Rhinoplasty, or nose plastic surgery, is one of the most commonly performed plastic surgery procedures performed. It can be a life-changing operation and have many different benefits ranging from improvement in nasal breathing to enhanced appearance and self-confidence.  Naturally, patients have many questions about rhinoplasty – details of the procedure, healing time, concerns about the risks, and whether they are a good candidate for the procedure.  This Rhinoplasty FAQs page is dedicated to addressing some of the most common questions encountered by rhinoplasty patients in NYC.  

Rhinoplasty has several specific goals and each case is unique. Some general benefits of undergoing rhinoplasty surgery include:

  • Removing a hump on your nose
  • Improving nasal breathing
  • Reshaping the tip of your nose
  • Reshaping or resizing your nostrils
  • Repairing your nose after an injury
  • Increasing or decreasing the size of your nose

Many patients qualify to undergo rhinoplasty.  In general, good rhinoplasty candidates are:

  • At least 16 years old so that facial growth is complete
  • Be in overall good health
  • Not be a smoker
  • Have specific changes they are looking for as a result of the procedure
  • Have realistic expectations about the outcome of the surgery

Rhinoplasty is usually an outpatient procedure performed under general anesthesia.  After the patient is asleep, the surgeon gently lifts the soft tissues covering the nose, which allows him to sculpt the bone and cartilage to the desired shape. Often additional cartilage is needed to augment or support the nose, and this is often taken from the nasal septum. If the patient has a deviated septum, the surgeon will adjust the septum and the inner structures of the nose to improve breathing, and then use the septal cartilage to perform the rhinoplasty itself. Once the desired shape is obtained, the soft tissues are re-draped and sutured closed.  Then the healing process begins, which starts immediately and continues for months to years.

Immediately after surgery, your nose and eyes are usually bruised and swollen. Splints and some supporting materials will remain inside your nose for about a week, sutured in place.  During this period, you may experience some nasal pain or a dull headache, as well as some bleeding, congestion and drainage from your nose. Most patients are comfortable enough to return to regular activities in about a week. Contact lenses can be worn immediately after the procedure, but glasses may need to be taped to your forehead or propped on your cheeks after the cast is removed for up to three or four weeks.  

Swelling goes down quickly at first, and then slowly over a long period of time.  At the 1 week mark when the cast is removed you will see a high amount of swelling in most cases.  Over the next few days, the swelling actually goes up as the compression from the dressings has been removed.  Then the fun begins, as the nose starts to take its final, improved shape.  I tell patients that:

– At 1 week the nose is very swollen, and often has some dried crusts or pen marking from surgery in place.  This improves as the patient can now shower and thoroughly wash the face.

– At 2 weeks the nose looks more normal but remains swollen.  However, it would be totally fine to go out to run errands, go to work, etc.

– A 1 month the nose looks essentially normal, meaning your friends and family likely barely notice anything.  You, your surgeon and maybe your significant other are the only people concerned with the swelling at this point.

– At 3 months there is usually a significant drop is overall swelling and puffiness.  This is really when the final result starts to become visible.  However, close inspection reveals a thickness to the skin that won’t be there in the future.

– At 6 months the nose skin thickness is clearly going down.  The shape of the nose is the same as at 3 months, but the skin is wrapping around it more tightly and there is improved definition. 

– At 12 months the result is considered “final”.  However it should be kept in mind that in many cases the nose continues to heal and change very slowly.  Additionally, the forces of aging will ultimately set in in the long run, which may change the result slightly.  However, a good rhinoplasty creates a nose that is built to last and it is not expected to need an update or revision.

Although every patient is different, rhinoplasty is usually low to medium on the pain scale.  It is still a surgery and pain can be expected; however, my experience is that most patients do not require narcotic pain medications.  Those that do only use them for the first 24 hours or so.  

If a rib graft is performed, then the surgery is a bit more painful since the chest moves with laughing or coughing.  Still, the recovery progresses quickly and the pain is manageable in a few short days.  

I encourage every patient to engage in an active recovery – this means purposely performing nonstrenuous activities like walking, and doing deep breathing exercises.  Staying well-hydrated also significantly improves postoperative recovery.

The ribs contain a large amount of cartilage that can be used to rebuild the nose if it has been badly damaged by trauma or previous surgery. Because of this, rib grafting is a very powerful tool in the field of revision rhinoplasty .Although these cases are always more challenging, the procedure can be performed safely by well-trained plastic surgeons who specialize in complex nasal surgery. Talk to your surgeon about whether a rib graft is required for your surgery.

Revision, or secondary, Rhinoplasty corrects deformities caused by a previous operation on the nose. 

It is a more difficult procedure to perform than primary Rhinoplasty because there is less cartilage to work with and there may be scarring or tissue contracture. The nose also heals differently due to changes in the blood supply and fluid drainage pathways, often taking longer to resolve and requiring more patience for the final outcome.  Frequently tissue from other sites is required to reconstruct the nose; these sites include the ear, scalp, or rib.  Not all rhinoplasty surgeons specialize in revision rhinoplasty due to its more difficult nature.

When performed by a highly skilled plastic surgeon, a revision Rhinoplasty can improve both the appearance and the function of the nose and can make a dramatic change in a patient’s life.  Dr. Dibelius is a highly regarded revision rhinoplasty specialist in NYC.

Complications arising from a Rhinoplasty are rare and, when they do occur, usually minor. Medical complications can include infection, bleeding, or problems with anesthesia.  The main complications of rhinoplasty are either cosmetic or with nasal breathing.  Still, overall the rate of patients needing revision rhinoplasty surgery is low and rhinoplasty patients are generally very satisfied with the outcomes of the operation. 

Dr. Dibelius  answers some questions about rhinoplasty and whether if the person is a good candidate for the procedure,  this will give you a  better understanding of whether rhinoplasty is a good option and how to approach the decision-making process with confidence.