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Rhinoplasty — Open vs. Closed San Francisco Nose Surgery

Deciding on a rhinoplasty technique can be a confusing task if the patient has no understanding of their choices. Here is a brief description between two of the major choices patients will be faced with: the open and closed techniques.

When using the open rhinoplasty approach, your plastic surgeon will make a tiny incision on the external skin that separates the nostrils. The nasal skin can then be lifted, offering a great deal of surgical access to the underlying architecture of the nose. This technique involves an incision that is more visible after surgery. Hiding the incision is preferable for many patients.

A nose is just a nose, except when it isn’t

rhinoplasty_sanfranciscoOver the years, plastic surgeons and other physicians and scientists interested in aesthetics have explored the “ideal proportions” of the human face and its features. This has led to myriad schemes for classifying facial types, suggesting courses of treatment, and even planning surgical modifications. More recently, we have begun to focus on facial recognition – using experimental psychology techniques to find out exactly how people recognize each other or assign certain faces to particular groups (e.g., age groups, ethnicities, etc.). Out of this inquiry has come an interesting body of literature regarding facial features that the brain uses as shorthand for gender – how a person can decide on the gender of a face after seeing a single image flashed on a screen for less than a second. This work has determined that the ridge of the brow plays an important role, as well as the prominence of the jaw.


The Princess’s Nose

Of all the obsessive publicity and incessant attention surrounding Prince William and Kate Middleton, the most interesting item I’ve seen recently was about the Duchess of Cambridge’s nose. Apparently, according to the Transform Cosmetic Surgery Group, her nose was the most popular celebrity lookalike feature in the United Kingdom for 2012 ( The timing is curious since only a few weeks later the unveiling of the official portrait of Kate was met with widespread disappointment ( To my eye, the portrait looks quite accurate in terms of facial proportions, coloring, and even expression . . . yet somehow it is not beautiful. Much more could be said on this topic, but we’ll leave that for another day.


To Smell or Not to Smell…

Among the amazing features and functions of the nose, in the world of plastic surgery we frequently overlook the sense of SMELL. As a nose specialist, I have worked with many patients suffering from smell-loss (called hyposmia if the sense is present but reduced, and anosmia if all meaningful sense of smell is gone). This deficit is not as debilitating as the loss of vision or hearing, nor is it as easily apparent to others around us. Rather, anosmia carries with it a unique burden and very real detriment in quality of life – diminishing our relationship with food, with our intimate partners, and even with our memories. I recently came across a short documentary film made by a sufferer of anosmia, and it was captivating. Jacob LaMendola, an independent filmmaker, created this piece, and it can be found in the Op-Docs archives on the New York Times website (



Based on 100+ 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.

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