What You Need to Know About Rhinoplasty

Reviewed by Jack P. Gunter, MD

The development of rhinoplasty occurred primarily as a plastic surgery technique to restore a proportional nose shape, or to correct for constricted breathing, whether after injury or due to a birth defect. In addition to these corrective procedures, surgeons now use cosmetic plastic surgery to perform subtle aesthetic changes to nose size and shape.

The Rhinoplasty Procedure

Primary rhinoplasty is a nose-reshaping plastic surgery that can be performed under local anesthesia (you are awake) or under general anesthesia (you are asleep). Cosmetic nose surgery is often performed in a doctor's outpatient surgical suite. Rhinoplasty normally requires one to three hours in surgery, depending on the amount of nose reshaping to be done. Two types of rhinoplasty include "open" versus "closed."

Secondary rhinoplasty is performed to correct problems that persist or develop after a previous rhinoplasty. Although the problems may be minor and easily corrected, often the problems are major, which makes the secondary rhinoplasty more difficult, requiring more expertise than the primary surgery.

The goals of secondary rhinoplasty are to reconstruc the nasal framework so that the nose appears natural, functions properly, and is in balance with the other facial features. To accomplish this, it is necessary to reconstruct and reshape the supporting framework of cartilage and bone through an open approach, using cartilage grafts obtained from either the ear or a rib. With the proper techniques, significant improvement and sometimes dramatic results can be achieved.

Because of the complexity, a secondary rhinoplasty can take two to three times as long as a primary rhinoplasty and can cost twice as much, depending on the number of grafts used to reshape the nasal framework. Most secondary rhinoplasties are performed with general anesthesia at outpatient surgery facilities or hospitals.

Incisions and Reshaping:
Closed Vs. Open

Open Rhinoplasty. For major nose reshaping, the incisions are not made inside the nose. Instead, incisions are made in the vertical strip of skin separating the nostrils. This is called the columella. This more complex procedure is referred to as "open" rhinoplasty.

Closed Rhinoplasty. For minor reshaping, many surgeons make incisions within the nose. The skin of the nose is then separated from the bone and cartilage, which form its supporting framework. Once exposed, bone and cartilage can be removed, reshaped, augmented, or rearranged to achieve the desired new shape. For example, to make the nose narrower, cartilage can be removed down the front spine of the nose. After the cartilage and bone have been changed, the nose tissues are redraped over the newly shaped structures and the incisions are closed.

After Rhinoplasty

Immediately after the incisions have been closed, soft puffy material may be used inside the nose to maintain the structure along the nasal air passages. Also after surgery, an external splint is applied to help the nose maintain its new shape. The splint provides some additional protection for the nose during the healing process. The external splint is typically worn for six to eight days.

The nose area will be bruised and puffy after surgery. This bruising may extend to the eyes and all areas of the face. Common post-surgery instructions include a cold compress to reduce swelling, pain medication to reduce discomfort, and elevating your head for the first 24 hours.

Most of the swelling and bruising should disappear after seven days. You may experience limited bleeding the first few days. Normally after two weeks, all stuffing, splints, and other post-surgical dressings are removed. There will be some internal swelling within the nose for several months, but this will not be noticeable to anyone but you and the surgeon.

Perhaps the most important instruction: Do not bump your nose.

Avoid any trauma to the nose during the first week after surgery. Even blowing your nose should be avoided for the first seven days.

Consult a Qualified Plastic Surgeon

Before deciding on rhinoplasty, be sure to discuss treatment options with a board-certified plastic surgeon. Your surgeon can show you photos of other rhinoplasty patients with similar nose shapes, which can help you better understand the likely results of the procedure. The cost and recovery period and your activities after surgery should be explained to you as well.

About the Reviewer of This Article

Jack P. Gunter, MD is among the world's top specialists in secondary rhinoplasty and has helped to correct the effects of previous surgery for many patients. He is a pioneer in developing the techniques of open rhinoplasty for correcting primary and secondary nasal deformities. Dr. Gunter is board-certified by the American Board of Plastic Surgery and the American Board of Otolaryngology - Head and Neck Surgery. He is a member of many prestigious medical associations, including the American Society of Plastic Surgeons, the American Society for Aesthetic Plastic Surgery, the American Association of Plastic Surgeons, the American Academy of Facial Plastic and Reconstructive Surgery, the American Academy of Otolaryngology, and several others. He is a founding member of The Rhinoplasty Society, Inc. Dr. Gunter founded and practices at Gunter Center for Aesthetics & Cosmetic Surgery in Dallas.

[page updated May 2008]