Rhinoplasty is the surgery of the nose to either thin, turn up, augment, shorten, elongate or otherwise refine and bring harmony to the face through its alteration.  It is also known as a nose job and may include Septoplasty to restore or otherwise introduce functionality as well improve breathing. Your surgery may only include  rasping of the dorsum to remove a hump or an infracture to thin the width of the nose.  Rhinoplasty is a surgery which is very individual and tailored to the needs and aesthetic tastes of the patient. 

Rhinoplasty is a very common procedure.  You would be surprised how much a little thinning or up-turning of the nose can soften or balance a face.  Sometimes Rhinoplasty is combined with a chin augmentation to better proportion the face if needed.  Although every case is individual and properly consulting with surgeons can help you understand what may be needed to reach your goals.

Reasons for rhinoplasty can be few or many. It is important to know what can and cannot be changed and what rhinoplasty can and can not do for you. Just remember, be sure to have proper communication with your surgeon - it is easier to take away than to add after the fact.

We will cover the most common reasons for rhinoplasty - both realistically and irrationally. We will start with the common complaints regarding physical attributes.

typical complaints:

• too large

• too flat

• too humped

• too wide or fat

• too thin

• too long

• too short

• too pinched looking

• scooped

• hanging columella

• breathing problems

• crooked

• asymmetry, in general

• bumps

• a bifid (BEYE-fid) tip (where there is a ditch between the two tip cartilages, sometimes horribly referred to as "buttnose")

• dents

• scar tissue build up from breaks

• hooked

• "piggish"

• pointy

• bulbous

• not angled enough

• angled too much

• career advancement (borderline)

Non-typical, irrational or unhealthy thinking:

• wanting more 'dates' or to attract a mate

• gain popularity

• Body Dysmorphic Disorder (BDD) or other self image disorders

• low self esteem due to emotional issues without apparent reason

• weight problems

• eating disorders

• deficient chin

• deficient jaw/mandible

• weak or prominent maxilla (upper jaw)

• for someone else

• career advancement (borderline)

Of course we will probably not see eye to eye if the above is true regarding the wrong reasons -- but I thought I should mention it should it be a possibility. Just be sure that you are doing it for yourself and not to try and trick yourself into thinking that you want it for the right reasons rather than the wrong ones -- it will save you MUCH grief in the future. Not to mention thousands upon thousands of dollars and worst case scenarios.

More Than Aesthetics:
Breathing Problems, Rhinorrhea, Turbinate Problems

Of course the primary function of the nose is to breathe efficiently and comfortably. Unfortunately, this isn't always possible. Many people are afflicted with breathing problems, both during the day and at night, at play and at rest - it is a reality. This can cause many persons to experience anxiety, depression and even anti social behavior due to not being able to participate in sports or other high or medium impact activities. 

There can also be problems where scar tissue not only partially or fully blocks the airways but can make it to where the air is forced through these hills and valleys caused by cars tissue and causes "whistling" or others loud sounds. This can be both embarrassing and cumbersome to the patient. 

There can also be what is known as rhinorrhea, which is what I have. This is where the turbinates, mucous membranes or sinuses produce an excess amount of mucous or fluid that drips constantly. Mine is caused not by standard inflammation or irritation from allergies but by damage to the concha media, or middle turbinate. This can happen due to scar tissue, during the breaking of the nasal bones, surgical instruments or just plain bad luck. It happens. And although it is VERY common to have rhinorrhea for many months after a rhinoplasty - at the time of this entry, it has lasted me almost 3 years.

rhi*nor*rhea
: excessive mucous secretion from the nose (Merriam-Webster Medical Dictionary)

Rhinorrhea Rhinitis is another disorder that can cause discomfort but is usually due to inflammation from allergies. Although the symptoms usually addressed by rhinoplasty, septoplasty/turbinectomy are due to mechanical obstruction.

How a Rhinoplasty Is Performed

If you are having your nostrils narrowed you may have two incisions one on each side where the nose meets the face and forms a crease. The surgeon will normally take care to make the scars as inconspicuous as possible. Sometimes only incisions on the floor of the nose are made to bring in the nostrils.

If the nasal bone structure needs thinning you will have incisions leading up through the cartilage into the bridge of the nose so that a chisel like tool, called an osteotome, can be inserted and tapped manually with a rubber mallet (rubber hammer). This may take a few (usually no more than 8 sets of two, but this is highly individual) taps to break the nasal/facial bones precisely. The surgeon does not just clumsily break your nose with a hammer -- it is precisely carried out. If a hump is present, an osteotomy (where bone is divided or removed) is performed; t he dorsal hump can be rasped (filed down).

After the bones are broken, they are moved together to form a narrower nasal area as well as a little more projection, if needed. After all the reduction or infracture/outfracture methods have been carried out, the incision lines are then sutured and you may or may not  have packing inserted. Your nose is then taped and a cast made from plaster, metal or more commonly, plastic, is applied to the nose to protect it and help it retain its new shape during the healing phase. The bones fuse together quite rapidly but refrain from contact sports until you receive the 'okay' from your doctor.

Risks & Complications Associated With Rhinoplasty

 It is possible to develop tiny red marks and spots, this can be the result of blood vessels that may have burst under the skin's surface during the surgery. Although this is extremely infrequent it can happen and the spots may not ever go away. Scarring is minimal if the incisions are made inside of the nose, however when an open technique is used, or if extensive narrowing of the nostrils is desired the scars made on the outside of the nose may be quite visible for an undetermined amount of time (Usually until maturation). Even when a highly skilled surgeon performs your surgery, sometimes your body may not heal correctly or have adverse reactions causing undesired results. If so it is quite possible that additional surgeries may be needed. Some patients will lose their sense of smell, temporarily. Your nose may be swollen and for up to a year -- and in some patients over that period. In rare cases, the scar tissue may heal in a way that may cause a whistling sound to be heard when you breathe in and out.

This surgery has the highest rate of revisions. This surgery is considered to be a type-changing surgery. It seems that some patients, especially mature patients, may not readily accept the new look. Being accustomed to their old nose they just can't seem to comfortably make the transition. 

Depression After Rhinoplasty?
It has been reported that disrupting the sensitive receptors such as the Turbinate structure -- 3 flexible spongy, yet meaty flaps which moisten and control the temperature of the air which you breathe -- in the nose can lead to minor disorientation and depression for several weeks and sometimes months after rhinoplasty or Septoplasty. Unfortunately, there is no sure fire way to know that this is the reason for uneasiness as you could generally be depressed due to being psychologically unable to accept your bruises and discolorations or swelling. As well as disliking the shape of your new nose.

If anything you must remember that your rhinoplasty takes about a year to fully refine although most of the swelling that others may notice, dissipates in a few months. Please be sure to choose your doctors wisely when it comes to rhinoplasty as secondary (revision) surgery is more difficult to perform due to scar tissue and less tissue to work with in general. In other words, it is easier to remove than to replace.

It is possible if you have a Rhinoplasty, Septoplasty or Turbinectomy that the Turbinate structure can be harmed. Be sure that your doctor advises of you of the risks and complications resulting from rhinoplasty and even though rare, Turbinate damage is possible.

Rhinoplasty Procedure Costs in North America

The costs of rhinoplasty varies significantly between surgeons, medical facilities, and regions of the country and world. Patients who need additional or more extensive surgery will require more intensive and expensive treatment. In non-private surgery centers or in-office Operating Rooms the prices may include the following. However, in hospitals - surgery charges can usually be separated into five parts: 

1. the surgeon's fee

2. the anesthesiologist's fee

3. the hospital charges, which includes nursing care and the operating room

4. the medications

5. and any additional charges that may arise

All fees are averages; out-patient charges, including surgeon fees, anesthesia, Operating Room charges, and implants if applicable - unless otherwise noted.  Lab fees, such as "blood work", are normally an extra $35. - $75., plus medications are usually an additional $120. Physicals are more, HIV tests are additional and any other fees that you may be responsible for (X-rays, etc.). If you are to be staying in a hospital or are opting for home healthcare - these expenses are additional. This factor really depends upon the region, surgeon, etc.

• Primary open rhinoplasty $3,152. - $6,500.
• Primary closed rhinoplasty $2,879. - $6,000.
• Primary Septoplasty/Turbinectomy $3,500. - $6,500.
• Secondary open rhinoplasty $7,000. - $9,000.
• Secondary closed rhinoplasty $2,643. - $10,000.; with implant: $2,500. - $10,200. 

* Please note the prices charged for surgeries represented in the documentations of the links above are representative of what an American doctor would normally charge. Of course, our fees are lower but our doctors are more experienced because more patients come to us due to the affordable prices. Thus, the doctors work on more cases (especially oriental patients and many Caucasians).