Facial plastic nose surgery or nose job, is also known as “rhinoplasty.” It is performed to recontour the size and/or shape of the nose, making the nasal structure more proportionate to your surrounding facial features. In turn, rhinoplasty can enhance your appearance and make the proportions of your nose look more balanced. Rhinoplasty is capable of improving the nose size, shape, and width, as well as the bridge of the nasal bone, size and position of the nostrils, or any humps and depressions that require correction.
Men and women who have concerns about nasal asymmetry typically benefit from this nasal surgery procedure. Also, patients who have breathing issues can find improvement as well, as the surgery may be utilized to correct structural defects, such as a deviated septum. In this circumstance, you may choose to undergo a combined procedure that addresses both cosmetic concerns as well as any breathing issues. Every person is different, and the overall results will depend on your unique facial structure and appearance of the nose. That said, the ultimate goal is usually a more symmetrical and aesthetically pleasing look for your nose.
Rhinoplasty, commonly known as a “nose job,” is a procedure designed to surgically reconstruct the size or shape of the nose, thereby increasing facial harmony and improving the entire facial appearance. Although rhinoplasty is most frequently performed under as a cosmetic surgery, the procedure can also be utilized to improve breathing problems and blocked airway also known as nasal obstruction caused by a deviated (or crooked) septum. This is accomplished by refining the bones, cartilage, and soft tissue of the nasal framework. Small incisions are typically very discreet and undetectable to outside observers. A thorough understanding of your overall goals is key to achieving the most successful rhinoplasty results, which is why our craniofacial plastic surgeon Eric Payne, MD pays close attention to your concerns to truly understand your needs. By primarily specializing in procedures of the head and neck, Dr. Payne retains a unique understanding of facial symmetry and can customize your treatment plan to achieve greater facial balance. Learn About Nasal Reconstruction
The best candidate for rhinoplasty is someone who has realistic goals for the outcome and the time it takes to recover. A good candidate is also someone who is aware that every patients structures of the nose is unique and no one individual’s nose is structured the exact same way. That said, those considering rhinoplasty should generally have:
With these key points in mind, Dr. Payne will show you before-and-after photos and explain the surgical process during an initial consultation. After assessing your concerns, Dr. Payne will help you determine whether rhinoplasty — or another treatment, such as chin augmentations — can best achieve your goals. In some cases, a chin implant or genioplasty can help balance the facial features by offsetting a large or dominant nose. Some patients have a birth defect such as a cleft of the upper lip which can cause a nasal deformity requiring a plastic surgery procedure. In these situations you may need further evaluation from a facial plastic surgeon specialized in otolaryngology or head and neck surgery to determine if sinus surgery is also required.
Dr. Payne has extensive training in facial plastic and reconstructive surgery and utilizes minimally invasive techniques whenever possible. Rhinoplasty surgery is performed in an outpatient hospital setting under general anesthesia. Dr. Payne has worked with patients who require extensive reconstruction of the nasal deformity which requires unique and more difficult techniques to complete their cosmetic procedure. This allows him to take on more challenging surgical problems when reshaping the nose. The surgery is performed either using small incisions that are concealed inside of the nose (a closed procedure), or with an incision made across the narrow strip of tissue that divides the nostrils — known as the columella (open procedure). During your consultation, Dr. Payne will review your specific needs, and create a treatment plan that is right for you.
Several factors, including the nature of the improvements desired, will influence whether your surgery uses an open or closed incision. Open rhinoplasty typically offers a greater degree of surgical visibility when compared to a closed procedure, therefore certain enhancements may only be possible with an open incision. The incision is placed on the undersurface of the nose and is generally very inconspicuous once fully healed. In contrast, closed rhinoplasty uses internal incisions and should produce no visible scarring after the procedure. However, the closed technique is somewhat limited when compared to open rhinoplasty and may not be suitable for all patients.
Dr. Payne approaches nose surgery with the goal of preserving as much of a patient’s natural bone, cartilage, and soft tissue as possible. Known as “preservation rhinoplasty,” this technique is meant to modify the nose while conserving your original tissue. In turn, the results can appear more harmonious and natural-looking when compared to a traditional rhinoplasty procedure. A common example of the preservation rhinoplasty technique can be observed when reducing the height of the nose bridge — rather than removing tissue from the top of the nasal bridge, Dr. Payne extracts meticulous amounts of bone and cartilage from underneath, thereby preserving a patient’s dorsal hump lines and facilitating a more natural-looking outcome.
Patients of different backgrounds often have distinctions in the characteristics of their facial features, particularly with regard to the nasal framework. Dr. Payne’s goal with any rhinoplasty procedures is to attain a result that complements a patient’s inherent beauty and the natural character of their face. He uses his specialized training as a board-certified craniofacial plastic surgeon to evaluate the unique features of a patient’s nose and tailor surgery according to their relevant anatomical differences and cosmetic surgery goals. In this way, Dr. Payne is able to provide a result that looks harmonious with a patient’s natural facial characteristics, whether he is performing Asian Rhinoplasty, Middle Eastern Rhinoplasty, Indian Rhinoplasty, or nose surgery for individuals of any descent.
Cartilage grafts are taken from other parts of the body and can be used to improve the shape of the nose. Common locations for self-donated grafts, or “autografts,” include the ear, septum, and rib cartilage. When a septoplasty is performed with a cosmetic rhinoplasty, the septal cartilage is the best for creating nasal tip support. It’s also possible to opt for donated cartilage from another person — typically known as a “cadaveric cartilage graft” in cases of rhinoplasty. Cadaveric rib cartilage grafts are specially treated to remove all cells and kept sterile for use to prevent infection. Another option involves synthetic implants for the nose. The challenge with an implant includes a possibility of infection or rejection by the body and extrude.
There are several cartilage techniques which can help with the shape of the nose. Some newer techniques involve placing spreader grafts which can help open the internal nasal valves if collapsed. This will relieve the nasal airway obstruction. Extended spreader grafts have the added benefit of providing more nasal tip support by rotation and elevation of the nose tip. Further tip support can be accomplished with columellar strut cartilage grafts.
Patients often return to work approximately 5 to 7 days after surgery; however, swelling and some possible slight bruising will be evident so some individuals wish to wait until this dissipates before returning to work. Swelling is expected after surgery. A splint will be placed over the nose and should remain in place until Dr. Payne sees you for a one week follow-up appointment. Changes are subtle over time, as your nose heals and begins to reveal the new you! Patience is key and it could take up to a full year for your nose to fully refine. Most of your improvement should be permanent; although as we age, it is normal to experience some changes to the look of the face and nose.
It is recommended that you stop smoking or avoid secondhand smoke and any nicotine products for approximately two months prior to surgery. We recommend stopping supplements such as aspirin, Motrin, herbal medications and NSAIDs at least one week before surgery. Avoid sun damage to the skin for at least two weeks prior to surgery and avoid any tanning beds.
Do not put any lotion or make up on the day of surgery. Do not wear any jewelry or piercings to surgery. We do recommend wearing loose fitting clothes that are easy to remove and put on after surgery. The use of a button up shirt or a zip up jackets and sweatpants is recommended.
After your surgery, we recommended to keep head elevated for 10-14 days after surgery even while sleeping. Swelling is considered normal after the first 48 hours. A dorsal nasal splint and possibly intranasal splints inside the nose help compress the tissue to reduce swelling. While the nasal splint is on, you may have your hair washed beauty salon fashion, keeping the splint dry. To prevent bleeding after septorhinoplasty, use Afrin spray intermittently as needed after surgery for improved nasal breathing. If you experience increased nasal bleeding with bright red blood (with a need to change your nasal pad every 30 to 40 minutes), please call our office immediately. Expect bloody nasal discharge for 3 to 4 days after surgery. Nasal drip pad can be used. Keep the inside edges of your nostrils and any stitches clean by using a Q-tip saturated with hydrogen peroxide followed by a thin coating of Bactroban/bacitracin/mupirocin/gentamicin ointment.
Your Nasal splint will be removed 5-7 days after surgery. After the nasal splint is removed, the nose can be washed gently with a bland soap, and makeup can be applied. Moisturizing creams/lotions can be applied if nose is dry. Once the splint is removed, do not wear glasses or allow anything else to rest on your nose for 4 weeks. Contacts can be worn as soon as the swelling has decreased enough for them to be inserted.
Dr. Payne will use local anesthesia during the procedure to help reduce your pain during the surgery and postoperatively. If you have pain, take pain medication every 4 to 6 hours. Please do not take pain medication on an empty stomach. If you have no pain, then do not take the pain medication. Immediately after surgery, begin with a light diet of liquids only. The next day you can begin a soft, regular diet, but for 2 weeks avoid foods that require excess upper lip movement such as apples, corn on the cob, etc.
The tip of the nose will sometimes feel numb after surgery and occasionally the front teeth will feel “funny.” These sensations will gradually disappear. Much of the swelling will be gone 6 to 8 weeks after surgery. It often takes approximately 1 year for the last 10% of the swelling to disappear. Your nose may feel stiff when you smile and not as flexible as before surgery. No contact sports for 8 weeks. No swimming for 3weeks. No strenuous activity for 2 weeks. Avoid hitting your nose for 6-8 weeks after surgery. Do not rub, blot, or blow your nose for the first 2 weeks after surgery. Try not to sneeze, but if you do, sneeze through your mouth. If you have nausea, vomiting, rash, shortness of breath, or diarrhea after taking your medications, or if you develop a fever (oral temperature greater than 101.3®F), develop redness, or have increased pain at the site of your surgical incisions, we advise you call our office immediately.
Scars can vary depending on the technique used during surgery. Small incisions are typically made during a rhinoplasty procedure which can be located in between nostrils or inside of the nostrils depending on the type of rhinoplasty surgery you will have. To help scarring heal after surgery, we recommend following our scar management plan which includes applying scar cream, massaging the scar, placing plenty of sunscreen and avoiding sun exposure as much as possible. Dr. Payne is a leading rhinoplasty surgeon and will use the latest advancements to help hide your scar.
The surgeon’s experience and certification is a key factor in the cost of rhinoplasty. Dr. Payne is a board-certified plastic surgeon who has had specialized training in craniofacial surgery. The price for rhinoplasty can range based on each person’s nose, and what area of the nose needs alteration. Any additional hospital or anesthesia fees will be factored in as well. Most rhinoplasty surgeries will range from $4,000 to $6,000 for minor to moderate nose surgery. In some cases where more reconstruction is needed, the price can be as high as $10,000 and more.
Although non-surgical techniques can provide some improvement in your nose shape, these results will be temporary and cannot provide greater facial balance like a surgical rhinoplasty. That said, dermal fillers injectables such as JUVÉDERM® and JUVÉDERM® VOLUMA™ can be injected to straighten humps and recontour the nasal bridge, if desired. Sometimes referred to as a “liquid rhinoplasty,” this treatment often provides improvement for four to six months depending on which products are used. Dermal fillers are often a good option for individuals who are not quite ready for surgery, or for patients who have a special event coming up, such as a wedding or reunion. Dr. Payne can help you determine whether you would benefit from a liquid rhinoplasty at the time of your consultation.
Dr. Payne has extensive experience performing nasal reconstruction and can tailor your rhinoplasty to achieve your unique, individual goals. He is board certified by the American Board of Plastic Surgeons and is a member of the American Society of Plastic Surgeons. To discuss your concerns further in a consultation, please don’t hesitate to contact our Houston plastic surgery practice