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Rhinoplasty Open

Rhinoplasty is the surgical modification of the shape of the nose, also known as “nose job surgery” or nose reshaping. This procedure can be performed either “open” (using an external incision) or “closed” (using incisions only on the inside of the nose). The choice of approach is dictated by the specific goals of the patient, as well as any functional or anatomic issues which require a specific technique. In addition, most revision rhinoplasty (secondary rhinoplasty) requires an open approach due to the complex nature of this procedure and the need to provide internal support for the nasal structures (see Revision Rhinoplasty section). Septoplasty can be performed along with either an open or a closed rhinoplasty.

Open rhinoplasty involves a small incision placed in the columella (the bottom of the nose or the skin between the two nostrils) and allows exposure of the nasal cartilages and bones. This facilitates precise assessment of the underlying issues with the shape of the nose, as well as accurate diagnosis of functional issues. For rhinoplasty patients desiring significant change to the tip of the nose, an external approach is essential – this allows Dr. Ransom to reduce the size of the cartilages, make the two sides of the nose symmetric, and create a more aesthetically pleasing shape for the tip. Examples of problems that can be addressed via this approach include a “bulbous” or “boxy” tip, asymmetric tip cartilages, a crooked nose, and a nose that is too long (“hook” nose) or “droopy” (hanging columella or excessive columellar show).

Dr. Ransom works with each individual patient to create the nose that he or she wants. Different noses work for different faces, and Dr. Ransom is sensitive to patients’ desires to “look like themselves” – especially in what is often called ethnic rhinoplasty. Recovery from open rhinoplasty is similar to closed rhinoplasty, though the swelling of the nose may last for a couple more days. Dr. Ransom does not use any nasal packing, which allows the patient to breath normally after the surgery and significantly reduces postoperative discomfort. Typically, patients will have a flexible plastic cast on the nose for about a week. Please visit the photo gallery for examples.

Who is a candidate?
Anyone who wants to change the shape of their nose, especially when the main concern is refinement of the nasal tip. In addition, patients with a crooked nose, a history of nasal trauma (for example, an untreated fracture), or significant functional concerns (breathing problems), are better served with an open approach. Finally, patients who have had a previous rhinoplasty or who have complex structural issues in the middle part or tip of the nose, are best treated with an open rhinoplasty.

Frequently Asked Questions

Q: What should I expect after my procedure?
A: In most cases, you will have a cast on the nose for about a week after the procedure. This helps to protect the nose from accidental trauma, and also stabilizes the bones during the initial healing phase. No packing is used in the nose, which makes recovery much more comfortable. Your nose may feel “stuffy” for a few days, but this resolves quickly. Pain is minimal. You will likely feel tired for a couple days and should limit your activities and concentrate on resting and recovery. Contact sports, racket and ball sports, heavy lifting, and straining must be avoided until Dr. Ransom gives you the “okay” – this is typically a couple weeks.

Q: How long is the recovery from an open rhinoplasty?
A: For most patients, the initial recovery is quick – typically a week. Due to swelling inside the nose, many patients feel “stuffed up” for a few days. Bruising is limited, though some swelling will occur throughout the nose. Much of this resolves over the first week, but some swelling will persist after that and may take longer to go away completely. Pain is minimal and Dr. Ransom does not use nasal packing, making recovery more comfortable for his patients. Most plastic surgeons agree that the final result of a rhinoplasty is not seen for at least six months, and it is common to see subtle changes up to a year from the surgery.

Q: Will rhinoplasty change my breathing?
A: During the healing phase after your procedure, there will be swelling inside the nose. This takes some time to resolve, and may cause a temporary sensation of blockage or “stuffy” nose. After the swelling resolves, there should not be any changes to your breathing. In fact, Dr. Ransom is a nose specialist and uses this knowledge to make sure that his patients’ breathing is not negatively affected by nose reshaping. In some cases where the septum is crooked or functional issues (difficult nasal breathing) exist before surgery, Dr. Ransom can actually improve the breathing during your rhinoplasty. Any issues pertaining to breathing can be discussed during your consultation.

Please note that all patients are different and individual healing times and results may vary. The statements regarding procedures and recovery made here are general rules.

5.0

Based on 19 reviews

Christina G.
I had several nasal/sinus issues including a severely deviated septum and a dorsal hump, which I wasn't crazy about. Dr Ransom did both the medical and aesthetic parts of my surgery and he did a wonderful job! While I did have some swelling, I didn't experience much bruising at all. I loved that he left the natural look of my nose just making small corrections. My breathing has GREATLY improved. His office staff was super helpful in scheduling and making sure payment and everything was very clear. I am very, very, very pleased with my results!!
Tk I.
I had a terrible surf accident in Bali and needed to get 50 stitches to repair what the reef did to my face. I had emergency cosmetic surgery in Bali the day of the accident. Immediately when i got back to the states i was introduced to Dr Ransom through some mutual friends. I was searching for the best cosmetic surgeon in San Francisco to help in my recovery. He and his team have been amazing! he helped establish a plan for my post-op wound care/treatment and administered some initial laser treatments. Dr Ransom and his team are extremely knowledgeable and very patient / helpful. I am very grateful for their help and support. I am finally looking normal again!
Joey B.
I had three issues with my nose - which inhibited my breathing: 1- broken nose, 2 - narrow nostrils that collapsed when I inhaled through my nose, 3 - deviated septum. When I was living in New York, I went to see a doctor about my breathing issues, and he said my skin was too thin and there was likely nothing he could do to rectify the problem. Dr. Ransom was recommended by an ENT I saw through One Medical. As soon as he saw him, he said he could easily fix my nose, and remove the bump that had formed from the trauma. His confidence and strong sense of self immediately put me at ease, and I had little doubt that he could accomplish exactly what he promised. He showed me a modified picture of my nose , and really liked what he proposed. The end result very closely matched what he promised. Not only can I now breath much more easily through my nose, it looks much better. He managed to make it look like an improved version of itself, however I still look like me, and unless I tell anyone I had it done, it's not overly noticeable, which I prefer. I'm pretty vain and very critical, and I can say that Dr. Ransom is great, and comes highly recommended.
Edward T.
Doctor Evan Ransom took my surgery on relatively short order and did a wonderful job. He is very talented and has a nice friendly professional support staff. I can not thank him enough, he was calm, caring, professional and interested in the follow results of his work . He seemed to bring a certain artistry to the profession.
Lisa C.
Dr. Ransom is a talented physician. He is knowledgeable, professional and goes the extra mile to make you feel comfortable during your treatments. He has been blessed with an artistic eye which brings wonderful results. I highly recommend Dr. Ransom and would refer all of my friends and family members to choose him as their physician.
Cheryl H.
Dr Ransom is very kind, honest, and conscience doctor. I was referred by my best friend, she is also Doctor Ransom patient. She has so much good things said about Doctor Ransom. So I had a face lift done by Doctor Ransom on July 2015. He did a wonderful job on my face and I have a lot of compliments on my face. So if anyone want to get their face done. I would highly recommended Doctor Ransom to you. I give Doctor Ransom a five stars.
Jill P.
I have currently been getting botox regularly with Dr. Ransom and he does a fantastic job. My previous doctor's office moved to another location where it was no longer convenient. I didn't realize what I was missing until I went to Dr. Ransom. I felt really comfortable, but most important he did a terrific job blowing my previous doctor out of the park. (Sometimes it's good switch it up a bit to make sure you are getting the best treatment.) On top of that, Dee the office manager is an incredible asset to the office. She personalizes your visit and relationship with the office to an extent I have never experienced before. I even get follow up calls to see how I am doing after a treatment. I highly recommend Dr. Ransom for his great work, and his team's impeccable customer service.
Arielle C.
Dr. Ransom and Dee are the BEST! Whether it's aesthetic or reconstructive, I'd trust him over and over again with my face.