Primary Rhinoplasty - techniques and recovery.

I am due for a primary rhinoplasty next month. My surgeon wants to do an open rhinoplasty using subcutaneous (external) osteotomies to reduce the hump, cephalic cartilage trim to refine the tip & spreader grafts to improve structure if necessary. The operation should last 2.5 to 3.5 hours. He is suggesting i stay overnight at the hospital. Does this approach sound appropriate? It seems more comprehensive than others describe. Will these approaches increase recovery time, swelling & bruising?

Doctor Answers 3

Rhinoplasty Questions

Dear Lisamarie12, Three and a half hours for a rhinoplasty and an overnight stay in the hospital is very unusual for a primary rhinoplasty procedure in experienced hands. Time is not necessarily always a factor of expertise however it is something I personally would have concerns about. I often perform two to three rhinoplasty procedures in a day with plenty of time left to see patients and all with excellent results. With that said, the approach is dependent on the surgeons personal choice and what he is comfortable with to attain the proposed results discussed. I would not perform osteotomies externally and prefer to use an internal approach where no visible incision is made. Please review your surgeons before and after photographs to ensure natural looking rhinoplasty results. I would also suggest that you read your surgeons reviews on realself and see how many of those reviews are regarding rhinoplasty surgery. If a large portion of the reviews are regarding nasal surgery then likely he denotes a large portion of his practice to this speciality. Best regards, Michael V. Elam, M.D.

Orange County Facial Plastic Surgeon
5.0 out of 5 stars 196 reviews

Primary Rhinoplasty - techniques and recovery.

Excellent cosmetic results can be achieved with both closed and open techniques. There is not a best way to perform the procedure. Individual surgeons have their own preferences of how to produce the best results in their hands. What is more important than the technique that is utilized is the experience and artistry of the plastic surgeon and your comfort level and confidence in that individual.

Having said that,  3.5 hours for a rhinoplasty and an overnight stay in the hospital would be excessive in the hands of most experienced rhinoplasty surgeons. It would, however, depend on your specific anatomy and any underlying medical problems that you may have.

Following the advice from a surgeon on this or any other website who proposes to tell you exactly what to do without examining you, physically feeling the tissue, assessing your desired outcome, taking a full medical history, and discussing the pros and cons of the operative procedure would not be in your best interest. I would suggest that your  plastic surgeon have extensive nasal surgery experience and be certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS) or a facial plastic surgeon that you trust and are comfortable with. You should discuss your concerns with that surgeon in person.

Robert Singer, MD FACS

La Jolla, California





Robert Singer, MD
La Jolla Plastic Surgeon
4.6 out of 5 stars 19 reviews

Primary rhinoplasty techniques and recovery

 What you have described is NOT appropriate or normal for a primary rhinoplasty.  In our practice, all the incisions are placed on the inside of the nose, also known as closed rhinoplasty, not open rhinoplasty.  In addition, the osteotomies are performed from the inside of the nose with no external incisions.  The procedure takes 1.5 hours, not 3.5 hours.   The procedure is performed in our Medicare certified outpatient surgery center and patient's are discharged home with a responsible adult.  An overnight stay at the hospital for cosmetic purposes will be rather expensive and is not necessary, unless there is extenuating medical circumstances. No packing or stents are placed inside the nose. Rhinoplasty is a very difficult endeavor, so choose your surgeon very wisely based on extensive experience with the procedure for best results.  For more information about primary rhinoplasty and many before and after results, please see the link and the video below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 126 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.