Surgical Procedures » Nose » Rhinoplasty

Rhinoplasty (nose job) is nose surgery that improves the appearance and proportion of your nose, enhancing facial harmony and self-confidence. Surgery of the nose may also correct impaired breathing caused by a deviated septum, collapsed valves, or enlarged turbinates in the nose.

Rhinoplasty, though a common procedure these days, requires an exacting knowledge of the structure and the function of the nose. Some believe that rhinoplasty is the most difficult type of plastic surgery simply because every nose is different. In addition, there are close to 200 types of maneuvers, grafts, and suturing techniques described to change the shape of the nose. This organ possesses three-dimensional qualities that must be respected and maintained. The intricacies and nuances of rhinoplasty can be overwhelming and a surgeon must be well trained in this specialty.

The goals of a rhinoplasty are different for every person. Some request a cosmetic change such as correcting a hook nose, removing a nasal hump, straigthening a crooked nose, repairing a saddle nose, or lifting a droopy nasal tip. Others desire a functional correction of their deviated septum or nasal valves. Frequently, however, a rhinoplasty is a combination of both. Many of the procedures require advanced training and a variety of factors must be considered before a rhinoplasty is advised.

Although the nose sits in the center of the face, rarely do we hear compliments about a beautiful nose. More often, we hear comments about a person’s beautiful eyes, lips, or hair. In fact, when nose-related comments are voiced, the speaker is usually someone who is unhappy with his/her own nose. Though this unhappiness with the appearance of the nose may wax and wane through the years, the feelings of unease or embarrassment generally persist and the person continues to have an underlying desire for change. Yet, however strong the feelings or how long the unhappiness persists, a person who is considering rhinoplasty for cosmetic reasons may be apprehensive or nervous about the procedure. These fears are unfounded and generally dispelled after a visit with a board certified surgeon like Dr. Funk.

The goal of rhinoplasty is to give you a nose with natural aesthetic changes that complements those other features of your face. Every nose is different and all the structural features of the face must be accounted for when performing rhinoplasty. We do not want people to notice your nose after surgery, but to have their attention drawn away from your current nose to your eyes, lips, or hair. A natural unoperated appearance is the final objective in rhinoplasty. However, we do want you to look in the mirror and exclaim, “Yes! This is the nose I should have always had!” An outward appearance that reflects your inner spirit. Dr. Funk’s intentions are for you to have a nose that is structurally stable for life, improves your confidence, inner well being, and your quality of life.

How is Rhinoplasty performed?

Rhinoplasty surgery is typically performed in the operating room under general anesthesia. Rhinoplasty under sedation or "twilight" anesthesia is more difficult as the airway is not protected from the small amount of blood that may trickle down into the throat from the nose. For open rhinoplasty or external rhinoplasty, a small incision is typically made just above the upper lip on the columella, between the two nostrils. This scar is almost competely invisible at one month. The rest of the incisions are all made inside the nose. Althernatively, all the incision may be made on the inside with an endonasal rhinoplasty or closed rhinoplasty. The bone and cartilage framework of the nose is exposed during rhinoplasty and shaped to improve the appearance of the nose. A deviated septum and/or enlarged turbinates are corrected at the same time of rhinoplasty.

Which is better, external-open rhinoplasty or endonasal-closed rhinoplasty?

Every surgeon is trained differently and feels more comfortable with certain techniques. Dr. Funk performs both external rhinoplasty and endonasal rhinoplasty. Dr. Funk does however feel that the external approach provides better visualization of the bone and cartilage and more exact placement of grafts. He feels that this provides for an improved aesthetic appearance to the nose overall. The external approach to rhinoplasty does leave a scar in the columella (between the two nostrils), however, Dr. Funk's patients rarely if ever complain about this. The scar from external rhinoplasty is almost invisible one month after surgery.

This patient had a traumatic injury to the nose. Functional (non-cosmetic) septorhinoplasty with open approach was performed 3 months after the traumatic incident. Notice the scar is almost invisible.

I want a nose job, but don't want my nose to look done. Can you make it look natural?

Dr. Funk's philosophy with all cosmetic surgery is centered around achieving natural results. Rhinoplasty results can frequently look operated or unnatural. Dr. Funk uses the most advanced and proven techniques that result in a natural and aesthetically pleasing nasal result. Dr. Funk looks to create a nose that blends into your face so that people will notice your eyes, lips, or hair. The goal is for people to look past your nose and for it not to be the center of attention (despite being in the center of the face!).

Do you perform digital imaging, digital enhancement, or morphing of my photographs to show me what my nose may look like after surgery?

Digital imaging is performed by Dr. Funk during your consultation for rhinoplasty. He uses the latest imaging technology to provide an idea of what your nose may look like after surgery. This also provides you, the patient, an opportunity to voice your opinion as to whether the changes you see are to your liking. Dr. Funk cannot guarantee that your surgical outcome after rhinoplasty will be that of your enhanced photos as he cannot predict wound healing or account for skin thickness. However, this provides both Dr. Funk and you an idea of what he may be able to achieve with rhinoplasty.

Is there packing in the nose after surgery?

This depends on the type of procedure that was performed and how much bleeding occurred during surgery. If Dr. Funk does need to use packing, he uses a small amount of packing after rhinoplasty that is removed the following day. This is to prevent any blood dripping which can be uncomfortable for patients. The removal of the packing is typically not painful or uncomfortable but has been described as feeling "weird" by patients.

Is rhinoplasty outpatient surgery? Do I go home the same day after rhinoplasty?

Almost all patients go home the same day after rhinoplasty. At home, you will rest with your head elevated and cool compresses over the eyes. A cast will be taped in place over your nose. A small drip pad is taped under the nose and is changed every 2-3 hours.

How many rhinoplasties do you perform?

The national average number of rhinoplasties performed by plastic surgeons according to the American Society of Plastic Surgeons is 11 per year. As a board certified ENT and a board certified facial plastic surgeon, Dr. Funk is capable of improving the appearance of the nose while still enhancing a patient's breathing. Dr. Funk performs more than 50 rhinoplasties per year.

Is rhinoplasty painful?

Most patients describe rhinoplasty as uncomfortable rather than painful. Although narcotic pain medication is provided by prescription, most patients require very little if any post-operatively. Pain, if any, after rhinoplasty is typically resolved completely 1-2 days after surgery

Is there bruising after rhinoplasty?

Rhinoplasty may require controlled breaking of the nasal bones. This can sometimes cause minor bruising and swelling around the eyes. Using cold compresess after rhinoplasty and keeping your head above the level of your heart will help decrease any bruising or swelling.

Is rhinoplasty covered by insurance?

Certain functional aspects of septorhinoplasty (truama or nasal obstruction) are covered by insurance. If you have a functional or breathing problem that needs correction, a septorhinopolasty is often covered by your insurance company, after your deductible is met. A deviated septum (the wall that separates the two sides of the nose), broken nose, enlarged turbinates (the organs inside the nose that humidify and warm the air as it passes), or collapsed nasal valves (the area of the nose with the most air resistance), are correctable functional problems that are also often covered.

However, if you are interested in changing the external appearance of your nose, then these are cosmetic changes that are not covered by insurance. Taking down a small hump or bump, refining the tip of the nose, making the nose more narrow, straightening the nose, decreasing the size of the nostrils, filling in a depression, or improving a scooped out appearance are all examples of cosmetic changes.

What is the recovery time from rhinoplasty?

Most patients can return to normal work and social interaction at ten days.