Rhinoplasty

What is Rhinoplasty?

Board-certified surgeons Dr. Paul G. Ruff IV and Dr. Justin Cohen perform rhinoplasty, also called a nose job, in Washington, D.C. to cosmetically reshape your nose and enhance the overall appearance of your face. This procedure is also used for reconstructive reasons to correct injuries, birth defects, and breathing problems. It is one of the most common types of plastic surgeries performed today.

comparative portrait of the same woman, before and after rhinoplasty

The meticulous techniques we use, some of which are unique to this practice, ensure a beautiful, natural-looking result that can permanently improve the look of your entire face.

Reasons For Nose Surgery

Women and men choose rhinoplasty for a variety of reasons, which often include one or more of the following:

  • Reducing or increasing the size of the nose
  • Changing the shape of the tip or the bridge of the nose
  • Narrowing the span of the nostrils
  • Changing the angle between the nose and upper lip
  • Correcting birth defects
  • Repairing injuries
  • Relieving breathing problems

Can I Improve My Breathing Without Changing The Look Of My Nose?

Yes. “Functional rhinoplasty” refers to a version of the surgery that improves the function of your nose without affecting its appearance. This is often performed to remedy a deviated septum and other irregularities that can affect breathing. Although your doctor may need to make very small alterations to the appearance of your nose, its overall size and shape can be preserved. Or, if you have both functional and aesthetic concerns, your doctor can change the look of your nose while improving your ability to breathe. During your consultation, you’ll talk more about the likely outcome you can expect.

Am I A Good Candidate for Rhinoplasty?

The ideal candidates for rhinoplasty are men and women who are in general good health and who have realistic expectations about the procedure. It is best to be at least 15 years of age before considering nose reshaping surgery to ensure that your nose is fully developed and will react well to the surgery.

"I recently went to Dr. Cohen for rhinoplasty and I can't even begin to explain how amazing my experience was. Dr. Cohen genuinely cares about his patients - I never once felt like I was sitting in a doctor's office. He truly got to know me and what changes I wanted to make to my nose and was able to take my vision, mix it with his expertise, and I am OVERJOYED with the results!"  - Francesca G.

Nose Surgery Consultation

Prior to scheduling your nose surgery, you will have an extensive consultation with your surgeon and the team at West End Plastic Surgery. Your plastic surgeon will ask you to detail at length what you want your nose to look like after the surgery. Your nose and facial structure will be evaluated and the surgical possibilities will be discussed with you. Additionally, you may have the option to review digital simulations of your projected surgical result based on photos taken in our state-of-the-art photography studio.

"Nose exam, female patient, Canon 1Ds mark III"

The doctor will thoroughly explain the procedure and its expected result and answer any questions you have. If you are unhappy with the results of rhinoplasty by another surgeon, we will discuss the additional details associated with revision rhinoplasty.

Your plastic surgeon and the team at West End Plastic Surgery will:

  • Review the various nose surgery options with you
  • Clearly discuss the potential risks of the procedure
  • Outline in detail how the surgery is performed and what you can expect before, during, and after the procedure
  • Provide detailed cost, and payment information
  • Answer all your questions

You will be asked to provide:

  • Details about your medical history
  • A list of all medication you currently take, including over the counter medications such as aspirin, vitamins, and herbal supplements
  • Information regarding your tobacco and alcohol use

Primary Rhinoplasty vs Revision Rhinoplasty

Primary rhinoplasty is the first rhinoplasty that a patient undergoes. In most cases, primary rhinoplasty yields ideal, permanent results and is the only surgery necessary. However, occasionally unfavorable results or future trauma can necessitate additional surgery. This is called a revision rhinoplasty. Although both procedures are performed similarly, revision rhinoplasty does require extra care around scar tissue. It’s also vitally important to choose a surgeon who fully understands your desires and offers you realistic expectations about your potential results. Our doctors are skilled at both primary and revision rhinoplasty techniques to give each of their patients the results they envision.

Rhinoplasty Procedure

Your rhinoplasty surgery will be performed at the state-of-the-art surgical suite in our Georgetown plastic surgery center. The surgery can be performed either under general anesthesia or local anesthesia with sedation depending on what you and the doctor prefer. With general anesthesia, you will be completely asleep throughout the procedure. With local anesthesia, you will be lightly sedated and your nose and the surrounding area will be numbed. You will be awake, but will be relaxed and will feel no discomfort. The type of anesthesia used will be discussed with you at your initial consultation.

There are two methods for performing rhinoplasty: the closed technique in which the incision is made within the nose and the open technique in which the incision is made between the two nostrils. The type of surgery to be performed will be discussed with you when you meet with your surgeon. With either technique, the surgery generally lasts from one to several hours.

Once the incision is made, either within the nose or between the nostrils, the supporting nasal framework of bone and cartilage is accessed. If one of the goals of the surgery is to reduce the size of your nostrils, small incisions are made at their base for this purpose. The bone and cartilage are then sculpted to the shape you and the doctor agreed upon prior to surgery. When the sculpting is complete, the skin is redraped over the new framework of your nose. A splint is applied to protect your nose and help it maintain its new structure.  Finally, small sutures are used to close the incision with extreme care.

Cartilage Grafts for Rhinoplasty

Your surgeon may recommend using cartilage “grafts” during your surgery to help provide support or structure.  These are generally created by borrowing cartilage from your septum (the dividing wall between the two nasal airways).  The cartilage is removed, shaped as necessary, and then re-inserted and sutured into specific locations in and around your nose.  If there is not enough cartilage within the septum (due to previous surgery or trauma), then other potential sources would include ear cartilage (without changing the look of the ear) or rib cartilage (often from a tissue bank). The following are some of the more common grafts that can be used during rhinoplasty:

  • Spreader graft – Placed along the middle third of the nose to straighten the bridge or help open a collapsed airway.
  • Columellar strut graft – Placed lengthwise between the nostrils to help support the tip. Can also be used to adjust the angle between the nose and upper lip.
  • Tip (shield) graft- Placed within the nasal tip to provide long-lasting shape and structure.
  • Alar rim graft- Placed within the nostril rims to smooth the transition between the tip and the nostrils.  Also help prevent the nostrils from collapsing during breathing.
  • Crural strut graft- Placed under the “crease” that sits above the nostrils to further support and stabilize a collapsed airway.
  • Dorsal onlay graft- Placed along the bridge to add projection or correct previous over-resection.

Rhinoplasty Recovery Process

Rhinoplasty surgery is typically performed on an outpatient basis and you go home shortly after the surgery. You may be sleepy from the anesthesia and you will feel mild to moderate discomfort so it is important to have someone drive you home after your surgery. You may also want to have someone stay with you for the first few days after surgery.

In the first 24 hours after surgery, your face will feel puffy, your nose may ache, and you may have a dull headache. You can use the prescribed pain medication to alleviate much of this discomfort. Most patients are up and around one to two days after surgery. The swelling and bruising around your nose will increase at first, reaching its peak about two to four days after the surgery. Applying cold compresses will help ease the pain and reduce the swelling and bruising.

Your discomfort level will improve rapidly after the first two days. A little bleeding is common in the first day or so after surgery and you may continue to feel some nasal stuffiness for the first few weeks. All dressings, splints, and stitches are usually removed within one week after surgery.

You will notice a marked improvement in your discomfort level during the first few weeks after your surgery. You can most likely return to work approximately one to two weeks after your rhinoplasty unless your work is strenuous.

What To Expect After Nose Surgery

ActivityWhen
Out of BedAs Soon as You Feel Comfortable
External Splint RemovedOne Week After Surgery
Stitches RemovedFive to Seven Days After Surgery
Back to WorkOne to Two Weeks After Surgery
Contact LensesAs Soon as You Feel Comfortable
DrivingAs Soon as You Feel Comfortable
Strenuous ActivityThree to Four Weeks After Surgery
Wearing Your GlassesFour to Six Weeks After Surgery
Contact SportsSix to Eight Weeks After Surgery

Things To Be Aware Of After Your Surgery

  • You should not blow your nose for several weeks or so after surgery to give the tissue a chance to heal. You should make every effort to avoid rubbing, bumping, or hitting your nose for several weeks.
  • After surgery small burst blood vessels may appear as tiny red spots on the skin’s surface. These spots are usually minor but can be permanent in some cases.
  • When rhinoplasty is performed from inside the nose there is no visible scarring. When the incision is made across the bottom the nose or when the procedure corrects wide nostrils, the scars are minor and are usually not visible within a few weeks of surgery.
  • Minimize sun exposure for up to one year following surgery.
  • The doctor will schedule regular follow-up visits in the months after your surgery. If anything unusual or troubling develops between visits call West End Plastic Surgery right away.
  • Internal swelling subsides very gradually, therefore, the final results of your nose surgery may not be apparent for a year or more.

What Can I Do To Minimize Scarring?

Rhinoplasty isn’t known for creating excessive scarring. “Closed” procedures, which are made through the inside of the nostrils, don’t produce any visible scarring at all, while “open” procedures require only a small incision across the strip of skin that separates the nostrils. Although this incision won’t be noticeable to most people once fully healed, closely following your doctor’s instructions can ensure an even more discreet result. It’s also important to protect the incision from the sun in the days, weeks, and months following surgery. Unprotected sun exposure can cause pigmentation irregularities and a more noticeable scar.

How Long Will the Results of Your Nose Surgery Last?

Nose surgery can reshape, resize, and enhance the appearance of your nose. In most cases these results are permanent. Of course, your face, including your nose, will continue to change as you age.

Risks of Nose Surgery

All surgical procedures have some degree of risk, however, major complications from rhinoplasty are unusual. During your initial consultation, your individual risks will be assessed and discussed. As with any surgery, you can help reduce the risks by closely following the pre and post-surgery instructions provided to you. Your surgeon and his staff will be with you every step of the way to ensure a safe and pleasing outcome.

Most likely risks include the following:

  • Infection
  • Nosebleeds
  • Persistent swelling
  • Asymmetry
  • Need for further surgery

Can Rhinoplasty Be Combined With Other Procedures?

Several surgical procedures can enhance your facial appearance and give you a more youthful and less tired look. These include:

Does Insurance Cover Rhinoplasty?

In some cases, your rhinoplasty may be covered by your insurance company. Please contact your insurance provider to confirm coverage. Be advised West End Plastic Surgery does not participate with any insurance provider and you are responsible for the full payment of the procedure. Cost and payment information will be fully discussed with you during your initial consultation.

Schedule a Consultation

Our surgeons are experts in rhinoplasty and will ensure that you have a safe and comfortable procedure and an outcome you are pleased with. To get started, request a consultation online, or call our office at (202) 750-5189 to schedule an appointment.

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