Rhinoplasty or Nose Job

 

Rhinoplasty

A Rhinoplasty is commonly referred to as a nose job.  Rhinoplasty is a cosmetic surgery procedure designed to improve the shape and appearance of the nose.  A nose job or rhinoplasty can be accomplished by several different approaches, including a non surgical rhinoplasty and a surgical rhinoplasty.  A surgical rhinoplasty can be performed by either an open rhinoplasty, where a virtually invisible incision is made on the columella (the part of your nose between your nostrils), or by a closed rhinoplasty approach where no incision is visible. The type of rhinoplasty that will be right for you will depend on many factors, all of which will be discussed during your consultation at our Beverly Hills office.  When performed by a skilled Facial Plastic Surgeon with a keen eye for aesthetics, a Rhinoplasty can help achieve balance and symmetry of one’s facial features.  The nose is the central feature of your face. As such, it is often one of the first things people see when they look at us.  With a nose job or Rhinoplasty, Dr. Aharonov can improve the appearance of a patient’s nose in a variety of ways, thereby creating harmony with the rest of the face.  As well as its cosmetic value, the nose has an important functional component.  It is extremely important when undergoing a  Rhinoplasty or nose job to have a skilled  Facial Plastic Surgeon who has specialized training in the form and complex functions of the nose.  In addition to being one of the leading Beverly Hills Plastic Surgeons specializing in Rhinoplasty surgery, Dr. Aharonov is a Board
Certified Otolaryngologist.  This means that he has additional years of specialized advanced
training in nasal function and nasal surgery.  This ensures that you get the most optimal cosmetic result, while maintaining or improving your breathing capacity. All of our Los Angeles California patients have been extremely happy with the results of their Rhinoplasty.

See What Your New Nose Will Look Before Your Rhinoplasty

Beverly Hills Plastic Surgeon Dr. Aharonov utilizes state of the art computer imaging techniques to help you visualize how  your new nose will look after a rhinoplasty or nose job. During your rhinoplasty consultation, you will discuss the areas of your nose you wish to improve, and how these improvements will affect the overall look and balance of your face. Working together, you and Dr. Aharonov will come up with a realistic, individualized expectation of your rhinoplasty. Dr. Aharonov is one of only a few Beverly Hills Plastic Surgeons who has this latest advance in imaging software.

Dr. Aharonov believes rhinoplasty surgery should be individualized.  This specialized computer imaging software allows you and Dr. Aharonov to communicate, and decide on the look that is right for you.  During the rhinoplasty consultation, Dr. Aharonov can also go over actual rhinoplasty patient results, and how they compared to the before rhinoplasty surgery imaging software results.

 

Open Rhinoplasty versus Closed Rhinoplasty

Many plastic surgeons promote either the closed Rhinoplasty or the open Rhinoplasty. Beverly Hills Plastic Surgeon Dr. Aharonov takes an individual approach to each patient. Depending on their starting point, and the look they want to achieve, each  patient is assessed and the type of Rhinoplasty that is best for that patient is determined.  Dr. Aharonov is a premier Rhinoplasty specialist in the Los Angeles area, and is highly skilled in both the Open Rhinoplasty and Closed Rhinoplasty surgeries, thereby assuring that each patient receives individualized treatment to reach their optimal goal without having an overdone "surgical" appearance to their nose.

An Open Rhinoplasty has a small virtually undetectable scar across the septum or vertical strip of tissue between the nostrils.  In the majority of people, this part of your nose is facing downward, and is even less noticeable.  Utilizing both open or closed Rhinoplasty or nasal surgery techniques, Beverly Hills Plastic Surgeon Dr. Aharonov can reduce or increase the size of your nose, refine a nasal hump or an overdeveloped dorsal ridge, modify the shape of the tip of the nose, narrow the span and reduce the appearance of the nostrils, or change the angle between the nose and upper lip.  Dr. Aharonov can also correct defects that have occurred to the nose after a traumatic injury, or broken nose, and can also relieve breathing difficulties.  

Who is The Best Candidate For A Rhinoplasty or Nose Job?

Rhinoplasty surgery or a nose job, can enhance your appearance and self confidence, but it won't necessarily change your looks to match your perfect ideal.  Before you  decide to have surgery, think carefully about your expectations and discuss them with Dr. Aharonov during your rhinoplasty consultation.

The best candidates for rhinoplasty surgery or a nose job are people who are looking for improvement, not perfection, in the way they look.  If you're physically healthy, psychologically stable, and realistic in your expectations, you may be a good candidate for a nose job. Rhinoplasty can be performed to meet cosmetic goals or for reconstructive purposes to correct birth defects or breathing problems.

Age may also be a consideration. Dr. Aharonov prefers to wait to operate on teenagers until after they've completed their growth spurt, around 14 or 15 for girls, and slightly later for boys. It's also important to consider teenagers' social and emotional adjustment, and to make sure it's what they really want.


What to Expect From Rhinoplasty Surgery

In Rhinoplasty surgery, the majority of incisions are made inside the nose (closed rhinoplasty), where they are invisible.  In some cases, an incision is made in the area of skin separating the nostrils, known as the nasal septum.  Certain amounts of bone and cartilage are then removed or rearranged to provide a newly shaped nose. If the patient has a deviated septum (cartilage or bone causing obstruction inside the nose), septal surgery, called septoplasty, is simultaneously performed.  The incision is placed entirely inside the nose. The septoplasty removes portions of cartilage or bone that is causing the breathing obstruction.  
The incisions are then closed with fine sutures, followed by placement of a splint or cast to the outside of the nose.  The splint helps retain the new shape while the nose heals.

If cotton packing is placed inside the nose during surgery, it is removed the next morning. The nasal splint is usually removed seven days after surgery. At that time, tape is applied to the nose for another seven days and then removed. The majority of bruising and swelling usually resolves about two weeks after surgery, although this varies between individuals. Cold compresses around the nose are used to help reduce the bruising and discomfort.  Patients should sleep with their head elevated after a Rhinoplasty or Nose Job, to help further minimize any swelling.  A short course of antibiotics and steroids are given after a rhinoplasty to help prevent infection and excessive swelling.  Although discomfort is minimal, pain medication is available if required.  Vigorous activity is avoided for four weeks following rhinoplasty surgery.  Sun exposure and risk of injury must be avoided.  If you wear glasses, tape should be used to avoid putting stress on the nose.

Preparing for a Rhinoplasty or Nose Job: Preoperative Information

During your Rhinoplasty consultation, Dr. Aharonov will discuss your goals for the surgery and ask about your medical history and any medication that you take.  Dr. Aharonov will most likely ask you to see your primary physician for a physical exam and blood tests prior to your rhinoplasty.  You should stop taking aspirin or anti-inflammatory medicines such as Alleve, Motrin or Advil one week prior to surgery to minimize bleeding during surgery and bruising after your Rhinoplasty surgery.  A list of over the counter medications and supplements to avoid will be given to you during your preoperative consultation.  You should avoid alcohol or
salty foods for three days prior to rhinoplasty surgery to decrease fluid retention and swelling. You should discuss all of the medicines that you take with Dr. Aharonov.  If necessary, you may take your essential medications with a tiny sip of water in the early morning on the day of your Rhinoplasty or Nose Job.

It is also essential that you disclose any medical conditions that involve the eye, thyroid disorders, cardiovascular disease, high blood pressure, circulatory disorders, diabetes, blood clotting disorders, or a history of forming large scars also known as keloid scars.  It is important to tell Dr. Aharonov if you smoke, or have had previous facial or nasal surgery.

You should be in the most optimal nutritional state prior to Rhinoplasty surgery. An  adequate diet with certain vitamin supplements such as Vitamin C is recommended.  Dr. Aharonov can discuss nutritional supplements with you during your preoperative consult.

During your rhinoplasty consultation, you will receive a recommended course of treatment based on your physical features, the condition you wish to have corrected and your realistic goals for improvement.  Dr. Aharonov will also answer all of your questions. Remember that by carefully following Dr. Aharonov's advice and instructions, both before and after your Rhinoplasty surgery, you can do your part to ensure the best possible outcome.


Anesthesia for a Rhinoplasty or Nose Job

Dr. Aharonov performs all Rhinoplasty surgeries in an AAAHC accredited outpatient surgery center in Beverly Hills.  Board certified anesthesiologists, which are medical doctors, perform all of his cases. Dr. Aharonov prefers to have a physician caring for your anesthetic needs during your Rhinoplasty surgery, as their experience minimizes  the potential of unpleasant postoperative side effects.  For his surgical cases, Dr. Aharonov uses an extremely safe combination of iv sedation and local anesthetic, and rarely, general anesthesia.  This technique provides superior operating conditions combined with maximal patient safety
and comfort.  In all likelihood, you will awaken with very little discomfort, nausea, or anesthetic side effects. In his Los Angeles area surgery center, all of the appropriate monitoring, medication and emergency equipment are available at all times. On the day of Rhinoplasty, you will meet your anesthesiologist and can discuss any questions that you may have.

Activity Level After Rhinoplasty Surgery or a Nose Job

Plan on taking it easy for the first week after your Rhinoplasty surgery, but you should be up and walking about the house in a day or so.  A return to light, normal activity is usually possible within a week after rhinoplasty surgery, but avoid bending at the waist or picking up heavy objects.  Avoid strenuous activity, including heavy housework for at least two weeks after your rhinoplasty.  Walking and mild stretching are fine.  If you overexert yourself, bleeding and increased swelling may result.  When you rest or sleep, keep your head elevated on 2-3 pillows and try to avoid turning on your side.  Avoid alcohol, steam baths, and saunas for several weeks after a nose job.  Above all, get plenty of rest and allow your body to spend its
energy on healing your new nose.

During the first week following surgery, restrict your diet to easily chewed foods and plenty of fluids.  Hard to chew foods, like meat, should be avoided.  You may carefully clean around the outside of the nostrils with a Q-tip and hydrogen peroxide three times a day.  Immediately afterwards, place a bit of pure Vaseline or antibiotic ointment around the nostrils to keep them from drying out.  Swelling for at least two weeks after your rhinoplasty will obstruct your nasal passages and hamper your ability to breathe. This is completely normal.  A humidifier may help you sleep by allowing you to breathe through your mouth more comfortably. Do not blow your nose or sniff excessively as this will only irritate the healing nasal tissues. If you must sneeze, open your mouth.

After your rhinoplasty, try to avoid any situation where someone may accidentally hit your nose, as with children or pets.  However, it is not uncommon to bump your nose one or more times during the first week. This will hurt, but won't cause a problem unless the force is excessive. With assistance, you may take a bath, and showering is allowed on the second day after your rhinoplasty.  Cover the nasal cast so that it remains dry.  If the nasal cast becomes wet, use a blow dryer to help dry it.  It is best to carefully wash your face with a mild soap and a clean washcloth or cotton balls.  Avoid cigarette smoking or even being in an
area of excessive smoke as this irritates the nasal tissue and impairs healing. Also, avoid alcoholic beverages the first two weeks following rhinoplasty surgery as this may increase your chances of bleeding.

It takes six weeks for the nasal bones to fully heal after a nose job.  Slowly resume your normal activity levels.  After the first week, let your body tell you how much to do.  Strenuous exercise may be resumed in 2-3 weeks following a rhinoplasty.  Build up to this level slowly. Semi-contact sports are to be avoided for four to six weeks.  Swimming is allowed 2 weeks after a rhinoplasty.  Do not let your nose become sunburned for six months after surgery.  This may result in prolonged nasal swelling and redness.  When outside, wear sunscreen with a SPF of at least 30.

What to Expect After Rhinoplasty Surgery: Pain, Swelling, Bruising or Bleeding

Pain, swelling, bruising, or bleeding are all very common, and to be expected.  It is normal to have some bleeding over the first 12 hours after rhinoplasty surgery.  Try not to swallow the blood, as it may make you nauseated.  It may be necessary to change the gauze many times immediately following your rhinoplasty.  It is normal to have a pinkish discharge from your nose and mouth for the first few days.  This will gradually subside.  If you develop profuse nasal bleeding, which is rare, immediately lie down with your head elevated on 3-4 pillows.  Do not try to pinch or squeeze the nose to inhibit the bleeding.  Iced washcloths on the back
of the neck and over the eyes may help.  Using nasal decongestants such as Afrin as directed will often help decrease nasal bleeding.  Once the bleeding stops, do NOT continue to use Afrin nose spray. Please call our office if these measures do not suffice and the bleeding is heavy and persistent.

Most of the post operative rhinoplasty discomfort experienced is from swelling due to nasal and sinus congestion than from actual pain.  Nasal swelling is expected and may be most noticeable after the nasal cast is removed.  Most of the swelling gradually subsides in 4-6 weeks, but subtle swelling may persist for 6-12 months. This is all part of the normal healing process.  Nasal breathing may be difficult for 2-3 weeks after surgery due to swelling inside the nose. This stuffiness will subside gradually and IS NOT improved with nasal sprays. Decongestant nasal sprays may actually cause damage to the nose and impair healing.  
Itching or numbness are common following Rhinoplasty surgery or a Nose Job.  These will subside, although it may take months for your nose to feel completely normal.

Any pain should be controlled with prescribed medication.  After the first day, the pain may subside enough so that plain Tylenol or Extra Strength Tylenol may be sufficient.  Swelling and bruising about the eyes and cheeks is normal, but varies amongst individuals.  Swelling reaches a maximum about two days after your rhinoplasty, then subsides over the next week or two.  An ice pack to the eyes for the first 48 hours may help decrease the swelling about the eyes and cheek area.  Bruising following a  Rhinoplasty or nasal surgery usually manifests as "black eyes."  Most bruising will resolve within 2-3 weeks after your nose job, and may
be concealed with makeup if desired.  Eventually, this will resolve completely, and won't adversely affect the result.  Bruising is variable from patient to patient.  Remember, this will all subside in time and has no bearing on the final cosmetic result of your rhinoplasty or nose job.  

Cosmetic Results Following Rhinoplasty

Initially after Rhinoplasty surgery, your face will be bruised and swollen. It's easy to forget that you are on the road to looking better. You may feel you look worse than before your surgery, and some patients may feel depressed for awhile after plastic surgery. This is quite normal and understandable.  This stage will pass. As time passes, your nose will begin to look better and your outlook will improve.  Within a week or two, you'll no longer look as if you've just had surgery, and you'll begin to see how your final rhinoplasty results will appear.

Still, healing is a slow and gradual process. Some subtle swelling may be present for months, especially in the tip of the nose. The final results of a Rhinoplasty may not be apparent for a year or more.  Our Los Angeles area patients have all been extremely happy will the results of their Rhinoplasty surgery.

Medications after a Rhinoplasty

Avoid medications such as Vitamin E, aspirin or ibuprofen for 2-3 weeks after your rhinoplasty, as they may cause bleeding. Pain medication will be prescribed, and as the pain level decreases, you may switch to Tylenol for pain relief.  Remember that pain medication may impair your reactions. Avoid driving or performing hazardous activities while taking pain medication. If the prescribed medication does not control your symptoms, please let us know. Prescription pain medication may cause nausea in some susceptible individuals.  Taking pain medication with food may help alleviate the nausea. If nausea is an issue, after the
first 24 hours after your rhinoplasty, switching to Extra-Strength or regular Tylenol may be best.

Infections after Rhinoplasty Surgery or a Nose Job

Infection is extremely rare following a Rhinoplasty, but occasionally occurs. Dr. Aharonov will prescribe antibiotics during the post operative period. Fever over 100 ° F, excessive pain and swelling with redness may signify a developing nasal infection and should be reported. Infections generally clear up quickly with appropriate antibiotic treatment.

Post-Operative Visits Following a Rhinoplasty

The nasal packing will be removed on the morning after your rhinoplasty surgery.  The nasal cast and any sutures will be removed after one week.  Brown paper tape will then be applied to your nose.  Dr. Aharonov will remove the tape a week later. When the nasal cast is removed, the nose will be quite swollen and the nasal tip will be turned up.  The swelling may worsen initially after the cast is removed.  This will settle down over the next few weeks, then more gradually thereafter.  It is important to remember that the nose does not assume its final shape until many months after rhinoplasty surgery, depending upon the type of nasal skin you
have.  It will probably look better than prior to the operation within two or three weeks, but the final rhinoplasty result takes longer. You must be patient.  Occasionally, a painless steroid injection is necessary to reduce the swelling in one area of your nose.

Rhinoplasty Frequently Asked Questions

Septoplasty or Repair of a Deviated Septum