Rhinoplasty: A Comprehensive Guide to getting a Nose Job

What is a Nose Job (rhinoplasty)?

Rhinoplasty surgery involves the reshaping of the nose, changing the size, shape, or structure of the nose.

Sometimes, individuals confuse rhinoplasty, which is usually for cosmetic reasons, with septoplasty, the surgical correction of a deviated septum (crooked nasal passage) to improve breathing ability.

These two surgeries are also occasionally combined into one operation and recovery period, being performed simultaneously as a septorhinoplasty. The septoplasty portion of the procedure may be covered by Medicare or private health insurance.

Additionally, aesthetic rhinoplasty may also include alarplasty, which decreases nostril flare and narrows the nose.

If you are considering a nose job, you are hardly alone. The International Society of Aesthetic Plastic Surgery (ISAPS) reports that rhinoplasty is in the top 10 most popular cosmetic surgeries, with more than 6,800 Australians getting the procedure every year.

_{Melon Tip:}_{Rhinoplasty for different ethnicities requires different specialized skill sets. For the best results, your surgeon should have experience operating on patients of similar ethnicity to you. Having the ability to reshape and resize your nose while keeping proportional to face size and retaining your distinct features. To evaluate, make sure to browse the surgeon's before & after photos, looking for patients who look similar to you and were able to achieve your desired result.}

Expected nose job (rhinoplasty) results

A nose job (rhinoplasty) can be uniquely customized to each patient’s facial features and desired outcomes.

No matter what your personal reasons are for pursuing a nose job, this procedure can help you achieve the ideal nose for your face by:

Narrowing the tip of the nose to trim down a rounded nose
Changing the position of the nose tip (up or down)
Reducing a prominent nose bridge bump/hump
Straightening a crooked nose bridge
Reducing nose size and shape to balance facial features
Improving asymmetry

During the consultation process, surgeons should offer 2D simulations on how your new nose will look. Increasingly, doctors are also offering 3D modelling, permitting a more accurate representation of the final result.

As with all plastic surgery, make sure to bring pictures of your ideal outcome, allowing you and your practitioner to have a realistic discussion regarding goals and a proportionate natural look.

What are the pros and cons of a nose job (rhinoplasty)?

Pros

Patients who undergo rhinoplasty surgery report a high level of satisfaction with the end result.
Reshaping the nose can balance out facial features
A Rhinoplasty does not require an overnight hospital stay, so you’ll be home the same day.
The procedure is not painful (thanks to anesthesia), and recovery pain is also relatively mild, with patients commonly reporting just a congested stuffy feeling.
A septorhinoplasty can help correct nose structure and resolve breathing issues.

Cons

The procedure can be expensive, and Medicare & private health insurance may only cover the medical aspects of the surgery, such as airway valve collapse or nasal obstruction. A solely cosmetic surgery may not be covered.
Rhinoplasty is a major procedure, you will experience significant swelling and bruising for at least the first 14 days following the surgery.
During the first few days of recovery after rhinoplasty surgery, patients may experience nausea, vomiting and a sore throat.
One week after the surgery, a solid cast is required to be worn, which can be uncomfortable and make your nose feel congested.
It can take up to one year to see the final outcome of your rhinoplasty.
A revision rhinoplasty may be required if your nose does not heal correctly, or if you are unsatisfied with the outcome, an expensive and complicated reconstructive operation.

How much does a nose job (rhinoplasty) cost?

Average Cost: $11,500

Range: $4,500 - $20,600

The experience of the surgeon & anaesthetist, surgical supplies, and hospital venue are all factors in the final surgery cost.

As rhinoplasty is cosmetic surgery the costs are not covered by Medicare. However, if there is a medical concern involved e.g. septoplasty, Medicare may partially cover the costs.

Private health insurance may also partially cover the costs of a rhinoplasty depending on your policy and level of coverage. Most often this will only include hospital fees, everything else, unfortunately, will be an out-of-pocket expense.

What are the potential risks and side effects of getting a nose job (rhinoplasty)?

A nose job rhinoplasty performed by an experienced and skilled surgeon is considered a very safe procedure.

However, all plastic surgeries come with side effects and risks.

Swelling, bruising and possible bleeding are the most common side effects after rhinoplasty.
There is an increased risk of infection if significant cartilage grafting is required or if the incision is not kept clean throughout the recovery process.
Despite not being life-threatening, nasal passage obstruction is a more serious potential complication of rhinoplasty.
Another risk is septal perforation, where both sides of the nasal septum lining tear forming a permanent hole. A whistling noise may be heard while breathing if the tear is small. A larger perforation can act as a site for mucus to build up forming a crust. Additionally, septal perforations are also known to cause nosebleeds.

What is a nonsurgical nose job (rhinoplasty)?

Liquid rhinoplasty, or non-surgical nose jobs, use dermal filler approved by the Department of Health, Therapeutic Goods Administration (TGA).

The treatment only takes around 20 minutes with no downtime afterwards. Depending on the kind of filler used and how your body metabolizes it. Results can last from 6 to 18 months.

Possible outcomes from this minimally invasive procedure include:

Disguise bumps, particularly along the nose bridge.
Balancing an uneven nose to be more symmetrical.
Create a more prominent nose bridge by lifting and building up.
Change the shape of the nose tip, however, this is considered riskier.

Nonsurgical rhinoplasty has several limitations. Firstly, dermal filler injections can not decrease the overall size of your nose, though changes in proportion can give the appearance of a smaller nose. Injectables also can not fix a crooked nose bridge.

Nose filler injections also carry the potentially serious risk of vascular compromise, when blood flow is blocked after filler is accidentally injected into a blood vessel.

Who is a good candidate for nose job (rhinoplasty) surgery?

There are several factors to consider before deciding if rhinoplasty is right for you, these include your cosmetic, medical and budget requirements, as well as the ability to take up to 2 weeks off for recovery.

Specialists recommend that teenagers delay getting a rhinoplasty until their facial features reach full maturity, this is around 16 years old for girls and 17 for boys. It should also be noted that the Medical Board of Australia requires underage patients to undergo a mental health assessment and wait a 3 month “cooling off” period before any major plastic surgery.

There is no upper age limit for a nose job as long as the patient is in good health. However, increased precautions and safety measures are necessary for older patients, this includes a more detailed review of patient medical history and a more thorough health examination prior. After the age of 40, it is also not uncommon for patients to combine a nose job with their facelift.

According to a 2011 study (High Prevalence of Body Dysmorphic Disorder Symptoms in Patients Seeking Rhinoplasty), 33% of 226 potential rhinoplasty patients displayed moderate to severe symptoms of body dysmorphic disorder (BDD), a type of obsessive-compulsive disorder characterized by negative thoughts regarding physical features interfering with quality of life.

The results of a follow-up study in 2013 indicated a strong correlation between pre-operation BDD symptoms and patient result dissatisfaction. Please keep in mind that even after surgery, you may still not like your nose if you have untreated BDD.

Learn more about BDD here

What procedures should be considered together with rhinoplasty?

A chin implant or chin augmentation is commonly performed concurrently with a rhinoplasty. Patients who are dissatisfied with their side profile and feel their nose protrudes too much may find a chin implant helpful in addressing the issue. The combination of a nose job and chin implant result in some of the happiest rhinoplasty patients.

How should you prepare for a nose job (rhinoplasty)?

Taking a few steps before rhinoplasty surgery can minimize swelling and bruising, leading to faster recovery.

Your surgeon may recommend the following:

Stop using blood thinners, 1 to 2 weeks prior to your surgery, specifically nonsteroidal anti-inflammatories (NSAIDs), like ibuprofen and aspirin. Your surgeon should provide a comprehensive list.
In order to reduce bruising and inflammation after surgery, your surgeon may recommend using bromelain supplements or arnica cream.
Don’t smoke 4 to 6 weeks before and after your procedure.
Stop drinking alcohol at least 48 hours before surgery and keep abstaining for 2 weeks after.
Avoid consuming fish oil and vitamin E supplements, as these can also thin the blood.

The most important precaution before your rhinoplasty is strictly avoiding aspirin or ibuprofen and other medications containing them. These medications are known to cause bleeding issues during and after surgery. It is suggested to use alternative pain medication with Paracetamol as the active ingredient e.g. Panadol, or Tylenol.

For more comfort and healing, you will need to gather some recovery supplies prior to surgery.

Your surgeon should provide a complete list of essentials, but here are other common over-the-counter supplies that patients have found useful:

Antibiotic cream (typically provided by your surgeon)
Nasal allergy spray
Cotton Buds
Small lightweight ice packs
Baby wipes
A comfortable neck pillow to help you sleep upright more easily
Cough lollies
Dry mouth spray

_{Melon Tip:}_{Avoid using antibiotic ointments containing neomycin as these have a very high risk of severe skin reactions.}

Does a nose job (rhinoplasty) require general anesthesia?

There are two main types of anesthesia for rhinoplasty, you and your surgeon will decide on the best fit depending on procedure complexity and personal preference.

The anesthesia options are:

Twilight sedation, local anesthetic with IV sedation during which you are technically awake but extremely sleepy and comfortable.
General anesthesia, putting you under into a deep sleep-like state

Your practitioner should discuss the advantages and possible risks of each option during the initial consultation.

What happens during rhinoplasty surgery?

Firstly, you will be administered anesthesia to keep you comfortable during the operation.

In order to determine the areas that will be altered, the surgeon often draws guidelines on the nose with a pen, before making any incisions.

With nose surgery, there are two primary methods: open and closed.

Closed rhinoplasty is performed by making two small incisions inside each nostril, leaving no visible scars.
During open rhinoplasty surgery, to allow the surgeon full access to the overall framework of your nose, small incisions are made at the base of the nose between the nostrils and inside each nostril.

An open rhinoplasty scar may concern some patients, however, the incision is usually concealed well and only visible when you tilt your head back. Your surgeon’s skill and experience are the most important factors in achieving a good outcome. Despite this, an open nose surgery approach allows said surgeon to more easily modify the nose structure.

The desired result, facial structure and rhinoplasty technique utilised mean each surgery is unique, but it may involve:

Decreasing the size of a large nose tip by removing portions of alar cartilage using stitches.
Reducing nostril flare and slimming the nostrils by removing a small amount of tissue at the corner of each nostril (alarplasty).
Eliminating a nose hump/bump and narrowing the nose bridge by rearranging and removing nasal bones and cartilage (osteotomy).
Creating a straighter nose bridge or changing the tip of the nose by taking a cartilage graft from the ears, septum or ribs. Synthetic materials, such as silicone may be used instead of cartilage, though studies indicate this may lead to more complications.

Following the nose reshaping, dissolvable stitches are used to close the incisions.

During the first week of recovery, you will wear a cast or splint to secure your nose, which is to be removed at a follow-up appointment.

_{Melon Tip:}_{To absorb blood and help stabilize your new nose structure, some surgeons will fill the nostrils with cotton or gauze. Modern rhinoplasty techniques have reduced post-operation bleeding, making nose packing less common. Nonetheless, if your surgeon deems nasal packing necessary, they may also prescribe antibiotics to prevent the packing from causing infection.}

How long does rhinoplasty surgery take?

A nose job or rhinoplasty surgery generally takes 1 to 3 hours to complete and does not usually require an overnight hospital stay (outpatient basis).

A high-quality surgeon will spend time carefully creating the best result for your overall face and features.

What should you expect while recovering from a nose job (rhinoplasty)?

Patients typically, require two weeks to heal after rhinoplasty surgery. The majority of patients are able to return to work in 10 days.

As you recover from your nose job, you may experience swelling, bruising, and a blocked-nose sensation, but not necessarily pain. After a week has passed and your cast/splint has been removed, that clogged feeling should dissipate.

Here are several recommendations to reduce swelling during rhinoplasty recovery:

To reduce swelling and avoid bumping your nose post-operation, sleep on your back with your head elevated on a few pillows. At the 3-week mark, consult with your doctor before returning to your regular sleeping position.
During the first 48 hours ice your nose constantly with either lightweight ice packs or frozen peas. Stop icing after this period, as excessive icing can prevent healing.
As directed by your surgeon, apply topical arnica cream and take bromelain supplements
Eat liquid or soft, bland foods. For the first few days, stick to porridge, smoothies, mashed potatoes, low-salt soups or any other soft bland foods. Avoid anything salty and spicy for a week as they can increase bruising and swelling.
Your practitioner may recommend taping your nose at night to reduce swelling and help elevate the tip. This can involve placing a strip of tape across the nose just above the tip or taping the area under your septum, and then pressing the tape around the side of the nose.

These additional tips can help you recover and heal faster while optimizing for the best possible results:

Stop wearing glasses for the first 2 months post-surgery. If you must wear glasses, ask your surgeon to keep your cast after removal, then you can wear glasses on top of the cast the spread the weight out. Alternatively, you can also try taping your glasses to your forehead or propping them up on your cheeks.
Avoid using blood thinners 1-week post-surgery, especially nonsteroidal anti-inflammatories (NSAIDs), e.g. ibuprofen & aspirin, which increase bleeding risk.
Refrain from blowing your nose for a minimum of one week (and then only gently), to avoid compromising your result and disrupting the healing process.
When sneezing ensure your mouth is open and if possible avoid it altogether.
Keep your cast dry. Skin irritation and itchiness can occur when a cast is wet, when you are permitted to shower, cover your cast with cling wrap taped to your forehead.
Stop strenuous physical activities e.g. exercise and sex, until 4 weeks after your procedure. Make sure to consult your doctor before starting back up as well.
Steer clear of close contact sports, anything, where you may hit your nose, should be avoided for a minimum of 3 months.

_{Melon Tip:}_{If you experience excessive itching around your cast and a rash is visible, you may be allergic to the cast adhesive. This should resolve itself upon removal or your doctor may prescribe topical creams to reduce itchiness.}

How long does swelling last after a nose job (rhinoplasty)?

After rhinoplasty, your nose can still appear somewhat swollen for months.

After your cast is removed and you’re excited to preview your new nose, the early results will probably not look how you expected.

It is normal for the swelling to actually get worse several days after removing your cast. Don't panic, everything will be fine.

As a result of the nasal cast being moulded to the shape of your nose, soft tissue is compressed. A few days after the splint is removed, the absence of compression allows the nose to expand. It is important to understand that this swelling can cause the nose to look large or still have a bump, but this effect is not permanent.

The degree of swelling depends on your facial structure and the surgeon’s technique.

A variety of factors contribute to the level of swelling after rhinoplasty, such as the type of rhinoplasty (open vs closed), skin thickness, the amount of modification required to the nasal tip and variation in patient healing responsiveness. For the first few months after the operation, some patients may require taping and steroid injections in the nasal tip to minimize swelling.

Below is a realistic timeline of what to expect with rhinoplasty recovery and swelling.

2 weeks after nose surgery you will look normal enough to resume regular life. Bruising and swelling will have decreased enough for most patients to return to work, run errands etc. without anyone noticing that something is off.
3 months after, you will have a good indication of how the shape and size of your new nose will look. Besides the nasal tip, most swelling should have died down by now.
6 months after, the only remaining swelling should be slightly in the tip of the nose, and overall, roughly 90% of the swelling should be gone.
1 to 3 years post-operation, you will be able to see the final size and shape with all the swelling resolved.

If your nose has undergone significant alteration it can take a year or more for nasal tip swelling to settle. As the nose tip has the thickest skin, it takes the longest to heal and mould to the new nose structure.

Wait at least a year before considering revision surgery, particularly if you still have a large nose tip even after rhinoplasty or just want a smaller nose.

How do you clean your nose after a nose job (rhinoplasty)?

While uncomfortable, infections can be prevented by gently cleaning dried blood clots around your sutures.

Using a cotton bud dipped in hydrogen peroxide, gently remove dried blood from the nostrils, taking care to not pick at any scabs. To prevent the nose area from becoming irritated, apply antibiotic ointment or Vaseline after carefully removing the dried blood.

Some practitioners recommend using sterile saltwater spray to clean the nasal area. Clarify with your surgeon for their preferred method.

Infections are rare, however, you should consult your surgeon if you experience any fevers, increasing pain, redness, warm skin or drainage issues.

How long do nose jobs (rhinoplasty) last?

While surgical rhinoplasty results are permanent, the normal aging process will mean there are some subtle changes to your nose over time.

After you have healed and you are still unhappy with your results or have difficulty breathing you may want to consider revision surgery. The most common reason patients are unhappy with results is because of the effects of scar tissue.

Unfortunately, as scar tissue forms it can change the shape of your nose, pulling it one way or another, turning it in etc. When this occurs, the surgeon needs to revisit their work.

These issues were more prevalent with older rhinoplasty techniques which left the nose structure relatively weak and more susceptible to movement caused by healing and scar tissue. However, modern techniques provide a higher degree of structural integrity, which may mean the nose is stiffer early on but will retain its shape and resist scarring better.