Rhinoplasty is the surgical modification of the shape of the nose, also known as “nose job surgery” or nose reshaping. This procedure uses a wide variety of approaches and techniques to modify the internal structures and external appearance of the nose. Some common goals include removal of a bump (“dorsal hump”) on the bridge of the nose, reduction or modification of the nasal tip cartilages, narrowing the width of the nose, making the nostrils smaller, and lifting a droopy or hanging tip of the nose. In the majority of cases, rhinoplasty is used to make the nose smaller or more refined (“reduction rhinoplasty”). Less commonly, rhinoplasty can also be used to make the nose larger (“augmentation rhinoplasty”) or to fix breathing problems or trauma (functional rhinoplasty). When a patient has undergone a prior rhinoplasty, but the results were unsatisfactory in some way, a revision rhinoplasty can be performed.
Choosing an Approach
Rhinoplasty can be performed either “open” (using an external incision) or “closed” (using incisions only on the inside of the nose). This choice is dictated by the specific goals of the patient, as well as any functional or anatomic issues that would require a specific approach. In addition, most revision rhinoplasty (sometimes called “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).
Open rhinoplasty involves a small incision placed in the columella (the bottom of the nose or the skin between the two nostrils) and allows complete exposure of the nasal cartilages and bones. This facilitates precise assessment of the internal issues with the shape of the nose, as well as accurate diagnosis of functional problems. For rhinoplasty patients desiring significant change to the tip of the nose, an external approach is preferred – 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 or twisted nose, and a nose that is too long (“hook” nose) or “droopy” (hanging columella or excessive columellar show).
Closed rhinoplasty, sometimes called scarless rhinoplasty, eliminates the incision in the columella and places the remaining incisions between the nasal cartilages inside the nose. This technique is very useful for patients with concerns about the bridge of the nose (nasal dorsum or “dorsal hump”) but who desire minimal or no change to the nasal tip. Narrowing of the nasal bones can also be performed easily through an open or closed approach. Septoplasty can be performed during any rhinoplasty and can help to straighten a crooked nose, improve your breathing, or reduce snoring.
Recovery from closed rhinoplasty is generally very quick. In most patients, the majority of the swelling in the nose lasts for a few days to a week. Typically, patients will have a flexible plastic cast on the nose for about a week. All the sutures in closed rhinoplasty are dissolvable, so no suture removal appointments are needed. Recovery from open rhinoplasty is similar to closed rhinoplasty, though the swelling of the nose may last for a few 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. Rhinoplasty and septoplasty procedures may be combined with other aesthetic facial surgery or non-surgical treatments. Please visit the photo gallery for examples.
Deciding on the Right Nose for You
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 “still look like me.” Our goals are to provide natural-appearing enhancement of the nose, in harmony with the other facial features, while preserving or improving the nasal function (breathing). This philosophy is especially important in what is often called ethnic rhinoplasty. So-called “ethnic rhinoplasty” is a surgical procedure designed to reshape a non-Caucasian nose, and deals with the anatomical issues specific to these noses. This procedure can be performed either “open” (using an external incision) or “closed” (using incisions only on the inside of the nose). Most ethnic rhinoplasty requires an open approach due to the complex nature of this procedure and the need to provide internal support for the nasal structures.
Choosing the Right Doctor
Undergoing rhinoplasty is a very personal decision and requires a true understanding between the doctor and the patient. It’s also a procedure that calls for a highly skilled surgeon. Dr. Ransom is experienced at helping nasal surgery patients meet their goals and fulfill their dreams of being more comfortable and confident. He cares about your surgery being successful every bit as much as you do and is known for the personal approach he takes toward every procedure. Take the first step in reaching your goals and join us for a consultation today!
Who is a candidate?
Anyone who wants to change the shape of their nose is a candidate for rhinoplasty (nose reshaping). In addition, patients with a crooked nose, a history of nasal trauma (for example, an untreated fracture), or significant functional concerns (breathing problems), may choose rhinoplasty as a surgical remedy for these issues. Finally, patients who have had a previous rhinoplasty but were left unsatisfied by the aesthetic result or have had functional issues may be a candidate for a revision rhinoplasty.
Dr. Ransom see patients from all over Bay Area, including Mill Valley/Marin County, Napa/Sonoma, San Raphael/Petaluma, Hillsborough, San Mateo, Menlo Park, Orinda, Palo Alto, Piedmont, Walnut Creek and the world.
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 a rhinoplasty?
A: For most patients, the initial recovery is quick – typically a week or so. Recovery from a closed rhinoplasty may be a bit quicker. 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. This is especially true of revision rhinoplasty and complex augmentation (making the nose bigger) rhinoplasty cases.
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.
Q: Are there non-surgical options for changing the shape of my nose?
A: Yes, some patients may be candidates for non-surgical rhinoplasty based on their specific anatomy and aesthetic goals. The most suitable patients have smaller noses and primarily desire changes to the profile. A low or flat nasal bridge can be elevated or a small bump can be camouflaged using carefully placed injections of a soft-tissue filler called Radiesse®. For more details, please see the page dedicated to this treatment, located under the Non-Surgical tab.
Q: I had a nose job years ago, but now it doesn’t look the way I want. Can this be fixed?
A: Changes caused by the healing process as well as normal aging of the tissues in the nose can lead to an unsatisfactory result over time. In these cases, a revision rhinoplasty may be appropriate. As we age, the skin may become thinner, the cartilages may become weaker or more droopy, and there can be loss of bone in the upper jaw. All of these normal processes can lead to long-term aesthetic changes in the nose. In many cases, revision surgery can be used to add support to the nose or return it to a more desirable shape.