Rhinoplasty

Rhinoplasty, commonly called a “nose job,” is a plastic surgery procedure for reshaping the nose by enhancing or reducing its size or shape. Nose reshaping is also becoming a popular age reversal procedure to correct common issues associated with aging like a droopy nose tip, uneven cartilage, which causes humps and bumps, and/or structurally supporting the nose bridge to fix or avoid sagging.

During rhinoplasty, your surgeon may make an internal incision in the bones and move them with a “controlled break” to alter the appearance of your nose. This is not like breaking an arm or a leg.

Rhinoplasty is performed either as an open or a closed procedure. An open procedure requires an additional incision across the narrow strip of tissue that separates the nostrils. In a closed procedure, incisions are hidden within the nose, though some surgeons feel that this can limit the extent of a rhinoplasty. Whether open or closed, the best approach for you is determined by the structural changes to be made to your nose and by your surgeon's preference.

A drooping tip can lead to a harsh and aged appearance. When the nose is pointed up, it creates a much softer look. A droopy tip can also cause the area between the end of the nose and the upper lip to look short—small, thin lips are common of an aged look.

Three Causes of a Droopy Tip:

Muscle movement and loss of volume: The force of gravity pulls the tissue of the nose down, causing it to droop which is often accompanied by a loss of volume. Your nose may appear larger with age because, as volume is lost from the face, the cheeks lose definition, in turn making the nose look disproportionate or even hooked.

Inadequate support: As support is lost in the nose, the tip begins to sag and point downward. It’s more common in those with thick skin, which weighs down the underlying supporting cartilage.

Facial expressions: Constant smiling compels the tip of the nose to move downward and droop as a result of years of muscle contraction. There is a muscle between the nose and upper lip that can become overactive with time. That muscle can be weakened by your surgeon, but it needs to be done conservatively. If too much of the muscle is weakened, it can potentially change the smile.

How to fix it:

The only way to permanently correct an aging nose is with surgery, and it’s important that your age be taken into consideration—the nose of a 70-year-old should not look like the nose of a 27-year-old. In older patients, surgeons say the tip shouldn’t be as high. By elevating a drooping tip to the appropriate position and adding support, your surgeon can bring the tip back up and prevent it from dropping back down. Other changes to the nose may be necessary, too. In some cases, injectables may be used to lift the tip of the nose. Injectables help to stop movement of the muscles that pull the tip down. They are also good for someone who has a gummy smile because it raises the tip and makes the lip look longer.

Most people with nasal humps and bumps, which are related to uneven amounts of cartilage, have always had them to some degree. Even if your nose developed with a bump, and it was always there, it may become more noticeable with age as support from the tissue and cartilage is lost. Others notice nasal humps and bumps later in life that virtually didn’t exist before.

Nasal humps and bumps can create an imbalanced look. Plus, as fat is lost from the surrounding areas and the bumps become more prominent, features like the cheeks can look less defined.

The most conventional way for your doctor to correct bumps and humps is with surgery. By filing down the bone and/or cartilage, the bump is smoothed out and the nose appears in better proportion. One thing to consider is that if the tip isn’t addressed, and just the humps and bumps are evened out, the outcome can be end up looking overdone or unbalanced. The various parts of the nose should be balanced to look natural.

To ensure the best results, it’s always important to seek treatment with a board-certified plastic or facial plastic surgeon who is experienced in this field of surgery.

VVisible from the side, a nose with a low bridge sits too close to the face. When you look at a nose from the front, a wide bridge makes the nose look out of proportion with the rest of the face. The nose may appear too short or bottom heavy, and the eyes may appear set too far apart. This flaw draws attention away from the eyes toward the nose.

To raise the bridge, volume is added with cartilage from another part of the nose. If there is no cartilage available, it can be taken from the ear or rib. When a bridge is too wide, the bones of the nose may need to be broken to make them narrower.

With a high bridge, both the nasal bones and the cartilage sit too high on the face. A nose with a high bridge looks too prominent and makes the eyes look too close together.

To remedy this problem, it’s essential to lower the nasal bones by cutting or filing them down. The bones will always need to be manipulated to lower the bridge, and as your surgeon gives the bridge a nice round shape, care is taken to support the cartilage that makes up the side walls.  

A crooked nose attracts attention, and exaggerates otherwise normal asymmetries that most of us have. These cosmetic issues are often accompanied by breathing problems caused by the same structural damage. A crooked nose bends to one side or the other, lacking a straight bridge. These noses can have either a curved or bumpy appearance, and can also be too big or too small.

A crooked nose can be caused by a deviated septum or an injury that has broken the bones. To straighten the nose, the bones need to be moved into a better position and are often reduced before being reshaped. 

According to St. Augustine, FL, facial plastic surgeon Deirdre Leake, MD, “Tip rhinoplasty is among the most technically difficult surgery we perform. After changing the framework of the nose, the skin may or may not take the new shape, making it hard to anticipate the final result.”

Having a bulbous tip means it looks like your nose has a ball on the end. This can be due to the shape of the underlying structure, or just thick skin, but regardless of the cause, this nose type looks bottom heavy and draws attention away from the eyes.

To refine the tip of the nose, the cartilage is narrowed. Rhinoplasty relies less on removing cartilage and more on strengthening existing cartilage or adding additional cartilage for support in order to improve definition.

When looking at the nose from below, the tip should be shaped like a triangle, and although nostril shape varies by ethnicity, the nostrils should be symmetrical.

Nostrils that are overly wide attract attention and take focus away from the eyes and the rest of the face. To make the nostrils smaller, portions of the surrounding tissue are removed through incisions beneath and inside the nose so there are no obvious scars.

Anyone seeking to improve the appearance of their nose for a more symmetrical look by correcting a droopy or bulbous tip, humps and bumps, a low wide or high bridge and/or wide nostrils should consider the benefits of rhinoplasty.

Rhinoplasty is not for anyone who is satisfied with the appearance of their nose.

Thin lips: If the nose is too droopy, it can mask the smile and hide part of the upper lip, making it look thin and limp.

Recessed chin: If your nose has too much projection, it can create the illusion of a recessed chin and weak cheeks. With age, the chin area can become saggy and appear set back, contributing to a poorly defined jawline. If the cheeks are not delineated, they can make the face look gaunt and sunken.

Poorly defined cheeks: If your nose is too long, it can cause your cheeks to look weak and ill defined. Flat cheeks that lack volume and definition are common with age.

You will wake up after rhinoplasty with a splint covering your nose and small tubes may be placed in your nose for a short time to prevent draining fluid from being swallowed. It's also possible that you may have packing to support the nose internally as it heals. When it comes to stitches, dissolving sutures are used internally, and dissolving or removable sutures close any external incisions. No matter how cumbersome or uncomfortable, you shouldn't remove any splints or packing without your surgeon's permission.

Added Post-Care Considerations:

Someone must drive you home and stay with you for at least the first 24 hours.

If you have a drip pad to catch any drainage, you'll need help changing it so you're clean and comfortable.

Expect to be swollen, bruised in the eye and cheek region and stuffed up.

No nose-blowing allowed.

A diet of soft food is recommended for a the few days after surgery as you may also have a mild headache and your cheeks and jaw might be sore

Keep your head elevated even while you sleep.

Cool compresses and anti-inflammatory medications can make you more comfortable and keep swelling down.

You may also experience mouth dryness because you'll be breathing through your mouth until the nasal swelling subsides. Sucking candies and drinking extra liquids can help.

Contact lenses can be used once swelling diminishes.

You should be back to your normal routine within a week and back to regular exercise within three to six weeks.

Wear appropriate protection if you are involved in any sport or activity that may cause injury to your nose.

Be sure to protect your skin and nose from sun exposure.

Other nose job risks:

Nosebleeds or ruptures of small blood nasal vessels are common after rhinoplasty. Visible vessels can be corrected with a laser, cautery or sclerotherapy.

Excess scar tissue can develop but is rare. This might impair breathing and, in some cases, can be treated with steroid injections. If bone is grafted or altered, minor irregularities may develop and occasionally be felt or seen.

Unpredictable results are possible. The aesthetic outcome of rhinoplasty cannot always be foreseen. Bones may dislodge, and cartilage and soft tissue may change in shape over time. In addition, results may not develop as you had hoped, and asymmetry is possible. Secondary procedures may occasionally be required to refine your results to achieve your original goal.