Name: Is Rhinoplasty Worth It?
Uploaded: 04/20/2020
Description: Is Rhinoplasty Worth It?

Question 1

What is rhinoplasty?

Accepted Answer

Rhinoplasty is a popular cosmetic surgery that changes the appearance of the nose. The term comes from the Greek: rhinos means “nose” and plasty, “to shape.”

The nose reshaping surgery is often paired with other procedures to achieve the ideal balance of form and function.

A septorhinoplasty includes a septoplasty to correct a deviated septum, a condition where the cartilage wall between the nasal passages is crooked. Septoplasty improves the function of the nose and makes breathing easier, while rhinoplasty is performed to enhance the nose’s aesthetics, or to correct an injury (like a broken nose) or birth defect. (The septoplasty portion of this combo procedure may be covered by insurance.)
For some patients, cosmetic rhinoplasty surgery also involves alarplasty, which narrows the base of the nostrils (the ala) and reduces nostril flare.
A chin implant or chin augmentation with filler is often done alongside a nose job to create a more balanced profile.

Rhinoplasty for people of Asian or African descent requires a specialized skill set. Surgeons who specialize in what some call "ethnic rhinoplasty" say that the challenge lies in reshaping and resizing the nose, while retaining its distinct features. It's worth seeking out a surgeon who has the expertise to meet your aesthetic goals, while being sensitive to your racial identity. Make sure that their before and after photo gallery includes pictures of people who look like you, with the kind of result you're after.

Question 2

What can rhinoplasty achieve?

Accepted Answer

This plastic surgery procedure is customized to address key structures of the nose and create the best nose shape for each patient’s face. Benefits can include:

Reducing a prominent bump or hump
Narrowing the nasal tip to streamline a bulbous nose
Lifting a droopy tip or bringing down an upturned tip
Straightening a crooked bridge
Fixing asymmetry
Balancing your facial features by giving you a shorter or smaller nose

Surgeons should be able to produce simulated images of what your final result would look like, says Dr. Gary Linkov, a board-certified facial plastic surgeon in New York City. “This is imperative to make sure you and your surgeon are on the same page when it comes to the look you’d like to achieve.” In a recent survey, 63% of surgeons report using computer imaging in patient consultations.

Question 3

Rhinoplasty pros and cons

Accepted Answer

Pros

Rhinoplasty surgery has high patient satisfaction, with a type: embedded-entry-inline id: Ks6V6ARYAktTMUTOEu3el Worth It Rating based on thousands of recent reviews on RealSelf.
If you’ve felt self-conscious about your nose for years, good results from this procedure can boost your self-confidence.
This nose reshaping surgery balances facial features.
It’s an outpatient plastic surgery, so you can go home the same day.
The procedure itself isn't painful at all (thanks to anesthesia), and postoperative recovery isn’t too bad. “It’s more of a feeling of congestion like a head cold for a week or two,” says Dr. William Portuese, a board-certified facial plastic surgeon in Seattle.

Cons

The procedure can be pricey, and insurance won’t cover it if it’s purely a cosmetic procedure.
Some patients experience nausea, vomiting, and a sore throat during the first few days of recovery.
You can also expect significant swelling and bruising for at least 14 days post-procedure.
The hard cast that’s worn for the first week can be uncomfortable and make your nose feel congested.
It can take up to a year for all the swelling to go down.
Nasal surgeries are considered by many plastic surgeons to be the most complex cosmetic surgery procedures, with some of the highest revision rates.
If your nose doesn’t heal properly—or if you end up with a botched nose job—you may need a revision rhinoplasty, a costly and complex reconstructive procedure.

Related: 8 Things to Know Before Getting Rhinoplasty

Question 4

How much is rhinoplasty surgery?

Accepted Answer

Your nose job cost will include fees for your surgeon, anesthesia, surgical supplies, and the facility where your procedure is performed.

Most surgeons offer payment plans or accept financing options like CareCredit.

See our complete guide to rhinoplasty costs

Question 5

Rhinoplasty photos: what to look for in before and after pics

Accepted Answer

As you're choosing your surgeon, look for nose job before and after pictures that show balanced facial features and the kind of results you want.

The rhinoplasty photos in our gallery have been shared by the surgeon who performed the procedure, with the patient's consent.

Question 6

How is nonsurgical rhinoplasty different?

Accepted Answer

A nonsurgical or liquid rhinoplasty temporarily reshapes the nose with hyaluronic acid–based injectable fillers, likeRestylane Lyft.

This off-label treatment is generally quick with no downtime, and results can last up to two years or more, depending on the type of filler used and how your body metabolizes it.

This minimally invasive nose augmentation procedure can:

camouflage bumps (especially along the bridge)
create more symmetry
lift and build up the bridge

Related: Doctors Weigh In on Surgical Rhinoplasty vs. Liquid Nose Jobs

However, the nonsurgical approach has limitations and can be risky.

Learn more about how nonsurgical rhinoplasty works.

Question 7

Who's a good candidate for a nose job surgery?

Accepted Answer

Whether rhinoplasty surgery is right for you depends on a number of factors, including:

the cosmetic and structural issues you’re looking to change
your budget
whether you can take up to two weeks off work for recovery
your age: facial features need to reach maturity before nose surgery, so girls should wait until they’re at least 15 and boys until they’re 16. Beyond that, “there is no upper age limit for rhinoplasty as long as you are in good health,” says Dr. Naficy.

If you're an older patient, you may need to provide a more detailed medical history and go through a more rigorous health screening. Still, it’s not unusual for patients beyond age 40 to combine this procedure with a facelift, especially because the nasal tip can descend over time.

RealSelf Tip: A 2011 study found that 33% of patients seeking rhinoplasty showed moderate to severe symptoms of body dysmorphic disorder (BDD), a form of obsessive-compulsive disorder in which negative thoughts about a physical feature interfere with your quality of life.

A follow-up study showed a strong correlation between those pre-op symptoms and patient dissatisfaction with their results. Keep in mind: You may still not like your nose, even after a successful surgery, especially if you have BDD.

Question 8

Is rhinoplasty worth it?

Accepted Answer

As we mentioned above, rhinoplasty has a type: embedded-entry-inline id: Ks6V6ARYAktTMUTOEu3el Worth It Rating from RealSelf members. This means that a solid majority of the thousands of people who’ve recently reviewed the procedure think their results were worth the cost, discomfort, and recovery time.

A good result can boost self-esteem and self-confidence, while decreasing anxiety.

“My nose was a huge insecurity of mine,” says one RealSelf reviewer. “I felt like my face wasn’t mine because my old nose threw everything off.”

Unfortunately, some patients are obsessed with their new nose in a negative way. In fact, 10% of nose job patients opt for revision surgery.

According to a 2019 study, “Patient selection is very crucial in rhinoplasty, as a significant percentage of patients may not be satisfied despite a good surgical result.”

During your consultation, ask what percentage of a surgeon’s practice is devoted to nasal surgery. They should perform over 100 nose jobs a year. Make sure their reviews reflect happy patients and their before and after photos align with the kind of results you’re after.

The key to a successful result—a nose that looks natural and functions perfectly—is to work with a qualified board-certified facial plastic surgeon who specializes in primary and reconstructive nose surgery. It takes considerable training and experience to get predictable results.

Question 9

How to prepare for rhinoplasty

Accepted Answer

You can reduce post-surgery swelling, bruising, and healing time by doing a few things in the lead-up to your procedure.

Halt all blood thinners, including aspirin and ibuprofen, two weeks before surgery (acetaminophen is a safe alternative). Your surgeon will provide a list of drugs to avoid.
Stop smoking for six weeks before and after your procedure (find out why).
Avoid alcohol for at least 48 hours prior to and two weeks after surgery.

You’ll want to pick up recovery supplies beforehand to maximize healing and comfort. Here’s what RealSelf members deem must-haves after a nose job:

Antibiotic ointment (typically provided by the surgeon)
Nasal spray
Cotton swabs
Light ice packs
Unscented baby wipes
The most comfortable neck pillow you can find
Cough drops
Biotene mouth spray

RealSelf Tip: Avoid antibiotic ointments that contain neomycin, which can cause severe skin reactions.

Question 10

How does rhinoplasty work?

Accepted Answer

Every surgeon has their own techniques, but here’s how a nose job generally works.

It typically takes 1–3 hours to perform, but more complicated procedures and revisions may take longer.
You’ll be given anesthesia to keep you comfortable during the procedure. Some surgeons use general anesthesia, which puts you in a sleep-like state, while others prefer local anesthesia with IV sedation (aka twilight sedation), which leaves you deeply sedated and comfortable but still technically awake. The type of anesthesia you have will depend on the complexity of your procedure and the preferences of you and your surgeon.
Before making any incisions, your surgeon may draw guidelines on the nose with a pen, indicating the areas they will modify.

Your surgeon will use one of two primary nose surgery approaches: open or closed.

The specifics of your surgery will depend on your anatomy, desired result, and surgeon's technique, but it may involve:

removing portions of nasal tip cartilage and using sutures to narrow a bulbous nasal tip
removing a wedge of tissue at the base of each nostril (a procedure called an alarplasty) to reduce nostril flare and streamline the nostrils
removing and repositioning nasal bone and cartilage to soften a dorsal hump and narrow the nasal bridge
using a cartilage graft from the septum, ear, or ribs to rebuild the tip or create a straighter or higher bridge (avoid surgeons who use silicone in lieu of grafts—studies show more complications with this approach)
Once the nose has been reshaped, incisions are closed with dissolvable stitches.

Your nose will be secured with a cast or splint for the first week of recovery. Your surgeon will remove it at your follow-up appointment.

Current clinical guidelines advise against painful packing—filling the nostril cavities with cotton or gauze post-op, to absorb blood. However, if your surgeon sends you home with packing, they’ll prescribe antibiotics and remove the packing after a few days.

Question 11

What is preservation rhinoplasty, and how is it different?

Accepted Answer

The preservation rhinoplasty technique spares as much of the original nasal structure as possible, while correcting cosmetic and/or functional issues. It can be performed open or closed, but it’s most commonly done closed.

According to Dr. Joseph Shvidler, a board-certified facial plastic surgeon in Seattle, preservation rhinoplasty has several benefits:

Preserving the original nasal structure can offer a more natural, proportional result.
The technique can be less invasive, with less swelling, bruising, and recovery time.
It avoids the risks associated with extensive tissue removal and manipulation, which makes it a safer option.

However, he cautions that it has drawbacks.

Patients who will need significant structural changes to the nose to achieve their desired result may not be good candidates.
The procedure can take longer than traditional approaches.
Preservation rhinoplasty may not offer the same level of control over the final result as a traditional procedure. In some cases, the tissue “may not respond to surgical changes and tissues may revert to their original shape,” says Dr. Shvidler.
While it preserves the upper bridge, the technique “requires extensive cuts in the nasal bones and the septum, completely disarticulating and dropping or pushing down the nasal bridge,” Dr. Shvidler explains. This can lead to unwanted “step-off irregularities.”

Recent studies comparing preservation rhinoplasty to traditional methods have not found either approach to be superior. In a 2022 retrospective study, the authors acknowledged the “theoretical functional and aesthetic benefits of SPR [structural preservation] techniques,” but concluded that “the patient reported benefits may be minimal.”

The most important factors in your outcome will be the skill and experience level of your surgeon.

Question 12

Is rhinoplasty safe?

Accepted Answer

Rhinoplasty is a very safe procedure when it’s performed by an experienced, board-certified surgeon.

However, all surgical procedures come with risks and side effects. During your consultation, your surgeon should walk you through these potential side effects and complications, and let you know how they’ve handled them with previous patients.

The most common side effects are swelling, bruising, and minor bleeding.
More rarely, some patients can experience serious nosebleeds (called epistaxis), which require immediate medical attention.
Infection is possible, if extensive cartilage grafting is needed or if the incision isn’t kept clean while it heals.
A more serious potential complication is nasal obstruction, though this issue isn't life-threatening.
Septal perforation, a tear in both sides of the nasal septum lining, can also occur.

Related: The 6 Biggest Rhinoplasty Risks, According to Plastic Surgeons

Question 13

Is rhinoplasty painful?

Accepted Answer

The surgery itself doesn’t hurt thanks to the anesthesia, but you will feel some discomfort during the first 1 to 3 days of recovery.

“Use pain medication for as long as needed,” advises Dr. Oakley Smith, a facial plastic surgeon in Toronto, Ontario. He recommends extra-strength Tylenol. “Remember it’s easier to stay on top of pain than to play catch-up. As the pain diminishes, break the pill in half or even a quarter.”

Question 14

How long does rhinoplasty take to heal?

Accepted Answer

It can take up to 2 weeks for the visible bruising and swelling to dissipate, but most patients are back to work in 10-14 days.

“The amount of swelling after a rhinoplasty procedure depends upon the type of rhinoplasty performed, the thickness of the skin, the amount of alteration required to the nasal tip, and the patient’s variability with the healing process itself,” says Dr. Portuese.

During your immediate nose job recovery, you can also expect bruising and a clogged-nose feeling. Once the cast is removed at the one-week mark, that stuffy feeling will start to dissipate.

The entire healing process takes a full year.

Here’s what to do (and avoid) during rhinoplasty recovery to help reduce swelling:

Sleep on your back with your head elevated, to help the swelling go down and avoid bumping your nose. Usually, it’s OK to resume your normal sleeping position after two weeks, but check with your surgeon first.
Ice your nose with cool compresses, light ice packs, or frozen peas almost continuously for the first 48 hours. After that, icing can actually inhibit healing, so don't overdo it.
Apply topical arnica gel or cream and take bromelain supplements, if your provider recommends them.
For the first day or two, stick to a diet of low-sodium broth or a light homemade soup; applesauce; mashed potatoes; or other soft, bland foods. Stay away from spicy or salty foods for a week; they can increase swelling and bruising.
Tape your nose at night, if your provider recommends it. Taping may simply involve placing a single strip of tape over the area just above the tip of the nose, or you may be instructed to tape under the columella (the bridge of tissue that separates the nostrils at the bottom of your nose) and gently squeeze the tape around the sidewalls of the nose, to reduce swelling and help elevate the tip.
“Some patients require steroid shots in the tip of the nose to reduce swelling in that area for the first several months after the procedure,” Dr. Portuese says.

These recovery tips can help you heal more quickly, with the best possible results:

Related: 8 Things Not to Do After a Nose Job

Question 15

How long does the swelling last?

Accepted Answer

Swelling after rhinoplasty can affect the appearance of the nose for months.

When your splint first comes off you’ll be excited to show off your new nose to the world, but these early results probably won’t be what you were expecting.

After a few days, the swelling actually gets worse. Don’t panic—this is normal. The nasal splint provides compression for the soft tissues, and removing it causes the nose to swell.

Doctors on RealSelf say this is the typical timeline for swelling:

Two weeks after nasal surgery, swelling and bruising should have diminished enough to return to work or run errands without anyone noticing anything is off.
Three months afterward, you’ll have a good idea of the new shape and size of the nose. Most swelling in the upper third will have resolved.
Six months after surgery, approximately 90% of swelling will be gone, with the remainder in the tip.
One to three years post-op, all swelling will have resolved and you'll see the final shape.

“The nasal tip takes the longest to heal and mold to the new framework since it’s the thickest skin of the nose,” says Dr. Deepak Raj Dugar, a board-certified facial plastic surgeon in Beverly Hills, California.

If you think you still have a bulbous tip after rhinoplasty or want a smaller nose, wait at least a year for it to heal completely before considering a revision.

Question 16

How long do results last?

Accepted Answer

Surgical rhinoplasty results are permanent. You will see some subtle changes to your nose as you age, but the shape and size will probably remain largely consistent.

If you’re not happy with your results or have breathing problems once healed, you may be a candidate for revision surgery.

In many cases, scar tissue is the main culprit. “The force of a scar is very strong,” says Dr. Miller. “It can pull a nose one way or another—push it in, pull it out, turn it.” When this happens, a surgeon has to go back in and tweak the work.

According to Dr. Naficy, “newer techniques provide more structural stability to the nose, which may mean that the nose is a bit stiffer early only, but does a much better job retaining its shape and resisting the healing forces of scar tissue.”

Question 17

Sources & studies

Accepted Answer

Goksel A, Tran KN. “Open Preservation Rhinoplasty Using the Piezo Electric Instrument.” Facial Plast Surg Clin North Am. 2023 Feb;31(1):59-71. doi: 10.1016/j.fsc.2022.08.007. PMID: 36396289.

Patel PN, Kandathil CK, Abdelhamid AS, Buba CM, Most SP. “Matched Cohort Comparison of Dorsal Preservation and Conventional Hump Resection Rhinoplasty.” Aesthetic Plast Surg. 2022 Oct 31. doi: 10.1007/s00266-022-03156-3. Epub ahead of print. PMID: 36316459.

Alan MA, Kahraman ME, Yüksel F, Yücel A. “Comparison of Dorsal Preservation and Dorsal Reduction Rhinoplasty: Analysis of Nasal Patency and Aesthetic Outcomes by Rhinomanometry, NOSE and SCHNOS Scales.” Aesthetic Plast Surg. 2023 Apr;47(2):728-734. doi: 10.1007/s00266-022-03151-8. Epub 2022 Oct 27. PMID: 36302983.

Fichman M, Piedra Buena IT. Rhinoplasty. [Updated 2023 Mar 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK558970/

Khan N, Rashid M, Khan I, Ur Rehman Sarwar S, Ur Rashid H, Khurshid M, Khalid Choudry U, Fatima N. “Satisfaction in Patients After Rhinoplasty Using the Rhinoplasty Outcome Evaluation Questionnaire.” Cureus. 2019 Jul 30;11(7):e5283. doi: 10.7759/cureus.5283. PMID: 31576273; PMCID: PMC6764642.

Ishii LE, Tollefson TT, Basura GJ, Rosenfeld RM, Abramson PJ, Chaiet SR, Davis KS, Doghramji K, Farrior EH, Finestone SA, Ishman SL, Murphy RX Jr, Park JG, Setzen M, Strike DJ, Walsh SA, Warner JP, Nnacheta LC. “Clinical Practice Guideline: Improving Nasal Form and Function after Rhinoplasty.” Otolaryngol Head Neck Surg. 2017 Feb;156(2_suppl):S1-S30. doi: 10.1177/0194599816683153. PMID: 28145823.

Kim, Hyun-Soo, et al. “Problems Associated with Alloplastic Materials in Rhinoplasty.” Yonsei Medical Journal, Yonsei University College of Medicine, Nov. 2014.

Picavet, Valerie A. M.D.; Gabriëls, Loes M.D.; Grietens, Jente; Jorissen, Mark M.D., Ph.D.; Prokopakis, Emmanuel P. M.D., Ph.D.; Hellings, Peter W. M.D., Ph.D. “Preoperative Symptoms of Body Dysmorphic Disorder Determine Postoperative Satisfaction and Quality of Life in Aesthetic Rhinoplasty” Plastic and Reconstructive Surgery 131(4):p 861-868, April 2013.

RHINOPLASTY

BEFORE & AFTER PHOTOS

William Portuese, MD

Karyn Repinski

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BEFORE & AFTER PHOTOS

William Portuese, MD

Karyn Repinski

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