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 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 breathe 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.
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.
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.
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.
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.
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.
Dr. Evan Ransom is an Ivy League-educated and Ivy League trained Facial Plastic and Reconstructive Surgeon. He is a Double Board Certified Head and Neck Surgeon and Facial Plastic and Reconstructive Surgery and fellowship-trained in facial plastic, reconstructive, and laser surgery. His practice is in the San Francisco Bay Area, serving patients from San Francisco, Oakland, Marin County, Palo Alto, Silicon Valley, Walnut Creek, the East Bay, and all over Northern California.