Nose Job Guide: Before & After Your Rhinoplasty Surgery

Considering a permanent way to transform the size, shape, or appearance of your nose? You're not alone. In fact, the 2017 Plastic Surgery Statistics Report by the American Society of Plastic Surgeons lists the procedure as the third most popular cosmetic surgery, with 218,924 recipients. If you're considering joining them, here's everything you need to know about rhinoplasty — initial consultation to the post-op.

Consultation Prior Surgery

Commonly referred to as a nose job, rhinoplasty is a procedure that "sculpts the shape of the nose externally for cosmetics, and internally for breathing," says Dr. Sidle, a board-certified plastic surgeon in Chicago. The goal, he says, is to give a "natural look to the nose, as if it was never touched, that balances the patient's face perfectly."

The first step in the rhinoplasty process for prospective patients begins in the office of a board-certified plastic surgeon for a thorough consultation. Following paperwork and initial photographs, the surgeon chats with the patient about any cosmetic concerns and "studies the inside of their nose for breathing issues," says Sidle. "I then morph the patient's photos on the iPad directly to show them the intended goals of the surgery."

Patients may also be shown other patients' before-and-after photos for noses that are similar to their own size and shape. "If they are a good candidate, I let them know. If they aren't, I also let them know," says Sidle. "It's the most honest 30 minutes of their life."

Male Rhinoplasty

Male rhinoplasty is becoming highly publicized by many cosmetic clinics as an excellent option to improve men’s looks and masculinity. Although rhinoplasty offers many long-lasting benefits, it is still important for the surgeon to remind his patients of the critical considerations that he must take note of even before undergoing the procedure, like the risks and complications, the recovery period, and the downtime the surgery would entail.

The ideal candidate for the nose job

• Dorsal hump: A bump at the bridge of the nose
• Nasal width: A nose that is too wide or too narrow
• Asymmetry: A nose that is twisted or deviated
• Prominent nasal tip: A nasal tip that is round, bulbous, fatty, or disproportionate to the rest of the face
• Drooping nasal tip: The angle between the upper lip and lower nose that is less than 90 degrees
• Post-traumatic deformities: Shape aberrations after nasal injury
• Nasal airway problems: Internal valve collapse and septal deviation

Key factors that also help determine the ideal candidate include nasal maturity (if the nose is mature enough — usually over the age of 15), emotional maturity (patients thoroughly understand implications, risks, and purpose of the surgery), having realistic expectations (understanding both goals and limitations of the procedure), and an absence of body dysmorphia.

The last on that last, Sidle explains, is something lots of patients have issues coping with. "We all to some extent, but some cross the normal spectrum," says Sidle. "It's our duty as surgeons to counsel them and avoid letting patients guide us into wrong ethical decisions."

Preparation for rhinoplasty

Like any surgical procedure, preparation is helpful for both a smooth surgery and recovery. To help reduce things like swelling, bleeding, and bruising (especially in patients who travel via plane for the procedure), Sidle recommends a "strict regimen of [applying] arnica [a homeopathic herb that can help decrease bruising and pain] preoperatively, as well as avoiding caffeine, alcohol, and smoking one month prior to surgery."

Rhinoplasty surgery procedure

Nose job surgery is typically performed on an outpatient basis and can be done in one of two ways: open or closed. Both approaches involve incisions being made within the internal nostril region, but the open rhinoplasty approach adds an external incision (a few millimeters) on the undersurface of the columella (i.e. the tissue that divides the nostrils).

That external cut leaves a permanent scar, says Sidle. The skin of the nose is then "undraped" so that the inner structures of the nose become visible. "This allows you to do massive changes to the nose and take things apart more readily and reconstruct the nose," says Dugar. "This is necessary for botched or revision noses, or noses with very difficult anatomy."

With closed rhinoplasty, "all of the incisions are made inside the nose, which means no external cuts and no risk of scarring," Sidle says. It is through these internal incisions that the nose is then shaped and sculpted for subtle changes. "We don't alter the face, yet we soften and improve the overall balance," he says of the procedure.

Ultimately, the plastic surgeon will select the most appropriate rhinoplasty incisions based on the specific structural modifications required for the patient.