Rhinoplasty Frequently Asked Questions

It is important to note that common frequently asked questions relate to the cost of elective procedures, such as cost of cataract surgery, or about new types of body sculpting procedures, such as Zeltiq.

1. What is rhinoplasty?

Rhinoplasty is cosmetic or reconstructive surgery of the nose. It is also known as nasal refinement and is often called a nose job. A rhinoplasty can correct many problems of the nose stemming from genetics, trauma, or disease and can fix many aesthetic problems as well. A hump may be removed to give a more pleasing, symmetrical look. The cartilages of the nose can be molded and trimmed to create a more compact or pleasing shape. Rhinoplasty can refine the nose and bring balance and harmony to the face.

2. At what age can rhinoplasty surgery be performed?

In general, rhinoplasty for purely cosmetic reasons should be avoided before the face and nose have completed most of their growth. For most people, this means that they should put off surgery until the middle or late teens.

Extensive nasal surgery is generally avoided in children unless there is severe disfigurement. There are major growth centers in the nose that affect the growth of the face as a whole. In cases of severe disfigurement due to accidents or birth defects, surgery is performed in an attempt to restore the alignment of those growth centers.

Rhinoplasties performed on teenagers and young adults are often beneficial to a person's social development and self-confidence. In older people, the aging process is reflected in many ways in the nose and correction of flaws can add youthfulness and freshness to the appearance.

3. What does a typical rhinoplasty consultation entail?

A plastic surgery consultation is your chance to meet with him and her and discuss what you want out of your rhinoplasty surgery. Your doctor will discuss your goals with you and will explain what can be achieved realistically. A good doctor will not just slim your nose or shorten it. He or she will take into account your entire face and bone structure to see what type of nose would suit you best. There is no "one size fits all" when it comes to this procedure. A rhinoplasty is as individual as you are!

4. How is a rhinoplasty performed?

A rhinoplasty can be performed under either local anesthesia with sedation or general anesthesia. Surgery generally lasts about one and a half hours. An incision is made either across the bottom of your nose between your nostrils (an open technique) or in the mucosal lining of your nostrils (a closed technique).

The surgeon then may use surgical tools to shave down a hum, remove or rearrange cartilage, or break and rearrange bone to reshape the nose. After he or she is done, the incisions are closed. Your nose may be packed with gauze or other material and a splint or cast may be applied.

You will be awakened after the procedure and after an hour or two of recovery, you can go home. You must have someone to drive you home since you will not be able, or be allowed, to drive yourself. The packing usually comes out in a day or two and the splint or cast, if you have one, comes off in about 7 days.

5. What should I expect postoperatively?

For the first day after your rhinoplasty you will not feel well. After your surgery your surgeon will have placed a dressing over your nose and a gauze pad underneath it to catch blood and secretions. You will be told when you can remove the dressing, but usually you can do this in a few hours. You will feel a bit sore and headachy for a day or two, and your nose will be tender.

Because the back of your nose connects to your throat and stomach, you may have swallowed some blood during the surgery. This can cause nausea, as can anesthesia, and you may vomit a black-looking mixture within a few hours of surgery. Usually, nausea subsides after you throw up. If you continue to vomit and/or run a high fever, contact your doctor immediately.

You may have some discomfort from the packing and cast on your nose. Some patients feel claustrophobic and feel that they cannot breathe. When the cast is removed, you might feel some pain during the removal.

You will need to sleep with your head elevated for several days to a week after your surgery. Bruising and swelling will be present for several days after surgery and your nose will be sensitive for about a month and a half during your rhinoplasty recovery.

6. When will the cast be taken off and does this hurt?

The cast is removed about 7 days postoperatively and removal is usually not very painful. You may feel a slight stiffness in the upper lift after the cast is removed because the swelling moves downward. This will subside in a matter of hours. Be very careful not to bump your nose for several weeks after the cast has come off as it is vulnerable to breakage. Your nose isn't a bone china figurine, but it will not be as strong as it was before the rhinoplasty until it completely mends in about 2 months.

If you had a rhinoplasty to narrow flared nostrils, you will have your sutures removed when the cast comes off. Suture removal may sting a bit, especially since it is in a sensitive area.

7. When will I be able to see the results?

Your nose is going to look swollen and bruised for at least a few days. The swelling starts to disappear about a week after the cast is removed or a week after surgery. About 80% of the swelling and all of the discoloration are usually gone by 2 weeks after surgery. Swelling starts to resolve more slowly after that. Ninety percent of the swelling is gone by 2 months after surgery and the rest slowly disappears over the next year.

Although the nose is still swollen after the first month, this will not be visible to anyone else. You will see your nose becomes more refined with better definition over the first year.

The inside of your nose may be swollen for about 3 weeks after the surgery. Nasal breathing may be difficult during this time. If surgery is performed to straighten the nasal septum, an improvement in breathing starts to be noted at about 3 weeks.

8. What are the risks of rhinoplasty?

Rhinoplasty is generally safe, but things can go wrong. There is the risk of infection, adverse reaction to the anesthesia, and excessive bleeding. Even when a highly skilled surgeon performs your surgery, sometimes your body may not heal correctly or have adverse reactions causing undesired results. If is possible that you will need additional surgery.

You may lose your sense of smell for a period of time; in rare cases, this is permanent. You may develop scar tissue inside your nose that interferes with breathing or causes a whistling noise. You can develop a permanently drippy nose. You may have red spots and bruises on your nose that fade very slowly, and are sometimes permanent.

Visible scarring is usually minimal if the incisions are made inside of the nose, but if an open technique is used, or if narrowing of the nostrils is desired, scars may be visible for some time.

You may also simply be unhappy with the results. Rhinoplasty has the highest rate of revision of cosmetic surgery.

9. What are Arnica montana and bromelain? I have heard that they reduce swelling and bruising? Which is the best kind to take?

Arnica Montana, often just called arnica, is plant that has been used as an herbal medicine for over a thousand years to reduce bruising and swelling and to shorten the recovery period after physical trauma. Bromelain is an extract of the pineapple plant and has properties that reduce inflammation and swelling. It is most often used after sports injuries, to relive edema and after surgical procedures to help with swelling. Always ask your surgeon first before taking any medication.

10. Are there any new techniques to repair a deviated septum. Is cauterization used? Does the nose always have to be packed after surgery?

There are several ways to fix a deviated septum. Generally cauterization (using a hot instrument to burn the mucosa) is used to help prevent recurrent nosebleeds, not to repair or straighten the septum.

Generally, packing the nose is needed after rhinoplasty and septoplasty to keep the repaired structures in correct alignment and to reduce bleeding and swelling. Some surgeons use tubes or straws placed in the center of the packing so that you can breath through your nose somewhat. Most patients find the packing to be a psychological discomfort rather than a physical one.

11. I am 16 and have been thinking of rhinoplasty for a long time. At what age is it safe to have a rhinoplasty?

Usually rhinoplasty is deferred until about age 13 to 14 in girls and 15 to 16 in boys. The difference in ages is because girls reach their full growth a few years before boys do. You need to complete your growth before your nose can be revised. There are major growth centers in the nose that affect the growth of the face and it is best not to disrupt these unless absolutely necessary. A qualified surgeon can better advise you after a personal examination.

12. I'm getting a deviated septum and a hump fixed all in one. What kind of scarring should I expect? Also, how long after the operation will it take before I see the results?

Usually, scarring with even an open rhinoplasty, where the incision is made at the bottom of the base of the nose, is very minimal. If your surgeon uses a closed technique, incisions are within the nostrils. Which technique your surgeon uses depends on what technique he or she prefers and whether you need extensive work.

You can expect swelling to subside within the first month or so and you will have a very good idea of the results then. But the end result may not be seen until at least 9 months to a year postoperatively.

13. How much does a rhinoplasty cost?

It really depends on where you live and the amount of work you need done. Prices can vary even over the course of the year and with the popularity of your surgeon. If you just need a tiplasty, surgical revision of just the tip of your nose with no bone work, then it may average about $3,800.

The average prices for rhinoplasty and it's related surgeries:

• Primary open rhinoplasty $3,152 to $6,500

• Primary closed rhinoplasty $2,879 to $5,800

• Primary septoplasty/turbinectomy $3,500. - $6,500

• Secondary open rhinoplasty $7,000. - $9,000

• Secondary closed rhinoplasty $2,643 to $10,000

and with implant: $2,500 to $10,200

A stay overnight in the hospital or in a recovery center costs extra.

You should discuss the fee for your rhinoplasty with your surgeon or someone in his or her office and get all the information in writing. There may be extra fees for the use of the surgical center or for the anesthesia. Find out what extra fees there will be in advance.

Some portions of some rhinoplasties will be covered by health insurance if you have documented breathing difficulties. You need to contact your health insurer to find out what might be covered. Your surgeon's office can contact your health insurer, but make sure that you get things in writing from the insurer.

14. It's been five months since my surgery and now I notice that when I run or workout my nose drips. Is this just part of the healing stage or do I need to bring this up to my doctor?

Many patients complain of runny noses after rhinoplasty/septoplasty surgery. Most of the excess mucous production stops after about 9 months, but it can continue well after that. For now, I can only advise you to carry more Kleenex around because the drippiness may persist for several more months.

15. My plastic surgeon mentioned that a shot of cortisone might help with some of the scar tissue in my nose. Why is this?

Injections of cortisone or similar corticosteroid drugs can help break up excess scar tissue. Injections like these are commonly used to reduce swelling and inflamed tissue. However, care must be taken regarding excess use of these injections because it can break down the tissue too much. Corticosteroids also have a number of side effects. Discuss the matter with your surgeon.\

This is a very common recommendation from a cosmetic surgeon. A weak chin can make even an ideal nose look larger than it actually is. Chin augmentation is a relatively minor procedure when implants are used, although it does have some risks of its own, such as lower lip numbness. A more extensive procedure would be to detach a piece of the lower jaw at the chin and move it forward and reattach it to the jawbone. Either type of chin augmentation can be done at the same time as a rhinoplasty. Chin augmentation is often performed by a maxillofacial surgeon, who may be a medical doctor or a dentist.

17. I have to get my cast off soon and want to know if it is going to hurt. Is there anything I can do beforehand?

Most patients report a little tenderness when the cast is removed, but if your surgeon uses a cotton swab saturated with alcohol to help remove the adhesive from the tape and glue you should be okay. It really shouldn't cause you great discomfort.

The sutures that may be removed at the same time may hurt a bit. Ask your surgeon if you can take a pain reliever (probably not anything with aspirin in it) in advance or if he can numb the area first.

18. I have thick nasal skin and a surgeon I spoke with said that I may not be able to see much detail with my rhinoplasty. Is this true? Should I see another surgeon?

For many patients with thick skin, the skin is thinned out in the surgery as the tip is worked on, which can help with definition. But many patients with thick skin actually do better with rhinoplasty. Very thin skin, shows every little imperfection.

Going on several consultations and getting a second, third, or more opinions is a good idea in any case.

19. Is it improper to ask to speak with other patients who have had revision rhinoplasty done by the surgeon I am considering?

It is not at all improper! And you absolutely should ask. All surgeons should have a referral list of prior patients who can discuss particulars and trade stories. I personally spoke with patients beforehand and I am on my own doctor's referral list.

You may wonder if all of the referral patients are only the happy ones or if they receive compensation. I have found in my experience that there are one or two patients who wish they had done more research beforehand or had gone to another doctor entirely. I think it is helpful to the patient considering the procedure to gain a well-rounded opinion.

20. What is a "hanging columella"?

The nasal columella is the fleshy section of the external nose that separates the nostrils. It is the bottom of the septum. A hanging columella is when this section is prominent or hangs down between the two nostrils.

21. Is it possible for someone to be allergic to dissolvable stitches? And if so, what is the reaction like?

An allergy to dissolvable sutures isn't as uncommon. The symptoms include redness, itchiness, and sometimes pus formation. Sometimes symptoms may not show up until about 3 to 4 weeks after surgery. The best thing to do in some cases is to remove any of the remaining suture material and replace it with nylon sutures. These sutures are usually removed in 10 days. Another option can be to use tissue glue, although this is not often done with rhinoplasty.

If your skin gets red and itchy around a suture, whether absorbable or nondissolving, it may be time for them to be removed. Your body will tell you when you are healing. Healing skin often turns itchy.

22. Do you have advice for African-American persons on picking a plastic surgeon?

Many African-Americans may want a better looking nose, but are afraid to have a rhinoplasty because they fear losing some of their ethnic features. This could happen if you go to a plastic or cosmetic surgeon who uses a cookie-cutter approach to all noses. However, there are plastic surgeons who understand African-American rhinoplasty, and how to give you the nose you want without making you lose your heritage in the process. This is true for Asian-American rhinoplasty as well.

Some of the advice about picking a plastic surgeon is the same whatever your ethnic background. Ask for recommendations among friends, beauty salons, and your doctor. Don't assume that the surgeon must be African-American to have the sensitivity and skill you need. That may be so and it might not be. You are looking for a surgeon with skill, artistic sensibility, and sensitivity to your needs, and those qualities are not tied to any one skin color.

23. Can pollybeak deformity be corrected?

Yes. Pollybeak deformity is a common complication of a rhinoplasty. The nose ends up looking a bit like a parrot's beak, hence the name pollybeak. It may be due to poor technique on the part of the surgeon, but may also due to unpredictable healing. The nose may initially look fine after swelling first starts to resolve, but then ends up with downward droop of the lower third of the nose. Sometimes, pollybeak will resolve on its own within a few months with further healing.

Treatment for pollybeak deformity can involve steroid injections to reduce swelling in the early stages of healing. Most surgeons will wait a year before recommending revision surgery. Revision surgery may include further work on the dorsum of the nose and, in some cases, an implant or graft.

24. I used to be addicted to cocaine, but I'm in recovery. As a result, I have a hole inside my nose, between my nostrils. Can I have the hole filled?

Cocaine use can lead to the erosion of the septum between the two nostrils. Most of the holes that come from cocaine are large and may not be treatable. In these cases, rhinoplasty must be combined with a septal perforation repair. Some surgeons use a flap of mucosal tissue to repair the hole. In some cases, a silicone button can be placed to close the hole.

25. I had a rhinoplasty and septoplasty almost 6 months ago. I still can hardly breath in one of my nostrils. Is this normal?

Breathing is usually restored by the sixth month after surgery. Most patients notice improved breathing within a month or two of surgery. I would suggest that you have a follow-up visit with your surgeon and ask his advice.