinoplasty it is called a septorhinoplasty.  Sometimes insurance may cover a small portion of the surgical fees if the septoplasty is being done to improve a patients breathing.

This is a very common concern amongst prospective rhinoplasty patients.  I tell my patients that it is no one else’s business but yours what you choose to do to improve your nose and your looks.  However, I also tell them that the vast majority of their relatives and closest friends will have trouble figuring out that a rhinoplasty was done because when a nose looks nice and natural it simply “fits” the face and won’t stick out like a sore thumb.  That does not mean their noses don’t look any different.  On the contrary, their noses can look significantly better and cuter but a natural nose often goes unrecognized and the beauty of the eyes and lips get highlighted instead.  That is also the reason some patients with less attractive eyes and facial structure remain unsatisfied with the “results” they see during their rhinoplasty digital imaging at the time of their consult.  Despite a much nicer nose, they may still not be happy with their face.

Bleeding and bruising can be minimized during a rhinoplasty by using good facial plastic surgery technique and dissecting in the proper areas to minimize tissue trauma.  Using smaller, finer instruments also minimize bruising.  But at the end of the day, each patient will bruise according to his or her genetics.  Some bruise very little while others bruise more.

Can sinus surgery be performed at the same time as rhinoplasty and how is this done? Many other surgeries can be done at the same time with your rhinoplasty.  Often I have body Plastic Surgeons perform Breast Augmentation or Tummy tucks on the same patient while I do their Rhinoplasty.  Sinus surgery or FESS can also be done at the same time but you would have to see an ENT (Otolaryngologist) for that and I would do your rhinoplasty after he or she does your sinus surgery.

Perfect symmetry can be unrealistic in many cases especially if the skin is thinner and especially if there were inherent asymmetries of the nasal cartilages to start with.  At 9 months most likely this is not due to swelling although swelling &/or scar tissue could be the culprit.  A revision rhinoplasty can be planned at the one year point after your original rhinoplasty.

Polly beak is when the area above the tip or the “supratip” is higher than the bony part of the bridge making the tip look full, heavy, droopy and bird-beak like. This is usually due to a plastic surgeon taking too much of the nasal bones away but not enough of the cartilage part of the bridge. Polly beak can also be due to excess scar tissue in the area above the nasal tip. Fixing a polly beak requires steroid injections if it is scar tissue related or removing extra cartilage & possibly adding cartilage to the bony part of the bridge to create a much more balanced nasal profile.

Cartilage grafts can be placed through an open or a closed rhinoplasty approach and it all just depends on your nose and your anatomy.  Most new plastic surgeons today do not know how to do a good closed rhinoplasty and the older plastic surgeons who do know how to do a closed rhinoplasty learned rhinoplasty at a time where grafts were not used much and excision was the predominant method of rhinoplasty.

Adenoidectomy is something that a general ENT surgeon would do.  It’s similar to tonsillectomy.  It is not something I do but if you need it done then a combination case can be done where your plastic or facial plastic surgeon does your rhinoplasty and a general ENT surgeon does the adenoidectomy.

Kenalog is a steroid like a Cortisone shot and it brings down swelling and scar tissue after a rhinoplasty especially in the tip region of the nose.

If you look at international plastic surgery data you will see that even in the best hands, there is a 5-15% chance or even higher of needing a minor touch up revision rhinoplasty after a rhinoplasty.  The chances of needing another revision go up with each subsequent revision rhinoplasty.  Much of this is due to the unpredictable nature of healing with rhinoplasty.  If your surgeon has done a safe and sound rhinoplasty then trusting him with the revision makes total sense.  But if he has done a horrible job of the 1st rhinoplasty then chances are he won’t have the skills to do a more complex revision rhinoplasty.

Thin skin and thick skin rhinoplasty patients have their own problems and benefits. Ideal skin thickness for a nose job is medium but not many patients seeking rhinoplasty have medium thickness skin. Thin skinned patients need to have a very meticulous nose job with onlay camouflage grafts or crushed cartilage or fascia or Alloderm just to smooth things out.

The fact is most people take one week off from work after their rhinoplasty. That is usually the downtime after a nose job but the nose continues to heal and change for months and years yet that is not usually something that prohibits you from enjoying the initial changes and improvements. You should get a nosejob for personal reasons rather than professional ones because your profession may change in the future but then you are left with the new nose and you need to make sure you love the new nose and the nose job regardless of your profession.

Well over 90-95% of my surgical practice is focused and dedicated to rhinoplasty and revision rhinoplasty. That is my focus and specialization. I am a Board Certified Facial Plastic Surgeon but I decided many years ago to specialize in nasal reshaping surgery rather than being a jack of all trades.

Hi. You need to see your own plastic surgeon today. You may be having an allergic reaction to the tape or cast or ointment and your cosmetic surgeon needs to examine your nose.

It does not. You will see the results immediately as soon as the cast or splint comes off but then your nose will go through changes for many months and many years to come. There is no “final results.” The results will be slightly different at 1 year and 3 years and 10 years, etc. But you can enjoy the new nose and the new results immediately while the nose heals and gets smaller and more defined in the first 2-3 years and even beyond.

There are many types of foods and drinks and supplements that can make bruising and bleeding worse so avoiding them will help. These are such things as Garlic, Ginko, Ginseng, Fish oil, Flaxseeds, etc. There are a few things that can help with bruising such as Arnika and Vitamin C and Vitamin K. But bruising is real and very possible and you should plan on it although many patient’s bruises in my practice are very mild due to meticulous technique, quick surgical times and very fine small instruments that I prefer to use.

I do not like foreign implants in the nose due to their risk of infection, shifting or extrusion but if the silicone nose implant is stable from many years ago then you may want to leave it alone and only change it if problems start to occur. It is up to you and your plastic surgeon. Talk to him about the pros and cons of each approach. There is no right or wrong answer on this type of revision rhinoplasty question.

Your surgeon is correct. Restylane may be an option in some cases to fill in minor depressions as a non surgical revision rhinoplasty. Restylane to the nose is not permanent but the nonsurgical rhinoplasty injections are inexpensive and quick and may be easily repeated once or twice per year. Other options would be cartilage or fascia placement in an actual surgical revision rhinoplasty. Regardless, the nose continues to change throughout your life and slight contour irregularities may develop.

13 is definitely too young for most cases of rhinoplasty but certain very rare exceptions can be made even down to 12 if breathing is severely obstructed and the teenager is mentally mature and relatively the same size and height as his or her parents. For most cases, 16 is OK while 18 is even better but I have done nose jobs on a rare number of 14 and 15 year olds as well.

There is no typical nosejob. Each patient’s nose is unique and each one has a unique surgery and a unique experience. However, most patients take one week off from work and school so the downtime after a rhinoplasty is about a week in most cases. Swelling goes down in stages and it can last for many years after a rhinoplasty but to the naked eye, after about 2 to 4 weeks most of the major visible swelling is gone.

You should discuss your unhappiness with your own plastic surgeon first of all. See what he says. I do see patients who have had unsuccessful Rhinoplasties by other plastic surgeons and they come into my office crying and panicking just a few weeks to a few months to many years later. It just depends but as far as undergoing another surgery, its best to wait at least a year before going through a revision rhinoplasty. But I can see you in my Northern Virginia or my Chevy Chase Maryland office to examine your nose and give you some ideas.

Thin skin rhinoplasty is very different in many respects than thick skin rhinoplasty but there are more similarities than differences meaning the underlying bone and cartilage framework of your nose has to be reconstructed properly during a revision rhinoplasty. In thick skin patients, stronger cartilage framework is needed and in thin skin patients, more meticulous placement of very small camouflage grafts may be needed but I would have to see you in my northern virginia or my chevy chase Maryland office to examine your nose before I can tell you what you need for your revision rhinoplasty.

A round nose tip is due to the size and shape of the lower lateral cartilages in your nasal tip as well as the skin thickness. Tip rhinoplasty can improve the appearance of your nasal tip if the surgery is done properly. There may be some limitations as far as how much the area can be improved depending on your nose anatomy.

Each plastic surgeon has his or her own instructions.  I am very particular and overly obsessed with how my patients heal and how they take care of their nose so I have lengthy specific instructions that can be found here: http://www.rhinoplastyspecialistsurgeon.com/information-for-rhinoplasty-patients/

Yes. A scar revision may be able to be performed to improve the indented scar on your nose columella.

A poorly performed previous rhinoplasty or a so called botched nosejob can be corrected and improved. A poorly healed nose after a well done rhinoplasty may also be improved with a revision rhinoplasty. There are many different nasal tip issues and this is a subject for large textbooks and not something that can be answered in a few lines. I have written 2 textbook chapters on the topic of revision rhinoplasty which you may be able to find online or on Amazon.

Pinched tip after rhinoplasty is due to excessive resection of lower lateral cartilages and a pinched tip can be corrected during a revision rhinoplasty with proper cartilage graft placements.

I do African American Rhinoplasties very frequently and bad visible scars have never been an issue. Due to the requirement for tip grafts and caudal septal extension grafts and nostril narrowing, there will be scars and they are visible if you look at them very closely but I have never had any of my African American Rhinoplasty patients complain about a single scar.

Tip ptosis or a droopy nasal tip can occur in many older men and women. A rhinoplasty to balance the nose can make the face look younger but it is important to make sure your nose is “age appropriate” because a nose that is too upturned will not look right on a 73 year old. I do Rhinoplasties on older patients very frequently and practically always they end up looking younger as if they had a facelift!

Totally symmetric nostrils may or may not be possible. The two halves of the face are quite different in 85% of people with the eyes, cheeks, nose and lips as well as the jaw showing significant asymmetry so nostril asymmetry is often just a part of normal human facial asymmetry. However, sometimes if one nostril is too retracted or too wide or too pinched after a rhinoplasty then a revision rhinoplasty can correct these issues of nostril asymmetry and give your nose a better overall balance. I would have to see you and examine your nose before I can tell you if correcting your nostril asymmetry is possible or not.

You need to take her to a pediatric ENT surgeon to get nasopharyngoscopy and be examined. She may have obstruction of her nose in any of various locations or even a mass inside her nose. Large adenoids can also obstruct air flow. Please have her nose and face examined as soon as possible.

Sounds like the lower 1/3rd or lower 2/3rd of his nose which are the cartilaginous portion are deviated. This may also be partially due to a deviated septum on the inside. Perfect symmetry is often unrealistic but significant improvements can be made with a rhinoplasty to straighten a deviated or crooked nose.

Rhinoplasty is about balancing a nose. Some parts of a nose may need to be reduced during rhinoplasty and other parts may need to be augmented or enhanced during rhinoplasty. Ultimately a nose job is called “nasal reshaping” for this reason.

I along with a few other Rhinoplasty Specialists coined the term “finesse rhinoplasty” to indicate rhinoplasty cases where very little changes would be required to make a significant difference. For example I have had patients who underwent a 12 to 15 minute closed rhinoplasty with me and that is all they needed but some of these same patients had been to other Plastic Surgeons for consult and had been told they needed 4 hours of open rhinoplasty!? Certainly a nose that needed a very minimal improvement would have ended up looking horrible after 4 hours worth of manipulation and swelling and scar tissue and nose job work! Therefore a nose like that would be best improved through a “finesse rhinoplasty.” Unfortunately many plastic surgeons are now using the term finesse rhinoplasty for marketing purposes and I have had patients who require a full major 2 hour rhinoplasty tell me that they saw on some other plastic surgeon’s website that he offers “finesse rhinoplasty.”

Swelling after any rhinoplasty lasts for months to years but not to the naked eye. Your down time is about one to two weeks but it takes several years for the healing to push out most of the swelling. However you can start enjoying the results immediately.

Most bad nose jobs can be improved. Perfection is not realistic but as long as you have nice realistic goals then a successful revision rhinoplasty may be possible. Revision Rhinoplasty is more complex than a primary rhinoplasty but I have corrected the bad noses of many patients who had previously undergone 3 or 4 poorly performed previous Rhinoplasties.

To lengthen a short upturned nose requires a major reconstructive or augmentative rhinoplasty with grafts. Recovery is in stages. Typically the downtime following a nose job is about a week but the nose continues to heal for many years. I do not want my rhinoplasty patients lying in bed. I rather you sit up and watch TV or read a book to decrease swelling to your face.

I perform about half of my Rhinoplasties closed and the other half open. Each nose has to be evaluated individually and the best approach to the nosejob be planned whether it be an open rhinoplasty or a closed rhinoplasty. The incision across the columella heals very nicely and it’s not a major issue but many patients do not require an open nose job.

The nose does not usually grow although in some people, especially men, it can. Usually though the issue is the tip droops and make the nose look longer and you lose volume from your cheeks and face thereby making the nose appear relatively larger. A good rhinoplasty can bring balance to the face and in my older patients who undergo rhinoplasty, it can make them look much younger. And in my younger patients, it supports the nose and tip and maintains the nose shape as they get older.

Whether you need a tip rhinoplasty or a dorsal height takedown or both needs to be determined. The “hook” that you describe could be from the shape and position of the tip cartilages which may need tip rhinoplasty. Or the hook nose may be from extra cartilage height just above your tip creating the appearance of a hook or it may be from both issues needing a complete top to bottom rhinoplasty.

Please talk to your own plastic surgeon so he can examine you and make sure you do not have a septal hematoma or other cause such as residual packing! Otherwise, internal swelling and scabs and clots and crusts will make breathing congested for a few weeks to a few months but if all is well then your breathing problems should resolve soon.

You should talk to your own plastic surgeon and let him know of your sun burn but I would tell you to postpone your nasal reshaping surgery until your skin has healed. Sun damaged or sunburned skin can complicate the surgery and healing whether you get the sunburn before or even after your nosejob.

You need to take your activities into account. I have many athletes and I tell them that for 2-4 weeks after rhinoplasty I do not want them to do any strenuous activity or anything raising their blood pressure or heart rate and for 3 months I do not want any contact sports. Gentle swimming in the pool is OK after a month but no diving for 3 months.

The nose continues to change for the rest of your life with or without rhinoplasty and rhinoplasty results continue to modify for many years and the saying that the “final results of a nose job are seen in a year” is a total myth. I would have to examine your nose to see what is the issue and what needs to be done. It may be a simple 10 minute operation or it may be a 2-3 hour complete revision rhinoplasty of the tip.

Each plastic surgeon is different but I do not routinely pack the nose. Making your nose tip smaller usually requires local or general anesthesia. IV sedation or twilight anesthesia is not usually recommended for rhinoplasty due to the bleeding but if it is only your tip then it may be an option. Pain and bruising are minimal to none at all with simple tip work but I would have to examine your nose to make sure the bridge does not need refining to make it match the tip because sometimes if the tip gets cuter and smaller then the bridge may appear too wide or high and the whole nose needs to fit and look good.

I see this all the time. Many plastic surgeons do not communicate properly with their patients so the nose cast removal often ends up being a sad and troubling occasion rather than a happy and momentous one the way it should be. Many plastic surgeons who are jacks of all trades and do not specialize in rhinoplasty end up creating results that may be too drastic and unnatural or even worse than the original nose requiring revision rhinoplasty. You need to see a respectable rhinoplasty specialist surgeon to be examined and then told of your options for revision rhinoplasty. If you are in the Washington DC area or Chevy Chase Maryland or Northern Virginia I would be happy to see you.

Yes. Scar tissue, lack of tissue, possible sutures, possible mal positioned grafts, changes in your skin and blood flow are just some of the many issues we encounter in Revision Rhinoplasty.

You should make sure your allergies are under control before going through any elective cosmetic surgery. Turbinate reductions in conjunction with cosmetic rhinoplasty may improve your allergy symptoms of nasal obstruction but allergies are medical issues that need treatment. If you are under the care of an allergist and under decent control then there is no reason you cannot undergo a cosmetic rhinoplasty as long as it is OK’ed by your primary care doctor.

I do not like local or IV sedation (twilight anesthesia) for rhinoplasty. Nearly all of my patients choose general anesthesia because it is much more comfortable that rhinoplasty awake under local anesthesia and also a better way of protecting the airway that with IV sedation. All surgery and all anesthesia have risks and performing your rhinoplasty in the proper hospital setting or major surgery center setting minimizes risk. I see too many plastic surgeons doing risky rhinoplasty in their office in a back room!

Good plastic surgery can do wonders but bad plastic surgery can destroy lives as well so be careful and do your research well before proceeding. All of the issues you described can be corrected with Rhinoplasty and I have many patients with your described nose features who underwent successful rhinoplasty with fantastic results. However, scar tissue will always form as scar tissue is the glue your body forms to heal things. I see my patients back frequently in order to assess if steroid injections or kenalog injections to their nose tip is needed to counteract the possibility of too much scar tissue forming.

Each plastic surgeon will have a different nasal splint or dressing or cast. I have seen ones that cover the forehead and cheeks. I use a very small cute splint that is not bad at all and I do not routinely pack the nose either. But most patients still choose to lay low for the week after their rhinoplasty when they have their nose dressing bandages on.

If the chin is weak, it can make the nose look over projected so to be able to balance the face and nose properly it is wise to correct the chin weakness as well. But it is not absolutely necessary. Some plastic surgeons get stubborn and refuse to do a nose job without a chin implant because they don’t want you to come back and say my nose is still too big while in fact the nose may look still too big because the chin is still too small. Chin implants have to be subtle and feminine in women and I have seen chin implants that are too large, too wide and too masculine for female rhinoplasty patients.

Every rhinoplasty patient has a somewhat different experience after their nasal reshaping surgery. Some patients barely bruise while others look like they got hit by a train or Mike Tyson! Bruises can last 1-4 weeks or even longer in much older patients with thinner skin. At 4 days after a rhinoplasty though bruising is normal but make sure you talk to your own plastic surgeon to make sure all else is OK. Most of my patients are quite surprised by the lack of pain and minimal bruising after their rhinoplasty.

Smoking is an absolute contraindication for facelift or any facial flap reconstruction. For Rhinoplasty if the surgery is an open rhinoplasty, then smoking will increase risk of skin necrosis and loss at the tip and it should be stopped for 2 weeks before and 2 weeks after the surgery. That includes all Nicotine containing products so you cannot use Nicotine patches or gums either. However, as far as Anesthesia purposes, smoking should be stopped several months prior because stopping just a few weeks can increase your airway secretions and complicate the anesthesia.

You should see your own plastic surgeon and an ENT surgeon to be examined. You may have a septal perforation or may have a prominent blood vessel that keeps bleeding or you may even have a tumor that is unrelated to the rhinoplasty. Please get evaluated soon.

Great question! If the hump or bump is small enough then the removal or rasping may not result in an open roof or a gap in the bone so osteotomies or breaking of the bones may not be necessary.

I have seen patients who have had multiple poorly performed Rhinoplasties. I corrected the nose of a beautiful African American female who had 4 or 5 previous Rhinoplasties in Loudoun County by the most well known plastic surgeon there and each time her nose ended up crooked. If the septum is crooked that may need to be fixed along with the external nose. While perfect symmetry is often impossible significant improvements can be made. The way your body heals and your own facial asymmetries are an important variable as well.

Healing takes months to years. I tell my cosmetic surgery patients that their noses will change drastically for the first 2 to 3 years after their rhinoplasty but the down time until they are ready to go out or back to work or school is about 7 to 10 days. Each rhinoplasty patient will have a different experience.

A runny nose or a dry nose can be common after a rhinoplasty . You need to see your own plastic surgeon to make sure the runny nose is not a CSF leak which albeit rare, is a much more serious condition!

Breaking of the nasal bones or osteotomies are done to narrow a wide nose, straighten a crooked nose, or close an “open roof” after removal of a large nose hump.

A large number of my patients come from other states, countries and continents! We start the process by email, phone and internet and we can do most of the rhinoplasty consultation and planning this way but I do need to see them the day before the surgery and examine them in order to finalize my surgical plan. Feeling and touching the nose is crucial in rhinoplasty as is looking inside the nose.

Swelling after a nose job depends on your surgeon’s technique and your own propensity for healing. Most of my patients only take 7 to 10 days off work at the maximum. A minority like to take 2 to 4 weeks but truly after about 10 days your nose should be good enough to go in public while it will take 2 to 3 years for most of the swelling to resolve.

Implants are not ideal for the nose and natural cartilage should be used preferentially. The implant can be removed and replaced with natural septum or ear or rib cartilage with a revision rhinoplasty.

Various types of anesthesia can be used for rhinoplasty. Typically most surgeons use general because it protects the rhinoplasty patient’s airway. Sedation is also used especially when doctors take short cuts to save money and do the rhinoplasty in their office or under-equipped surgery centers. Local may also be used but numbing the nose is painful.

Making a narrow nose wider depends on many factors such as your skin thickness and whether this is a primary rhinoplasty or a revision rhinoplasty and on your breathing ability, etc. I do not like any fake implants or substances. I prefer natural cartilage, Fascia and/or Alloderm for the nose. These are all natural building blocks and are safer.

The old saying that “your nose grows with age” is true in some ways and false in others. As we get older, most of us lose volume and fullness from the face and cheeks there by shrinking and therefore the nose looks proportionately larger. The tip can become weak and droop creating tip ptosis which can make the nose looks longer or larger. All of these changes can be improved in an older patient to create a more youthful nose through a rhinoplasty. However, the nose has to look age appropriate since a 16 year old’s nose looks funny on a 60 year old. I have had many patients who looked like they underwent a facelift or a facial rejuvenation after a rhinoplasty since the correction of the aging changes of the nose and adding volume to the cheeks with liquid cheek lift made them look so much more rested and younger.

Absolutely! I would have to see and examine you first but using computer digital image morphing I can show you the various possibilities and guide you to choose the best nose for your face. Often this requires building up of the bridge, narrowing the bridge as well as narrowing the tip and nostrils but in a way to remain natural looking and fitting for your face. Rhinoplasty should improve the balance of your face not distract from your other features. You can retain your beautiful ethnic features with a properly planned out and performed rhinoplasty.

Out of all the implants for the nose in a nosejob Gore-Tex (PTFE) is probably the best choice followed by Silicone implants. Medpor are the worst implants for rhinoplasty. However, I much prefer natural cartilage or fascia or Alloderm to any implant and I have not used an implant in the nose for years however I have taken many implants out of noses and replaced them with cartilage during revision rhinoplasty of other surgeon’s Rhinoplasties.

Implants in rhinoplasty are often used in Asia by Asian surgeons. Infection, shifting and extrusion are very real possibilities with nasal implants and that is why most rhinoplasty specialist surgeons prefer using natural cartilage or tissue.

All rhinoplasty can be considered “tricky” because a nose job is the most complex of all facial cosmetic surgery procedures. In expert hands of a rhinoplasty specialist surgeon these are not tricky but in the hands of an average plastic surgeon or a novice, these may be “tricky.” Regardless, perfection after a rhinoplasty is “tricky” due to the unpredictable healing forces acting on a nose for many years to come after a nasal reshaping operation.

Most patient’s nasal tips will drop down and back in the first 3-4 months after rhinoplasty. Your 1 week results are hardly the final results of your rhinoplasty so do not judge a half cooked meal just yet.

You haven’t mentioned if I am your surgeon or if you are simply asking me this because your own surgeon has not gone over this information with you. If I am your surgeon then I would have already gone over these things with you at least twice and you should have gotten the info in detailed writing so you can prepare. My staff also go over pre and post rhinoplasty instructions with all my patients in great detail. If your surgeon is someone else then you should contact him/her to see what he/she wants you to do. Each plastic surgeon has his or her own set of instructions. You can get an idea of what I tell my rhinoplasty patients by reading this: http://www.virginiafacialplasticsurgery.com/vfps-instructions.html

Tip ptosis or drooping of the tip is very common as we get older. A rhinoplasty to elevate your nasal tip and correct the droopiness can help improve your face and make you look even younger. It is important for the new nose to be age-appropriate as well as sex-appropriate and natural looking. Once the tip has been elevated and supported it should withstand gravity better over the coming years.

Sixteen is typically a good starting point for patients seeking Rhinoplasty. Occasionally I will offer a rhinoplasty to a 15 or even a 14 year old if they are mentally and physically mature. Then again, I have seen plenty of 40 year olds who are unrealistic about the surgery and hence are not mature candidates for the surgery. I would be happy to see you along with your parents in my chevy chase Maryland or my Herndon, virginia office to examine you, perform computer imaging and discuss your options, etc. Having support of your parents is important and often parents have their own set of fears and hesitations and questions that may be different from yours

Your rhinoplasty will depend on your anatomy which includes bone and cartilage shape as well as skin thickness.  I would have to see you to examine you and then take pictures and, using computer imaging, show you what your options are and what your nose may look like after an ethnic rhinoplasty.  Skin thickness is a very important part of ethnic rhinoplasty and you can read more about it here: http://www.rhinoplastyspecialistsurgeon.com/ethnic-rhinoplasty/thin-skinned-vs-thick-skinned-rhinoplasty/

The width of the nostrils or “ala” can be reduced in several ways depending on the anatomy.  This nostril reduction or alar reduction is a very common procedure amongst African American rhinoplasty patients.  You can read more about African American Rhinoplasty here: http://www.rhinoplastyspecialistsurgeon.com/ethnic-rhinoplasty/african-american/

I would have to see and examine you to determine the cause or causes of your nasal tip asymmetry. This could be due to lower lateral cartilage asymmetry or could be due to a crooked caudal septum or a crooked anterior septal angle, just to name a few potential causes.

Tip plasty or tip rhinoplasty is basically rhinoplasty of the nasal tip. Anytime you alter the nose, its “rhinoplasty.” Some surgeons try to be cute about it to minimize it but it is what it is – a rhinoplasty! For example, a few patients only require alar base reduction or nostril narrowing. You can call it alarplasty but it is again essentially a rhinoplasty limited to the nostril width only.

It just depends. Many times the septum may be deviated creating the external nasal deviation. Correcting the septum through septoplasty may straighten your nose. Other times, the outer parts of the nose need to be adjusted as well through rhinoplasty. Occasionally, injection of safer fillers like Restylane to the more concave side (non surgical rhinoplasty) can create the illusion of a straighter nose.

Absolutely. You should always be able to see what your own face and nose may look like and not rely on before and after pictures of other patients with what may seem to be similar noses or faces because each person will have different skin and soft tissue and cartilage anatomy resulting in variations in post rhinoplasty results. Using digital computer imaging or morphing, I show my patients their various nose options. Imaging is not a guarantee of outcome but a valuable discussion tool and road map for surgery which without puts you at increased risk of ending up with a nose you did not ask for nor like.

Depends on the type of heart surgery.  You need to get the clearance and OK from your heart surgeon and medical doctors.  If you are taking Aspirin or Plavix or Coumadin after your heart surgery, then those would need to be stopped if OK’ed by your heart doctors and if they say you cannot stop the blood thinners then you cannot and should not have elective cosmetic rhinoplasty.  Your heart and your safety are more important than your nose.

Probably not.  If your septum is deviated or your turbinate are large then they can be addressed to improve your breathing but allergies are medical issues that need medical management with allergy medication, sprays or allergy shots.

The “obvious” swelling and downtime and bruising is typically about 5-14 days.  The vast majority of my patients only take one week off work.  Arnica is an herbal supplement that can reduce bruising and swelling.  There are also a list of medications and herbal supplements that should be avoided as they increase swelling and bruising.  Pristine surgical technique is important in reducing excess trauma.  But your genetics and luck are also a huge part of it.  But again, most patients only need to take one week off work.

Combining cosmetic surgery procedures is very common.  I have many patients who wants breast augmentation at the same time as their rhinoplasty and what we do is we have a Board Certified Plastic Surgeon who specializes in breast augmentation do the breast implants first then I do the Rhinoplasty while the patient is under anesthesia.  It saves cost for the patient and it saves them from having to undergo anesthesia twice.  The same can be done with eyelid surgery and a nose job or really most other plastic surgery procedures.

Absolutely.  Augmentative Rhinoplasty is very common in revision nasal reshaping cases but even in some primary nose jobs.  Essentially cartilage grafts are used to increase the size of the nose to balance it with your facial features better.  The limitation often is the amount of skin because the skin has to drape back over the new, larger underlying framework.

Depends on the blood thinner and the reason he takes it. He would definitely need to be off all blood thinners before and after surgery. If his primary care doctor feels that is safe and its possible then things can be coordinated and taken care of but if his doctor thinks its unsafe for him to be off his blood thinners more than a few days then its probably best to avoid elective rhinoplasty surgery. While emergency surgery can be done in these cases, elective cosmetic surgery is not wise due to risks associated with being off his blood thinners.

About 20% of my patients come in from other states or countries and they stay here for about 10 days then fly back. I would say 2 weeks is a good time frame to shoot for after your rhinoplasty. If you can give it more time then it’s even safer but 10-14 days after a rhinoplasty is usually OK.

Pain is usually not an issue with Rhinoplasty if the nose is not packed. I do not pack the nose and about 80% of my patients hardly take any pain medicine at all after surgery. But I do prescribe antibiotics to every patient as well as anti-nausea medication and pain medicine.

Absolutely! Not only is there a way but you should not ever undergo a cosmetic rhinoplasty without seeing an approximation of what your new nose may look like so you can see if you like it and make pre-op adjustments during the rhinoplasty consultation with your plastic surgeon.

If you get a septoplasty or turbinate reduction then your nose should look exactly the same after your functional nasal surgery. However, I have seen patients who had their nose surgery elsewhere and too much septal cartilage was removed and their bridge collapsed or their tip drops due to disruption of nasal tip support. But this is a rare issue.

Not necessarily but she does need to be evaluated for causes of nose bleeds. I always check CBC with Platelets and a PT/PTT/INR blood test to see if anyone has a bleeding disorder. There are other more specific tests as well that we may obtain or we may send a patient to a hematologist doctor to be evaluated for other occult bleeding disorders such as Von Willebrand disease, etc. A deviated septum can cause nose bleeds as well as does constant nose picking or nose blowing. She just needs to be examined and properly evaluated. If she has a severe bleeding disorder then undergoing an elective Rhinoplasty may not be the best idea although with proper peri-operative management, it can be done.

If you were getting a facelift or neck lift and then lost more than 15 pounds, most likely the skin would loosen up a bit again and deflate requiring another mini facelift. Weight is not that important when it comes to the nose however your plastic surgeon needs to take your facial bone’s architecture in mind when designing and planning your new nose. If you have a very obese face then your nose will look small and once you lose a lot of weight then your nose may look larger but a lot of weight needs to fluctuate for this phenomenon. However, your nose job should be planned for your “average face” and not for any particular weight. Its design is based on the underlying bones and facial proportions. With that said, losing weight is good for your health and makes anesthesia easier if you are markedly overweight. If its just a few pounds then its not that important when it comes to Rhinoplasty. You do need to make sure to be evaluated for sleep apnea because overweight patients often have OSA (obstructive sleep apnea) which can complicate anesthesia issues.

I typically as my patients to avoid exercise for 2 weeks after rhinoplasty and avoid contact sports for 3 months after a nose job. Your plastic surgeon will have his or her own preferences. I would say a month is a good estimate as long as you are careful and as long as you don’t play too hard!

A secondary or revision rhinoplasty may be a shorter procedure than your previous or initial nose job if minor touch ups are needed or it may be a much longer procedure if extensive “grounds up” redo of your nose is needed. Recovery will partially depend on this. Recovery also depends on your body and how it heals and how it deals with the stress of surgery and anesthesia. Recovery after rhinoplasty also depends on the meticulousness of your plastic surgeon and his skills. The more pristine his skills, the less trauma you endure and the quicker you will heal.

Tinnitus or ringing in the ears has many causes but not many of them are well understood. Cold and sinusitis are medical conditions that can be exacerbated by anatomic blockage inside the nose and sinuses. None of these conditions are truly addressed by a cosmetic Rhinoplasty. If the septum is deviated or the turbinates are too large then your breathing may improve but these conditions are essentially separate medical entities that should be evaluated by a good general ENT (otolaryngologist) doctor. While Rhinoplasty may improve some of them, it most likely will have no benefit and it may even make things worse.

You should see your surgeon to make sure everything is OK and you don’t have an infection or fluid collection.  Sleeping with your head up on a few pillows helps.  Decreasing salt intake helps.  Avoiding exercise to prevent your blood pressure and heart rate increasing helps.  Avoiding plane flights helps. Avoiding sun and heat helps.  A short course of oral steroids may also be beneficial but there are always risks associated with oral steroids.  Taping of the nose may also help.  See your doctor and see what he says.  Good luck.

Open and closed rhinoplasty can be used for primary as well as revision rhinoplasty.  It just depends on the issue being addressed and the surgeon’s skill and preference.  Both are good techniques when individualized for the unique patient’s nasal deformity.

The only time I suggest a non surgical nose job is when the bridge height needs to be built up conservatively or small depressions filled after a previous rhinoplasty.  Large amount of fillers should not be injected into the nose in order to not risk scarring or infection.  Permanent fillers should also be avoided during non surgical rhinoplasty for the same reason.

The African American Rhinoplasty is very different than the caucasian rhinoplasty in many ways.  The skin is thicker and heavier and the cartilages are weaker so to create a smaller, more defines and cuter nose, cartilage grafts and support must be added to the nose to tent the skin and provide definition and shape.  Risks are no different than any other rhinoplasty other than the potential of a keloid or hypopigmented scar in the incision under the nose.  That being said, this problem is rare to almost unheard of on African American noses unlike the issue on African American ears, etc…

Middle eastern noses often have droopy tips, and/or dorsal humps, and or wide bulbous or “meaty” tips and/or wide thick nostrils, and/or long vertical length.  They can also often be under projected but each nose is unique and you cannot generalize traits.

Ear cartilage is a very nice source of cartilage for certain areas of the nose during rhinoplasty or revision rhinoplasty.  Septum and ribs are other sources.  Some surgeons make the ear incision in the front.  I prefer usually making it in the back so its nearly invisible.  The cartilage usually comes from the bowl of the ear and it should not result in major changes in the shape of the ear.  Sometimes the cartilage comes from an area in the front of the ear when composite grafts are needed (grafts of cartilage with skin also attached.)

Correction of a small or pug nose involves major tip grafting including caudal septal extension grafts, spreader grafts and tip grafts.  Lots of cartilage is needed from the septum, ears and or ribs but it is very correctable.  I often have to correct this deformity during revision rhinoplasty after another plastic surgeon aggressively reduces and elevates the nasal tip but it is also seen with primary virgin noses.

Yes.  You have normal senile ptosis.  Almost everyone experiences this to some degree.  Its one of the reasons the nose looks larger with age because it drops and looks longer. There are techniques for improving the droopy nasal tip without making it look like a snout of a piggy nose.

Without seeing you and examining you I cannot tell why you are congested.  You may have swelling or crusts or scabs or dry blood clots in your nose.  You may have a deviated septum or large turbinates or internal valve collapse or narrowing or scar tissue.  There are lots of reasons for congestion.  I have even heard of some doctors forgetting to remove packing sponges from the nose after surgery!  You need to see your doctor and be examined.  If its normal swelling then it should get better with time.  Rinsing your nose with saline salt water should also help after rhinoplasty.

Your entire face is more swollen in the morning even without surgery.  This is a normal phenomenon.  After surgery your nose is like a sponge and it holds swelling more.  You will experience this for months and years but again its usually not an issue and it should get to be less of an issue with time.

Not necessarily unless your orthodontist is planning on making major changes and shifting your dentition around.  slight changes are not issues but more major changes may have to be considered when calculating the ideal nasal projection and tip rotation, etc during rhinoplasty.

Hi.  Changing the dorsal hump does not need to affect the tip however changing one view such as the profile will somewhat affect the other views as well.  This is why I insist on doing computer imaging so my patients can see what their noses may look like before going through rhinoplasty.  That way, I can show you what a partial hump reduction would do to the look of your face, nose and tip and we can decide if its a good idea or not or if other procedures are also needed during your rhinoplasty.  If the tip is droopy to start with, hump removal will make it “look” even droopier which would need to be addressed during your nose job.

Hi.  Good question.  Cosmetic rhinoplasty is just that – cosmetic. However, often functional changes for breathing may also be necessary.  The functional portion of the rhinoplasty, such as septoplasty or turbinate reduction should be covered by insurance.  If so, then a part of the hospital fees and anesthesia fees should also be covered by insurance.  If the problems are purely functional then the entire nose surgery should be covered by insurance but in my practice most patients are seeking cosmetic improvements as well so there is almost always out of pocket expenses as well.  Occasionally the entire surgery is covered by insurance but that is a rare scenario and happens only a handful of times per year.  Runny nose may be a medical issue requiring medical management with allergy medications or nasal steroid sprays but turbinate reduction may or may not improve a runny nose if its “runny” because of blockage internally.

Hi.  Not necessarily.  The narrowing of the nose during rhinoplasty is done on the cartilage and bone under the skin and the skin is then draped over the newly sculpted nose.  The only time potentially visible scars occur with nasal narrowing is if the nostrils need to be narrowed.  Even then the nostril narrowing or alar reduction scars should not be extensive.

Hi.  Topical medicines should be stopped 3 days before rhinoplasty.  Accutane is the one acne medication that is the big problem and if you have been on Accutane then you should wait 6-12 months before having elective rhinoplasty.

Long nostrils are often due to the shape of the lower lateral cartilages and the relationship of the medial crura portion of these lower lateral cartilages to their infra-tip lobule portion.  This may sound like complex nasal anatomy but that is usually the cause and reshaping these cartilages can improve the shape of the nostrils.  Nostril skin removal may or may not be needed as well.  It all depends on your nose.  Typically patients with long nostrils have thin nostril skin as well and often an over projected nose as well.  All of these issues need to be addressed.

An overhanging or droopy tip is called tip ptosis in nose anatomical terms. This may be due to the shape of the tip cartilages, the length of the septum or the tip support mechanisms or a combination of above. Rhinoplasty can certainly address these issues and make your nose as well as your lips look better – if done properly.

I tell my patients to avoid exercise for 2 weeks after surgery.  After that I tell them they can get back to the gym but take it slow and work their way up back to pre rhinoplasty state.  Running and exercise will make your nose swell up more after rhinoplasty especially if you have had major tip work but life must go on!

It sounds like you need a tip rhinoplasty.  The bulge at the tip which some patients refer to as “the ball at the end of their nose” is due to wide and convex Lower Lateral Cartilages.  Reshaping these tip cartilages with a closed or open rhinoplasty ends up refining the tip.  Some of the cartilages may need to be shaved and other parts may need to be bent using sutures.  It all depends.

Each patient’s nose and face dictate a unique nose and a unique rhinoplasty surgery.  I have operated on many close family members and each needed and got a very unique and different Rhinoplasty.  The change needed is the change needed.  Sometimes that is minimal which I call a “Finesse Rhinoplasty” and sometimes it’s a significant or “monumental” change as you put it.  Regardless of the degree of change, if your nose looks natural after your nose reshaping, 90% of your closest friends and relatives would be fooled and will not be able to tell any surgery was done.  Comments like “did you lose weight?” or “did you change your hair style?” are often heard after a well done rhinoplasty.  I hear this all the time even with patients who end up with a monumental change! But I have plenty of patients who come to me for a finesse minimally invasive rhinoplasty done through a closed approach with no external incisions or scars.  Computer imaging is what helps you and I decide the best nose for your face.

Itching after surgery can be due to allergic reaction to the tape or cast on your nose or due to more benign issues. You should see your plastic or cosmetic surgeon today and try to be evaluated.

I started my Rhinoplasty career in 2000 so about 10 years or so. My practice is 95% or more exclusively dedicated to Rhinoplasty. Just as an example, this month alone I am performing 29 Rhinoplasties while the average number of Rhinoplasties performed by the average Board Certified Plastic Surgeon in the U.S. is about 1 per month. But number and length of time is not the whole story. I consistently see patients with horribly deformed noses after they had surgery by some of the most prominent older local plastic surgeons who have been doing Rhinoplasties poorly for almost 20 or 30 years. You have to do lots of research to find the right surgeon. There are lots of pieces to the puzzle. Training, board certification, practice focus and specialization, and artistic sense and capable hands are all parts of it. I see patients who try to compare prices between different plastic surgeons who say things like “Dr. X charges this much less than you, etc..” but the fact is that you cannot compare the skill and service of Dr. X with Dr. Y or Dr. Z. While you can price shop for the exact same car or pair of shoes at different places and try to get the best deal based only on price, with plastic surgery you cannot compare apples to apples.

Rhinoplasty is about bringing balance to the nose and face. A nose that is too small can be as distracting as a nose that’s too big. Augmentative rhinoplasty, to make the nose larger or longer, is often encountered in revision rhinoplasty, after a previous poorly trained plastic surgeon has over aggressively reduced the nose. Asian & Latina patients also often need additions to certain parts of their noses such as the bridge height or tip length. Again, not all patients within the same ethnic heritage will have the same nose but there are some general principles that apply. Cartilage from the septum, ears or rib is the tissue of choice to add more structure to the nose. There are limitations especially with the skin so that it can stretch out over the larger foundation of the nose. While implants can also be used, they are a quick fix that should be avoided due to risks of infection, extrusion or displacement.

Great cosmetic question! The nose has to fit the face. If it fits the face and if it looks natural then it wont attract undue attention to itself and it will highlight the beauty of your eyes and lips. There are limitations to how small a nose can be made during a Rhinoplasty because the skin is not removed so it has to be able to drape over the reduced cartilage and bone framework underneath. Scar tissue always forms after any surgery. Period! You cannot get surgery without scar tissue anywhere on the body. If the nose surgery is done well by an expert Rhinoplasty specialist then that is the best you can hope for and scar tissue should not be an issue. Sometimes, simple steroid injections into the nose after Rhinoplasty may be needed to reduce scar tissue. Very rarely a Rhinoplasty surgeon may have to do a minor revision to remove excess scar tissue but this is rare. Whether or not bone work or breaking the bones or rasping the bones is needed during a Rhinoplasty completely depends on the individual’s nose. Its not always necessary.

Great cosmetic question! The nose has to fit the face. If it fits the face and if it looks natural then it wont attract undue attention to itself and it will highlight the beauty of your eyes and lips. There are limitations to how small a nose can be made during a Rhinoplasty because the skin is not removed so it has to be able to drape over the reduced cartilage and bone framework underneath. Scar tissue always forms after any surgery. Period! You cannot get surgery without scar tissue anywhere on the body. If the nose surgery is done well by an expert Rhinoplasty specialist then that is the best you can hope for and scar tissue should not be an issue. Sometimes, simple steroid injections into the nose after Rhinoplasty may be needed to reduce scar tissue. Very rarely a Rhinoplasty surgeon may have to do a minor revision to remove excess scar tissue but this is rare. Whether or not bone work or breaking the bones or rasping the bones is needed during a Rhinoplasty completely depends on the individual’s nose. Its not always necessary.

A runny nose is not a problem and in fact, turbinate reduction or septoplasty may help improve your nasal airway and help improve the allergies although allergies are truly medical conditions that require medications, allergy shot treatments or nasal steroids to improve or control. As long as you have been seen by an ENT or Allergist and you do not have severe Sinus disease or other causes of a runny nose then you should be OK for a Rhinoplasty.

Rhinoplasty combined with septoplasty can straighten the nose. It may not become 100% straight as truly symmetric faces or foundations for the nose are exceptionally rare but improvements can be achieved with a Rhinoplasty combined with a Septoplasty or occasionally Rhinoplasty alone. Nostrils can also be narrowed or reduced in size during Rhinoplasty. This is very common in African American nose jobs and to a lesser extent in Middle easter, Asian, Latino and Caucasian Rhinoplasty.

You can choose your surgeon and your surgery but once you have chosen your surgeon it’s important to trust his professional opinion and advice as long as you have chosen the “right” surgeon. Rhinoplasty can be done under local, twilight sedation, MAC or general anesthesia. I prefer general due to its protection of the airway during Rhinoplasty. While the other options are OK for lets say an eyelid lift or facelift, general endotracheal protects your airway from blood that may be dripping down the back of the nose and throat. While there are always risks with every surgery and every type of anesthesia, I minimize these risks significantly by operating at hospitals with Board Certified Anesthesiologists rather than operating in my office or small surgery center like many plastic surgeons do. That is not safe and it cuts corners. I also perform every type of Rhinoplasty, every ethnicity and every age group and sex. I also use Open Rhinoplasty and Closed Rhinoplasty techniques frequently. I prefer Open Rhinoplasty for major tip work and I prefer Closed Rhinoplasty when concentrating on the bridge or minor tip work. I use computer imaging to show you how each version would possibly look and my patients choose which computer imaging version and based on that I plan Open Rhinoplasty or Closed Rhinoplasty.

I see all of my Rhinoplasty patients the next day after surgery and what I can tell you is that the degree of bruising or black eyes varies between Rhinoplasty patients. Some patients have no or hardly any bruising after their nose job and other get more severe bruising. Most of the times the bruises after cosmetic surgery are light enough to be covered by makeup 7 days after surgery, when the nose splint or cast is removed. Typically my Rhinoplasty patients can go out of the house in 7-10 days after their surgery without drawing attention to their selves. The nose should look very natural after a rhinoplasty as early as 10 days or latest 30 days but it does take months and years for it to truly settle down and shrink wrap. However, even as early as 7-10 days after a rhinoplasty, my patients have better noses than before their surgery and can enjoy these improvements while time takes care of the rest of the subtle changes.

On another note, I do worry about your statement about “looks are everthing.” Be careful about putting this much emphasis on your face and nose. While looks are very important and good elective cosmetic surgery can enhance your beauty and looks, looks are not everything.

The answer is double fold. Yes and No!

Lets clarify the “yes” answer first. When you look at African American, Asian, Hispanic and Middle Eastern noses, there are some important anatomic differences compared to Caucasian or northern European noses. These differences in skin thickness, cartilage size and strength, bone versus cartilage proportion on the bridge, nostril width, and septal cartilage size or abundance are important to recognize in order to plan the proper technique during rhinoplasty for the best outcome. Furthermore, the relationship between the nose, lips, chin and other facial structures must be recognized.

For example many Asian, Black, or Latino patients have thicker skin and weaker cartilages. This combination is not ideal for support and definition. However, if properly recognized pre-op and properly planned for, great aesthetic results are readily achievable in such patients. This often includes using more structural cartilage grafting and more suture techniques.

The mistake that I often see is surgeons who fail to recognize or plan for this anatomic situation and take the dangerous opposite approach by removing too much cartilage which results in further lack of definition and further lack of support. This results in a nose that is amorphous due to thick skin and scar tissue.

Now lets clarify the “no” answer. So with everything that I mentioned above, you may be wandering how could I possibly say that ethnic rhinoplasty is no different than non-ethnic rhinoplasty! Simply said, a successful rhinoplasty is impossible without proper initial diagnosis!

The most important skill any rhinoplasty surgeon has is the skill of diagnosis. The problem at hand must first be diagnosed before the solution can be reached. Diagnosis, diagnosis, diagnosis! I cannot emphasize this enough. No two noses are exactly the same. Each is different. Each needs its own individualized plan. A plan is impossible without initial diagnosis of the aesthetic issues needing correction. Furthermore, the nose is a three-dimensional structure and as such, any changes in one area or view will result in changes in other areas or views. Furthermore, correction of one problem surgically can result in creation of a whole new problem. These issues must be clearly planned out prior to the surgery. However, during the surgery, the skilled rhinoplasty surgeons must possess the knowledge and expertise to be able to successfully recognize and deal with new potentially unforeseen issues that may come up as a result of variations in tissue dynamics.

In this respect the ethnic nose is no different than the non-ethnic nose. Each and every patient’s nose must be examined thoroughly and an individualized proper plan devised. Rhinoplasty is an operation of fractions of millimeters. The surgeon must diagnose and recognize the nature and dynamics of the tissue (cartilage, bone, skin, scar, etc) with which he/she is working in order to be able to manage and predict these minute but significant changes.

There are two main methods of nose surgery or Rhinoplasty. The “open” technique more appropriately referred to as the “external rhinoplasty” versus the “closed” technique more appropriately referred to as the “endonasal rhinoplasty. ” To make matters slightly more complex for patients (and some surgeons) the “closed” or “endonasal” method is further subdivided to a “delivery” and a “non-delivery” method. Therefore truly there are 3 ways of performing a rhinoplasty.

The fact is that some surgeons do all of their rhinoplasties through an open approach and there are others that solely choose a closed approach. That is how they learned it and that is how they perform “the nose job. ”

More commonly these days, we see surgeons who have not learned the closed technique and so they perform all of their rhinoplasties with an open approach. The open or external rhinoplasty is arguably easier to learn and easier to teach and so the pendulum has swung to this side of the debate currently in favor of the external or open rhinoplasty. Not because this is the better operation but rather because this is how most surgeons today have learned to perform the nose job.

So what is the difference between these different techniques? What are the advantages and disadvantages? And what kind of surgeon should you look for to do your Rhinoplasty?

The open technique is characterized by a “columellar incision” which is a small incision on the bridge of skin at the base of the nose that divides the two nostrils. When this incision is made in an “inverted V” fashion and then closed meticulously with fine sutures, the scar is practically invisible. The incision should not be made straight across or even in a “stair-step” pattern, which some plastic surgeons choose.

The remainder of the incisions for the open rhinoplasty are very similar to the ones in a closed rhinoplasty which are essentially all hidden inside the nose. Many patients needlessly focus on the incision and scar and many surgeons who market their closed technique use the phrase “No Scar Rhinoplasty” to advertise their approach. However, as I mentioned, the scar is almost never an aesthetic issue when done properly.

The advantages of an open technique are that the surgeon will be able to clearly visualize the tip structures and cartilages of the nose as they lay in a natural position in order to be able to diagnose causes of asymmetry or twisting. With an open technique, the rhinoplasty surgeon can also place and secure, with fine sutures, more structural grafts such as tip grafts and spreader grafts. Finally as I have mentioned above, the open technique is easier to learn and perform by less experienced surgeons. Furthermore, this is the preferred method when total tip (lobular) reconstruction is necessary in complex revision rhinoplasty cases or in patients with a history of cleft lip disorder.

The disadvantage is that the operation does take longer to perform and there will be more swelling and numbness at the tip of the nose.

The bottom line is that the open rhinoplasty is a fantastic operation for the proper nose. However, it is too invasive in a nose that needs minor changes or no tip work at all. Opening the nose in such patients creates more risk and unnecessary trauma and prolongs the healing time.

As far as the closed rhinoplasty goes, there is nothing “closed” about the operation! Some patients are shocked and awe stricken when they hear about an endonasal or closed rhinoplasty. They cannot visualize how a surgeon can perform the surgery through the nostrils! The fact is that for an experienced and skilled rhinoplasty surgeon the closed technique allows excellent visualization of everything that needs to be seen and altered.

The “delivery” modification allows the tip cartilages to be “delivered” through each nostril for clear inspection and alteration. The “non-delivery” modification allows the extremely skilled rhinoplasty surgeon to alter the nasal anatomy and create an aesthetic and beautiful nose with the least amount of trauma, minimize unnecessary dissection thereby improving healing time and minimizing scarring.

Just as there are many surgeons who perform each and every one of their nose jobs through an open technique, there are some surgeons who perform each and every one of their surgeries through a closed technique. It is much less important which technique your surgeon chooses but rather it is critical to make sure your surgeon is skilled and vastly comfortable with the operation allowing him or her to obtain great and safe results consistently. Rhinoplasty is arguably the most artistic operation ever invented by man and it requires a dedicated surgeon with a true understanding of the nose, its anatomy, and its response to surgical maneuvers. A true “rhinoplasty surgeon” dedicates the vast majority of his or her surgical practice to the operation of the nose.

Ideally, a skilled “Rhinoplasty Surgeon” will be well versed in all of the above techniques and will diagnose the aesthetic and/or functional problem with each patient’s nose and then choose the most appropriate method to obtain the best results with the least trauma for each and every patient.