Drastic Rhinoplasty - More Than One Surgery Required?

I've read that the best nose jobs are conservative ones. I want to get rhinoplasty but the changes I want (nostril width reduction; hump removal; reducing the size of my bulbous nose’s tip and refining so that it has a more normal shape) seem (at least to me) to be requests that would not be considered “conservative.” My question is: Can nose jobs that significantly alter the shape of the nose be completed in one operation? or does a “drastic” kind of change take several procedures?

Doctor Answers 23

Beverly Hills Rhinoplasty

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Hello and thank you for the question.

Rhinoplasty procedures routinely address several constituents of the nose which often require surgical modification to impart optimal aesthetic results. These include dorsal humps, bulbous tips, boxy tips, nostril width modification, hanging columella, tip ptosis, a long nose, a "wide nose", and more. 

While addressing several aspects of the nose may seem "drastic" to the general population, it is standard protocol among rhinoplastic surgeons to address multiple issues at once.

Kindest Regards,

Glenn Vallecillos, M.D., F.A.C.S.

Rhinoplasty- drastic versus conservative

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The changes you describe do not sound "drastic" or unusual. They sound like reasonable goals that can be performed in one operation. Each individual step of the operation can be done in a conservative or drastic fashion, and the terms themselves mean different things to different surgeons. The best thing to do is avoid vague terminology, be very clear with your surgeon on what you want, and ask if your surgeon feels your goals are reasonable and achievable. Photographs of what type of look you like are helpful. I also recommend looking at the surgeons before and after photos to see if you like his or her results. If you dislike the noses you see in the after photos, it's possible you and the surgeon have different ideas of what is attractive. I would also be clear on communicating how much of a change you are looking for.

Rhinoplasty Results

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Rhinoplasty surgery has evolved over the past several decades from a surgery that relied primarily on removing tissue to one that relies more on modifying and remodeling existing tissue.  From this perspective, current rhinoplasties are "conservative" when compared to previous techniques.  Why the change?  Although noses looked terrific immediately following rhinoplasty surgeries employing aggressive cartilage removal, the long term results were much less satisfying.  The modifications you list in your question are all commonly and safely addressed during a single procedure.  The "conservative" vs "aggressive" moniker refers more to how things are done vs how many things are done.  

Andrew B. Denton, MD
Vancouver Facial Plastic Surgeon

Drastic Results Possible With Single Rhinoplasty

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An experienced, certified plastic surgeon will be able to correct each of the requests you have described in a single rhinoplasty surgery. Though it may seem to you that you have many changes you want to be made, the ailments you have described are actually very typical of nose job candidates. In my professional opinion, you should be able to achieve each of these goals in one surgery. If you find that, after this initial rhinoplasty, you are still unhappy with the look of your nose, you may then want to consider additional surgery. There is a small percentage of rhinoplasty procedures that require a touch up or revision after the primary rhinoplasty.

Sam Rizk, MD
New York Facial Plastic Surgeon
4.7 out of 5 stars 77 reviews

Rhinoplasty, no matter how drastic, should look natural

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Conservative surgery is best, and it sounds as if yours needs more than subtle changes.  The key is to understand what a natural nose looks like and give you a similar type of nose.  No matter what changes are made and how relatively "drastic", all is well as long as the end result looks normal (triangular nose that fits your facial features).

All the potential changes you speak of are not daunting and absolutely can be done in a single operation.  Please look at many b/a pictures to get a realistic understanding of what's possible. 

Ramtin Kassir, MD
New York Facial Plastic Surgeon
4.7 out of 5 stars 155 reviews

Drastic rhinoplasty

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The typical reduction rhinoplasty is usually performed in 1 procedure.  This includes refinement of the tip, bridge, hump removal, osteotomies, and reducing the bulbus nasal tip.  There is a 10% chance of having to go back for a touchup procedure after the first year for further refinement.  90% of the time patients do not require a touchup.  All of this can even be accomplished for a conservative rhinoplasty result or a drastic rhinoplasty result.  

To do photo imaging with your own photo, download our iPhone app free of charge.  Just enter "Seattle Plastic Surgery with Dr. Portuese" as search terms.  Once downloaded, you can simulate rhinoplasty by changing the shape of your nose to be smaller, larger, etc... Y

Drastic Rhinoplasty in One Procedure Possible

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Absolutely, all these problems can and should be addressed in one primary surgery. However you need to find an experienced rhinoplasty surgeon who is comfortable with this work ,and gets great results doing it.

Rhinoplasty - One procedure or Multiple procedures

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Hi 8428anon,

Rhinoplasty is not one operation, but many potential operations. Every patient is unique. Reducing nostril width, reducing the hump, and refining the tip are commonly performed at the same time during rhinoplasty.

Reducing the hump from a nose is the most common request for cosmetic nasal surgery. Humps are usually made up of both cartilage and bone, and come in various sizes and shapes. Reducing small humps is a relatively easier procedure, as compared to more extensive rhinoplasty surgery. Large bumps will require bone reshaping/breaking after the hump is removed.

A goal in nasal surgery is to recreate balance of the nose with the rest of the face. A small hump may be filed or rasped without needing more surgery. A subtle change in the nose may create a profound improvement in facial balance. Occasionally, complementary surgery may be recommended along with the rhinoplasty to help improve overall facial balance, such as chin implant or augmentation.

Rhinoplasty surgery ranges from relatively simple to more complex. Prior nasal surgery and trauma, such as a broken nose, increases the complexity of any future rhinoplasty. While it's possible to only have one more operation, there is a potential chance for revision surgery. Only after a comprehensive nasal evaluation can a rhinoplasty surgeon help determine the most appropriate option for you. Best of luck.

Dr. Chaboki

Rhinoplasty should result in naturally attractive look

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No, I think you misunderstood.  The best Rhinoplasties are those that result in the nose looking more naturally attractive.  This doesn't mean that what was done during the Rhinoplasty was conservative at all.  In fact, I've removed half an inch from the bridge of noses and 60% of the nasal tip cartilages to shape them...which is hardly conservative.

Conservative means that little is done during surgery....

Hope this helps.

Major changes of nasal shape can be achieved.

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The short answer to your question is "yes," even major changes to the nasal shape can be achieved in one rhinoplasty surgery. In fact, it's especially important to try to get the nose done right the first time. The primary limitation on how much the nose can be changed is related to skin thickness. Very thick skin, for example, will not allow for aggressive reductions in size or major alterations in definition simply because there's only so much the skin can contract down onto the new framework.

An experienced rhinoplasty surgeon should be able to give you a realistic idea of how much change can be achieved with rhinoplasty. Computer imaging can also be helpful--but only if the surgeon morphs the images to something actually possible given your specific anatomy.

All the best,


David C. Pearson, MD
Jacksonville Facial Plastic Surgeon

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.