Do Plastic Surgeons Need to Be So "Violent" in Their Technique when Performing a Rhinoplasty?

I have been watching various rhinoplasty and liposuction procedures on youtube. I noticed that plastic surgeons even though I am very sure they know what they are doing, are quite "violent" in for example shaving down the nose or using the vacuum needle to suck out fat. I was just wondering if a surgeon was to shave down a nose more gently over a longer time period, would this result in less bruising, swelling and a quicker recovery?

Doctor Answers 5

Surgeons and their technique in performing rhinoplasty

The rhinoplasty procedure is not a violent procedure.  It is a delicate procedure which involves shaving off millimeters of both bone and cartilage.  Most of the bruising and swelling that occurs from the rhinoplasty is due to osteotomies which are cuts in the nasal bones to narrow the bridge line.  Most visible swelling and bruising has dissipated by 2 weeks after the procedure.

Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

Aggressiveness of rhinoplasty techniques

Great question, and one that illustrates why such procedure videos may not be appropriate for a public domain.

In medicine, sometimes we have to perform maneuvers that, to a lay eye, may seem brutal or violent. But, in reality, they have to be done in that fashion to get the most optimal end result. What might seem violent to you may not be when considering what the surgeon is trying to achieve. In this case slow gentle “shaving” may not impart enough force to achieve the goal and may take so long that the risk of extending the time of surgery (anesthesia, etc) would far outweigh the slight increase (if even that) in bruising or recovery. Same for liposculpting.

-Dr. A

Ahmed Abdullah, MD, FACS
Fargo Plastic Surgeon
4.9 out of 5 stars 18 reviews

Rhinoplasty technique

You have brought up an interesting question. When performing a delicate procedure such as rhinoplasty, the surgeon will take as much care as possible and use a meticulous technique to obtain the desired result. It is important to understand that all of the specific procedures performed during a rhinoplasty are not equal in regard to the necessary force required. For example, when rasping a nasal hump or performing osteotomies (fracturing of the nasal bones), your surgeon will have to be a bit more aggressive than when they are refining the nasal tip during an open procedure. For specific parts of the surgery, if your surgeon were to use less force over a longer period of time, they:

1) May not be able to obtain the desired outcome
2) Would not be minimizing associated swelling or promoting a quicker recovery  


I hope this helps answer your questions!

Jonathan Kulbersh, MD
Charlotte Facial Plastic Surgeon
5.0 out of 5 stars 66 reviews

Do Plastic Surgeons Need to Be So "Violent" in Their Technique when Performing a Rhinoplasty?

 IMHO, there are many differences between plastic and cosmetic surgeons including training, skill, aesthetic vision and how gently they perform various surgical procedures.  Viewing one or even several examples of surgeries online would not encompass all of those differences.  In surgery, it's always best, IMHO, to treat the tissues as gently as possible but in the some cases the bones of the nose do need to be removed and broken.  It might seem that gently shaving down the nasal bone for 30 minutes might result in less bruising and swelling but in fact the opposite is the case.  Quick removal using a sharp chisel accomplishes that while the slow shaving will increase swelling due to prolonged time of tissue exposure.  

 The longer the nasal tissues are disrupted, the more swelling that results...generally speaking.  So a Rhinoplasty that can be performed in 1 hour would generally, all things being equal, have less anticipated post-op bruising and swelling than one that took 2-3 hours.  IMO, the degree of anticipated bruising and swelling goes up exponentially the longer the tissue is disrupted...hence the need to experience and efficiency when performing plastic and cosmetic surgery.  I would leave you with this thought.  As a layperson, it's not unusual for you to see surgery and feel that it is in some way violent but in the hands of a gifted, trained surgeon the proper amount of intervention is used to accomplish the desired goals, no more or less.  Hope this explanation is helpful.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 24 reviews

Rhinoplasty techniques

Dear Timmy89,

  • Everyone does it a little differently, and what looks violent sometimes just requires a little more force
  • For example, if you are slower with the liposuction, you may suck out bigger chunks and leave more divots
  • The nasal bruising usually comes from the nasal bones being narrowed
  • The key is that no matter what technique is used, you have to love the results


Nima Shemirani

Nima Shemirani, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 74 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.