The results are usually permanent, aside from normal changes that come with the aging process. If you’re really not happy with your results or have breathing difficulties once your nose has healed, you may be a candidate for a revision rhinoplasty. In many cases, scar tissue is the main culprit. “The force of a scar is very strong,” says Dr. Miller. “It can pull a nose one way or another—push it in, pull it out, turn it.” When this happens, a surgeon has to go back in and tweak the work.
A few weeks before your surgery, you will meet with the surgeon to discuss your personal goals and plan out the procedure. You will also have follow-up appointments post-op to monitor your progress. After surgery, you will need ice packs, gauze and certain pain medication for pain management purposes. All of these pre and post-op appointments and supplies are necessary to take into account when determining what the overall cost of the procedure will be. Be sure to ask your surgeon’s office whether appointments and supplies are included as a package cost and what, if any, additional supplies you may need to buy as you recover from your nose job.
You can also ask to see before and after photos and testimonials from past patients. In addition to making sure your surgeon is highly experienced, you should feel comfortable talking to him or her. Do you feel the surgeon is hearing you and understanding your goals for the procedure? Establishing a rapport with the surgeon is extremely important to ensure that you get the results you want.
A rhinoplasty reshapes your nose, changes the shape of your nostrils, removes a bump or corrects an injury to the bridge of your nose, or addresses other issues, such as breathing problems. In some cases, people choose to have a nose job in order to correct a defect in the nose that makes it difficult to breathe. In short, a good nose job is one that achieves your personal vision for the surgery and doesn’t require additional procedures.
Once your bone and cartilage have been resculpted, your surgeon pulls the skin back down and stitches it along the open-rhinoplasty incision across the columella (the tissue that links the nasal tip to the nasal base). “When done properly, that incision is extremely hard to see, once it’s healed,” says Dr. Miller. With a closed procedure, the incisions are made inside your nostrils, so there’s no visible scarring, and the sutures are usually dissolvable.
Facial plastic surgeons and board-certified plastic surgeons are the specialists to go to for nose surgery. Facial plastic surgeons do their residency training in otolaryngology, or head and neck surgery, followed by fellowships in facial plastic surgery. Facial plastic surgeons should be certified by the American Board of Facial Plastic and Reconstructive Surgery. Plastic surgeons do their residency training in general surgery followed by a fellowship in plastic surgery. They should be certified by the American Board of Plastic Surgery.
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Hospitals are the most expensive choice of facility. In Manhattan, fees can reach $6,000 and beyond for a single procedure. Though it is the most costly option, a hospital is also the best equipped to facilitate surgery involving a patient who is prone to excessive bleeding, or has other conditions that increase the risk of complications. You can expect your doctor to closely examine your medical history to determine if surgery in a hospital is necessary.
“I’ve found that sometimes MRIs are not actually very reliable. In some instances, a patient’s MRI said the silicone gel implant had ruptured, and then when I went in to operate on it, it actually hadn’t. I’ve had one or two patients where an MRI showed the implant wasn’t ruptured, but based on my clinical exam I really thought there was a concern, so I went in and it turned out it was ruptured.”
Some people opt for a temporary nonsurgical nose job—also called a liquid rhinoplasty—with hyaluronic=acid-based injectable fillers, like Voluma or Restylane Lyft. This minimally invasive procedure can camouflage bumps, create more symmetry, or lift and build up the tip of your nose. This approach has its limitations though. “If you have a large nose, it’s not going to get any smaller with fillers,” says Dr. Miller, though changes in proportions can sometimes make it appear smaller. It also can’t fix a crooked nose.