Rhinoplasty, also known as nose surgery, nose reshaping, or a nose job, is a surgical procedure that reshapes the nose in order to create a more aesthetic facial appearance. Rhinoplasty may also help to improve nasal function.
Most rhinoplasties today emphasize a more natural and lasting result using more conservative techniques. In this way, the nose can be reduced or increased in size, a hump can be removed, the nostrils can be narrowed, the tip or bridge of the nose can be reshaped, and the angle between the nose and upper lip can be changed. Altering the appearance of the nose can often help to achieve facial balance and enhance the other facial features.
What is Rhinoplasty(Nose Job)?
Rhinoplasty is a plastic surgery procedure that can reshape the nose and help to improve nasal function. Many changes can be made to the nose including a reduction or increase in overall size, removal of a hump, reshaping of the tip or bridge, narrowing of the nostrils, or a change in the angle between the nose and upper lip. Reshaping the nose can help to achieve a more aesthetic facial appearance by creating harmony among the facial features. Today’s techniques for rhinoplasty are more natural and creative, focusing on reshaping, sculpting and restoring skeletal deficiencies rather than performing large volume removal and resection of bone and cartilage.
Before and After Gallery
* All patients are unique and individual results may vary.
Open vs. Closed Rhinoplasty
Patients often ask about or are concerned about whether their rhinoplasty will be done by an open or closed technique approach. They express concerns about the external columella incision in the open approach, which they fear will leave a visible scar as well as longer periods of swelling and healing. Some will only seek out surgeons who exclusively do the procedure the way they want it done.
Dr. Schwartz uses both the open and closed approach but counsels not to worry about the approach as much as the desired result. “After evaluating what a patient needs to have done to get the result they want, I’ll tell them what approach I’m going to use” says Dr. Schwartz. “I don’t think the external incision creates a problem scar and I think getting the result you want is worth a little more healing time”. “If a patient is set on a certain approach and I don’t think I can get the result that way then I’ll recommend they see another surgeon who can.”
Dr. Schwartz feels that it comes down to training and experience. There is no “right or better way” to do a rhinoplasty. Some surgeons are very comfortable with open rhinoplasties only, some with closed and some with both.
The following patients illustrate how Dr. Schwartz uses both open and closed rhinoplasty for his patients. All patients are seen at over 3 years after their procedures.
Case Studies
Case 1
Case 2
Case 3
Case 4
Case 5
Benefits of Closed Approach
From a patient’s point of view, the biggest benefit of a closed rhinoplasty is that there are no visible scars on the exterior of the nose. A person can enjoy the benefits of a nose job without the scar serving as evidence of the surgery.
Another benefit of a closed rhinoplasty procedure is that it typically has a shorter recovery time. Since fewer incisions are made during the procedure, there is less that needs to heal, as well as less swelling after surgery. Patients still need to take a week or two off from work and to take it easy for the first month or so after surgery, but they are more likely to feel better and to see improvement more quickly, compared to those who have an open procedure.
Benefits of Open Approach
If a closed rhinoplasty means less recovery time and no visible scarring, you might wonder why anyone would want an open rhinoplasty. As it turns out, an open procedure allows the surgeon greater access to the interior of the nose. During an open rhinoplasty, a surgeon can do things to the nose he just can’t do during a closed surgery.
For example, during a closed rhinoplasty, the nasal cavities remain divided. It’s more difficult for a surgeon to fully reshape the cartilage during a closed procedure and it can be challenging for a surgeon to re-drape the nasal skin during the surgery. During a closed rhinoplasty, there’s an increased risk for deformity of the nasal cartilage and for excess stretching of the skin in the nasal area.
In contrast, during an open surgery, the surgeon has easy access to the interior of the nose. The top of the nose is flipped up, similar to the way you might open the hood of a car. The surgeon can clearly see and manipulate the nasal skeleton. It’s also easier for a surgeon to work on the tip of the nose during an open procedure.
While the open technique does involve making a scar across the columella, the tissue that divides the nostrils, the size of the incision and the location of it means that it is likely not to be very visible once all is said and done. In many cases, the incision heals nicely, leaving almost no visible scar. Since the incision is placed on the underside of the nose, a person would have to lean down and stare directly up at another person’s nostrils to even catch a glimpse of it.
How Do You Choose?
In the end, deciding between open and closed rhinoplasty isn’t as simple as answering the question of “external scar or no external scar?” Your surgeon will evaluate what changes you’d like made to your nose, your expectations for the surgery, and a variety of other factors when deciding whether an open or closed procedure is best for you.
In fact, it can be a red flag if your surgeon insists that he only performs one type of rhinoplasty and not the other. While an open procedure might make sense for the majority of cases, it’s not always the best option. The same is true of a closed technique. You want to work with a surgeon who has the experience with and understanding of rhinoplasty to be able to choose the technique that best suits you and your nose.
Who is a good candidate?
Healthy men and women over the age of sixteen who would like to improve the appearance of the nose may be good candidates for rhinoplasty.
The Deviated or Crooked Nose
The patient with a crooked or deviated nose presents a special challenge in rhinoplasty. The deviation may be a result of previous trauma or just an aberrant growth pattern.
These types of noses often have asymmetrical features, uneven amounts of bone or cartilage on either side, areas of collapse opposite areas of excess prominence. Often underappreciated is the amount of internal deviation which may also be present and if not also corrected will doom the aesthetic result to failure. The surgeon also must take into account the natural tendency of “cartilage memory” to return to it’s original deviated position even after correction and take steps to counteract this.
Deviated or Crooked Nose (Before & After)
The Consultation
During the consultation with Dr. Schwartz you will discuss what it is that you dislike about your nose and what you hope to achieve through surgery. Your nose will be examined, a thorough medical history taken, and your options discussed, including whether a closed or open approach will best be able to achieve your desired result. All details of the procedure will be explained, any questions or concerns that you may have will be addressed and “Computer imaging” may be used to show you the results you want to achieve. You will find some case studies using “Computer imaging” later in this article.
Preoperative Computer Imaging
Dr. Schwartz says: “I find computer imaging to be a great communication tool for my rhinoplasty patients and me.” Many patients come in with a picture in their mind of a certain nose on their face. Others may be focused on only one area they want changed and don’t appreciate that when this is altered other areas become noticed in a way they were not previously and will need to be addressed as well.
Computer imaging helps them see what the best options for them are and make certain that Dr. Schwartz understands what they want to achieve. “I want to be on the same page with my patients,” says Dr. Schwartz “and this gives me the best opportunity to give them the result they want.” Many patients express concern about how accurate computer imaging is in predicting their result. “I tell my patients that computer imaging is not exact, but I will only show them a result that I think I can achieve for them,” says Dr. Schwartz. “If we use it as a guide to set boundaries of being realistic about expectations of how small or how wide or how much change will occur it helps us both.”
The following photos are examples of how computer imaging can be used to preview and guide surgical results. On all photos the pre operative photo is on the left, the computer image is in the center, and the actual postoperative result is on the right.
The Rhinoplasty Procedure
Dr. Schwartz performs the rhinoplasty procedure at an outpatient surgery center with IV sedation or general anesthesia. The surgery typically takes two to three hours to complete. In some cases, a small external incision is made on the columella, which is the column of skin between the nostrils. This is known as the “open rhinoplasty approach”. In other cases, a “closed” approach is used which involves internal incisions made solely on the inside of the nose. Dr. Schwartz uses both closed and open approaches, emphasizing that it is not the incision that should concern patients but rather the best approach to achieve the patient’s desired result. Because all noses are different to start, Dr. Schwartz does not apply a “one incision fits all” approach and instead recognizes that a variety of techniques are necessary for achieving different changes.
Working through the incisions, Dr. Schwartz will reshape the nose to the desired appearance. Contemporary rhinoplasty emphasizes creativity in fashioning a new nasal architecture by reshaping, sculpting and restoring skeletal deficiencies as opposed to large volume removal and resection of bone and cartilage. This is a more natural and creative approach which has the added benefit of decreased bruising, a quicker recovery, and more natural, lasting results.
After (Post-Op) Rhinoplasty
Most patients begin to resume normal activities within seven to ten days after rhinoplasty. Swelling and bruising may occur, particularly around the eyes. While the majority of swelling will subside within two weeks, it can take as much as a year for some subtle, unnoticeable swelling to fade. Any discomfort that patients experience can be controlled with medication. Stitches are removed after one week, and work can usually be resumed after seven to ten days. Aerobic activity can often be resumed after two weeks, while heavy lifting and contact sports should be postponed for four weeks or longer.
Rhinoplasty Risks
As with all types of surgery, there are potential risks associated with rhinoplasty which may include:
- Adverse anesthesia reactions
- Bleeding
- Scar Infection
- Slight nose asymmetries, irregularities
- Nose Deviations
- Unpredictable scarring
Rhinoplasty and Aging
A common myth is that the nose “grows as we age”. This is not so. The nose does not “grow”, but the ligaments that support the cartilages lose their strength and ability to support the nose and that combined with the loss of facial volume (especially if the upper gums have receded) results in the appearance of drooping, larger nose. This is often disturbing to patients who feel that “they never looked the way before.” It can also result in functional problems because as the nose droops it may impinge on the breathing passages as well. It is also a myth that patients experiencing these changes are “too old for rhinoplasty”.
The following patient exhibits what great results can be achieved by performing conservative rhinoplasty in older patients.
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This active 80 year old male still runs distance races. He complained of increasing airway problems from his drooping nose along with difficulty in shaving his upper lip. Preoperative photos show the deviated, elongated nose with drooping tip cutting off his breathing along with creating the illusion of dorsal hump due to poor tip support. While generally healthy there were definitely concerns about doing elective surgery at this age. A conservative rhinoplasty and septoplasty done under local anesthesia provided him great relief with low risk and quick recovery.
Post-operative photos demonstrate straightening of his nose with increased tip support and elevation thus improving his airway and allowing him to more easily shave his upper lip. Conservative lowering of the profile and tip shaping add a more youthful look as well. He now reports his running to be the best he has done in years.
At what age can rhinoplasty be performed?
Rhinoplasty can be performed on patients over the age of sixteen, or once the nose has completed its growth.
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Frequently Asked Questions
The incisions made for rhinoplasty do result in scars though they are hidden. They may be located entirely on the inside of the nose or an additional small incision may be located on the underside of the nose between the nostrils.
Dr. Schwartz performs rhinoplasty with IV sedation or general anesthesia.
Rhinoplasty procedures that are performed for cosmetic reasons are generally not covered by insurance. When performed for reconstructive purposes or when treating breathing problems or deformities, some degree of coverage may be available. Patients should consult with their own insurance carrier.
According to the American Society of Plastic Surgeons, The average cost of rhinoplasty is $5,350. The cost of a rhinoplasty surgery in South Florida usually range from $3,000 to $7,000.
Dr. Schwartz performs rhinoplasty at an outpatient surgical center.
Once anesthesia is administered, incisions are made. Incisions are hidden and may be located entirely on the inside of the nose or an additional small incision may be made on the underside of the nose between the nostrils. Working through the incisions, the nasal structure is then reshaped to the desired shape.
Rhinoplasty surgery usually takes two to three to perform.
The incisions for rhinoplasty are hidden and may be located entirely on the inside of the nose or an additional small incision may be made between the nostrils on the underside of the nose.
There can be some discomfort after the rhinoplasty procedure as the head and nose may ache at first. This can be managed with medication.
Patients can expect a recovery time of about one week after rhinoplasty. Swelling and bruising, particularly around the eyes can occur, with most of the noticeable swelling fade within about two weeks. Medication can help to manage any discomfort. Work and other normal activities may be resumed in about one week and more strenuous activities may be resumed in about two weeks.
Patients can usually return to work in about one week after rhinoplasty.
Exercise and other strenuous activities may need to be postponed for at least two weeks after rhinoplasty.
As with all types of surgery, there are potential risks associated with rhinoplasty and these may include adverse anesthesia reactions, incomplete improvement, infection, small burst blood vessels, and the need for additional surgery.
There are financing options available for many plastic surgery and cosmetic surgery procedures.
At 8 days this is not unusual depending on what you had done. It usually resolves within a month.
Contemporary rhinoplasty stresses preservation of tissue but each situation is individual. At times cartilage, bone or soft tissue may need to be removed, added or some combination of both. A long nose that needs to be shortened will likely need some cartilage removal.
Meet Dr. Schwartz
With over 25 years of plastic surgery experience, Dr. Schwartz is an expert in facial plastic surgery. But what sets him apart from other plastic surgeons is his ability to create aesthetically beautiful results while ensuring full proper functionality of the nose. As a double board certified doctor, Dr. Schwartz is not just a talented facial plastic surgeon but also a skilled ENT. With Dr. Schwartz you can achieve the look you want with the comfort of knowing that the air passages within the nose will not be affected. Often times, Dr. Schwartz performs revision rhinoplasties to amend surgeries performed by other doctors that either aesthetically missed the client’s desires or caused breathing issues post-surgery. As an ENT, Dr. Schwartz knows how to achieve the right design without any interference with breathing. You can trust Dr. Schwartz with your surgery. Call the practice today to schedule your consultation, 561-655-5562.
Why choose Dr. Schwartz?
- Dr. Michael Schwartz is certified by both the American Board of Facial Plastic and Reconstructive Surgery and American Board of Otolaryngology.
- MD from Baylor College of Medicine, where he completed his General Surgery Residency at Beth Israel Medical Center and ENT Residency at Columbia Presbyterian Medical Center.
- He is also a fellow of the American Academy of Facial Plastic and Reconstructive Surgery, the American Academy of Otolaryngology-Head and Neck Surgery, and the American College of Surgeons.
- Dr. Schwartz is an active staff member with Good Samaritan Medical Center, West Palm Beach, Florida.
- He has over 30 years of experience as a surgeon and is extensively trained in the latest advancements in facial plastic surgery.
