Rhinoplasty is one of the most commonly requested plastic surgery procedures at the San Francisco Bay Area office of Dr. Joseph Mele. The nose is the most central feature of the face. A nose which is too small, too large, or misshapen can make one feel self-conscious. Thanks to rhinoplasty, our board-certified plastic surgeon and his experienced staff can help reduce the size of a large nose, enlarge a small nose, and smooth irregularities in a misshapen nose.
What Is Rhinoplasty?
Rhinoplasty surgery can dramatically improve the overall appearance of your nose and face and significantly increase self-esteem. The word rhinoplasty literally means “nose changing.” The main goal of rhinoplasty is to create a more aesthetic nose which is proportionate to the rest of the face.
Rhinoplasty includes many surgical techniques that can change the shape or size of the nose. For patients bothered by a bump on their nose, rhinoplasty can smooth it out and improve their profile. Rhinoplasty is often used to reduce large nasal tips and can also increase nasal projection for patients with flat noses.
Rhinoplasty Before and After Photos
Am I a Candidate for Rhinoplasty?
What defines a good candidate for rhinoplasty? The most important consideration is that the surgery is safe and predictable. That is, that rhinoplasty can provide the type of changes you are looking for, with minimal risk.
You need to be healthy to have rhinoplasty. If you have pre-existing health problems, they need to be well controlled. If you have a cold, surgery should be delayed until you are well. If you take medications that cause bleeding, proper evaluation and adjustments are necessary before proceeding. If you smoke or vape, stop four weeks before surgery.
You need to have a problem that rhinoplasty can fix. The most common problems are:
- Dorsal hump (a bump on the nose)
- Droopy nasal tip
- Large nose
- Wide nose
- Bulbous or boxy nasal tip
- Asymmetrical nose
- Breathing problems (often combined with septoplasty or other surgery)
- Lack of a nasal bridge
- Other aesthetic nasal concerns
If you have recently had nasal surgery, and are looking for a revision, unless there is a medical emergency, in general it is recommended to wait a year before another rhinoplasty. You can certainly get a second opinion before a year is up, but most experienced surgeons agree that cosmetic revisions work better after giving the nose time to heal.
What Can I Expect During My Rhinoplasty Consultation?
Dr. Mele will spend time discussing your expectations and the specifics of your nasal surgery procedure to ensure that you are comfortable with each facet of the treatment. Dr. Mele uses state-of-the-art computer simulation during your consultation to facilitate communication and help make certain that you are fully informed before surgery. Making certain expectations match results helps assure that you will be satisfied with the outcome.
Dr. Mele welcomes any questions you may have and will explain all aspects of the rhinoplasty procedure during the consultation. Additionally, our practice is designed to provide a relaxing environment and our friendly support staff will instantly put you at ease.
What Are the Benefits of Rhinoplasty?
The term rhinoplasty encompasses a wide variety of surgical procedures and non-surgical approaches. Below are a few examples of what can be accomplished with cosmetic surgery of the nose:
Reduction of a Dorsal Hump
One of the more common reasons to have nasal surgery is to reduce the dorsal hump. The dorsal hump is the bump located on the upper aspect of the nose caused by excess bone or cartilage. A small incision is made, often inside the nose, and the excess is removed. Sometimes, after larger reductions, the nose needs to be narrowed, and the nasal cartilage and bones can be brought together for a better aesthetic outcome.
Reduction of the Nasal Tip
When the nasal tip is large, it can give a boxy or bulbous appearance to the nose. Nasal tip surgery can reduce a large tip, and give a refined appearance. By enhancing the tip’s definition, the entire nose appears smaller. By bringing the nasal tip into proportion with the rest of the nose, a more pleasing appearance can be created. The nasal tip can be addressed through open rhinoplasty to help improve the symmetry of nasal cartilage, or via closed rhinoplasty depending on the type and amount of correction you desire.
Rotation of the Nasal Tip
When the nasal tip is droopy, it can give a sad or hooked appearance to the nose. Nasal tip surgery can rotate the tip of the nose up, providing enhancement of the profile. By bringing the nasal tip up, a more youthful appearance can be created. Care is taken not to over-rotate the tip as this can expose too much of the nostrils.
Reduction of the Nasal Base
Weir Excisions can be made along the edge of the ala (the skin around the sides of the nostrils) for patients who wish to reduce the width of the nasal base. Further reduction of the nasal width can be achieved with a spanning suture.
A flat nose can be corrected with nasal augmentation. A nasal graft, or nasal implant, is placed below the skin of the nose to augment the nasal bridge. This provides an enhanced, stronger nasal profile.
Post-Traumatic Deformities (Fixing Broken Noses)
Nasal fractures are one of the most common facial fractures. A fractured nose can give a flattened appearance, or result in a nose that is no longer in the midline. Adjustments can be made to a broken nose in the week after injury, or can be delayed six weeks to allow the bony fragments to unite. Repair of nasal deformities after trauma is directed toward restoring the normal anatomy, and the approach needs to be individualized.
Depending on your condition and needs, additional procedures may be performed with nose surgery, if desired. Options include advanced treatments such as facelift surgery (“rhytidectomy”), eyelid surgery (“blepharoplasty”), and/or brow lift surgery (“forehead lift“). During your initial consultation, Dr. Mele will help you decide on the procedure(s) that are right for you. Before-and-after plastic surgery photos are available to view featuring some of Dr. Mele’s excellent work.
General Approaches to Rhinoplasty (Nose Surgery)
It is important to consider exactly what it is about your nose you would like to change so that you can get the most from your rhinoplasty consultation appointment. When we get down to basics, there are only two ways to change the shape of the nose. Either volume is removed (for instance: to lessen a bump on the nose), or volume is added to create definition when absent. Often the combination of lowering bumps and building up more refined features is utilized. This allows for the reduction of a “big” nose, with enhancement of the best features.
Here are some of the general approaches common in rhinoplasty surgery:
The concept of reduction is pretty easy to understand. When the nose is too large, a portion is removed to reduce the size. This is done with attention to the aesthetics of the nose to form a new, smaller nose that remains proportionate to your face. The simplest example is the treatment of the dorsal hump – a bump on the upper nose. Removal of the bone and cartilage that supports the skin in this area creates a smooth nasal dorsum. However, sometimes the nose looks like it has a bump because the tip is hooked. In this situation, adding volume and projection to the tip may be advantageous, or even preferable.
Augmentation Rhinoplasty (Nasal Autografting)
Sometimes adding volume to the nose is the best solution. Nasal autografting is a technique that allows for recycling of your own cartilage. The cartilage typically removed during rhinoplasty can be used, or if insufficient, additional cartilage can be borrowed from the nasal septum, ear, and less commonly, the rib. Since your own cartilage is used, your body accepts it, and long-term augmentation can be obtained. The simplest example is the dorsal onlay graft used to augment a flat upper nose for Asian Rhinoplasty, or to build up the bridge of the saddle-shaped nose deformity often seen after trauma.
Closed Rhinoplasty vs. Open Rhinoplasty
The debate between closed rhinoplasty or open rhinoplasty continues to this day. Each technique provides both advantages and disadvantages, and the final determination of which technique is best for your nose depends on a careful, professional evaluation of the aspects of your nose you want changed. The exact type of surgery needed to provide the safest and most predictable results will determine whether the open rhinoplasty or closed rhinoplasty technique is right for you.
One hundred years ago, most rhinoplasty was performed closed. Closed rhinoplasty eliminates the small incision between the nostrils used in the open technique. Closed nasal surgery works well for dorsal reductions (removing the bump on the nose) and narrowing of the wide upper nose. For these standard rhinoplasty maneuvers, the open technique does not provide much advantage. Since the closed technique incisions are all inside the nose, they are hidden. However, the small external scar needed in the open technique usually heals extremely well and is very difficult to see in most circumstances. The closed technique may have less postoperative tip swelling, but when similar operations are performed, it is difficult to demonstrate the difference. There can be more problems with symmetry of the nasal tip with the closed approach because the lower nasal cartilages providing support for the tip cannot be completely seen at the same time in their natural position.
Open rhinoplasty has simplified tip rhinoplasty. Its pioneers have advocated for its superior visualization of the lower nasal anatomy. The difference between open nasal surgery and closed nasal surgery is the 1/4 inch incision made between the nostrils. This small columella incision allows the nasal skin to be lifted, and the underlying cartilages to be seen in their normal position. While the nasal tip cartilages can be seen with the closed approach, it is necessary to deliver (pull out) one side at a time for tip work. The open technique reveals both sides simultaneously, and facilitates the symmetry of the result.
What Does the Rhinoplasty (Nose Surgery) Procedure Involve?
Every rhinoplasty surgery is different. At our office, each surgery is customized to best meet your objectives and goals. During most rhinoplasty procedures, Dr. Mele will remove or rearrange nasal cartilage and, if necessary, reposition the bone to reshape the nose. The goal of nose surgery is to achieve a proportionate, natural-looking nose that is in harmony with the other features of your face.
In general, rhinoplasty is an outpatient surgical procedure, typically performed under general anesthesia. The length of surgery can range from an hour to four hours depending on the complexity of the procedure.
During rhinoplasty, our board-certified plastic surgeon can reduce the size of an overly large nose, enlarge a small nose, or minimize the abnormalities of misshapen noses. In order to accomplish your desired goals, he may need to remove cartilage and reposition the bone to reshape the nose. By making subtle changes, Dr. Mele can greatly enhance the shape and size of your nose. The goal is to create a natural-looking, more proportionate nose, which is in harmony with the other characteristics of your face.
When evaluating rhinoplasty patients, it is important for Dr. Mele to evaluate the entire face. The interplay of the nose with the eyes, mouth, cheeks and other important facial characteristics must all be taken into consideration. A large nose and a small chin can interact to accentuate the disproportion. In other words, a small chin makes a large nose look bigger and vice-versa. Sometimes a chin implant can substantially help the proportions of a reduction rhinoplasty.
Attention to proportions are an important key to a successful rhinoplasty. Like all of cosmetic surgery, it requires a combination of art and science, an eye for ratios and the surgical skill to craft them.
What Can I Expect During Recovery from Rhinoplasty?
Recovery after rhinoplasty is very manageable. It is important to keep the head elevated and avoid bending over, straining, or hitting the nose. A little bleeding from the nose is to be expected, and a mustache dressing may be applied beneath the nose to catch it. When the bleeding stops, after 24 hours, it can be removed.
If a splint is applied to the dorsum of the nose during your rhinoplasty, it is there to stabilize the nose and control swelling. It is important that the splint remain clean, dry, and intact to preserve your operative results. Walking is fine, but activities that increase heart rate and blood pressure, such as running or other vigorous activities, are to be avoided. Crowd avoidance is also recommended to reduce the likelihood of inadvertent trauma such as an elbow to the nose.
Most patients expect a lot of pain after nasal surgery, but rarely experience it. If you are having a lot of pain after rhinoplasty, you should contact your surgeon. Let them check you to be certain you are not experiencing a problem like bleeding, infection, or a splint which is too tight. The sooner problems are identified, the sooner they can be treated.
Bruising can occur. It is generally under the eyes and can take 7-10 days to resolve, like a typical black eye. Working out is allowed two weeks after surgery in most cases, but this will depend on the type of rhinoplasty performed.
It takes time for all the swelling in the nose to resolve. You will notice changes day-to-day for the first weeks. Swelling on the dorsum of the nose typically abates by three months. Swelling in the tip of the nose can take a year or longer in some cases. It is important to be patient as these changes will occur gradually. Reoperations are typically delayed at least a year to be certain that the nose is fully healed and a stable platform exists on which to make additional changes. Overall, reoperation rates for the nose are 15-20%, but are usually smaller, touch-up types of procedures.
How Noticeable Are Rhinoplasty Scars?
Rhinoplasty scars are usually hard to see because they tend to heal well and they are mostly hidden. “Closed Rhinoplasty” scars are inside the nose. The “Open Rhinoplasty” scars include one that goes across the skin between the nostrils under the nose (the columella). This typically fades in a few months. Revision of these scars is rarely necessary.
How Long Do the Results from Rhinoplasty Last?
Rhinoplasty results last. Changes to the bone and cartilage are permanent. Changes made during surgery are expected to last for years if not decades. Postoperative changes occur during the year after surgery. After this, changes are primarily due to the natural aging of the nose. Fortunately, the nose changes slowly and gradually as it ages. Typical aging of the nose includes thickening of the skin at the tip and tip drooping. Tip surgery tends to thin the skin and cause firmer attachments to the underlying supporting structures. Reduced drooping is typical in patients who have had rhinoplasty.
Are There Any Non-Surgical Rhinoplasty Alternatives?
Dermal fillers, more commonly used to reduce facial lines or for lip augmentation, can be used to reshape the nose. Small changes can be made rapidly, and with minimal downtime. When nasal depressions are present, fillers are used to smooth the contour. Small bumps can be hidden by filling above and below them. If the upper nose is flat, or minor nasal augmentation is desired, filler can be used in this area for correction, or as a preview to what a more permanent surgical correction can provide.
It is important to remember that any improvements made with filler are temporary. They either need to be maintained with repeat treatments or surgical intervention can be utilized for more permanent correction.
Rhinoplasty can be combined with additional corrective and cosmetic procedures. The most commonly combined procedures include:
Rhinoplasty with Septoplasty
Septoplasty is performed to straighten a deviated septum. If you have difficulty breathing through one side of your nose, your septum may be deviated. This can be from trauma (a broken nose usually means a broken septum), or it may just be the way your septum developed. Septoplasty is a technique used to straighten the septum and open up the constricted airway.
Rhinoplasty with Turbinate Reduction
Turbinates are normal folds in the nasal lining that heat and add humidity to the air we breathe. The lowest turbinate, also termed the inferior turbinate, happens to be placed at the narrowest portion of each nasal airway. When the inferior turbinate swells, it can restrict, or even block, the airway. Since each side has its own inferior turbinate, air flow in one or both sides can be restricted. Since the turbinates can expand and shrink, the blockage may be intermittent. Seasonal allergies tend to worsen these symptoms, and the turbinates tend to slowly enlarge as we age. There are several different ways to reduce the turbinates, and if this is a problem for you, be certain to discuss your options with Dr. Mele during your consultation.
Rhinoplasty with Chin Augmentation (Chin Implants)
A large nose often looks larger when accompanied by a small chin. In this situation, chin augmentation may provide the solution you desire. Microgenia is the medical term for a small chin. Microgenia is corrected by a chin implant inserted via an incision placed discreetly under the chin or inside the mouth. Chin augmentation can be performed at the same time as your rhinoplasty to help provide overall balance to your face with a single surgery.
Rhinoplasty with Chin Augmentation Before-and-After Photos
A number of other procedures can also be performed to complement the results of rhinoplasty and provide an even more comprehensive cosmetic makeover. Combining the procedures provides the advantage of one anesthetic and one recovery period for multiple surgeries.
Chin augmentation, as discussed above, is the most common cosmetic surgery combined to complement the rhinoplasty. Septoplasty is also a frequent addition, and is used to improve the air movement inside the nose.
Sometimes the combined procedure is unrelated to the nose, and is done concurrently to take advantage of combining the recovery times. These include many of the most commonly performed cosmetic plastic surgery procedures, like breast augmentation and tummy tucks. Other examples of complementary pairing of cosmetic surgery include: facelift (rhytidectomy) with eyelid lift (blepharoplasty); breast augmentation (breast implants) with tummy tuck (abdominoplasty) and liposuction (liposculpture).
How Much Does Rhinoplasty Cost?
The cost for rhinoplasty ranges widely. Procedures to treat small dorsal humps, minor tip revisions, or narrowing the nasal base are shorter and cost less. Full rhinoplasty, revision rhinoplasty, rhinoplasty combined with airway procedures (septoplasty), and rhinoplasty requiring augmentation with rib grafts are more complex, take longer, and cost more. A price range is available if you call (925) 943-6353, but an exact cost can only be provided after a full evaluation in the office.
Financing is available, and more information can be found on our plastic surgery financing page.
Schedule a Rhinoplasty Consultation
For more information about rhinoplasty, or to schedule a consultation, call (925) 943-6353. You can also contact our Walnut Creek plastic surgery practice online today by filling out our contact form.