Dr. Phillip Chang M.D.
Everything You Need to Know About
Surgical Nose Reshaping
From one of Northern Virginia's Premier Plastic Surgeons For the Cosmetic Appearance of Your Nose
Reshaping the nose is the third most common plastic surgery procedure next to breast augmentation and liposuction. Rhinoplasty surgery is the medical term for reshaping the nose, whereas “Nose Job” is the most common term.
About 218,000 nose jobs were performed in 2017 according to the American Society of Plastic Surgeons database. 75% of nose jobs were performed in women. 14% of nose jobs were performed in patients between 13-19 years old and 50% were performed in patients between 30 and 40 years old.
What Nasal Features Can be Changed with a Rhinoplasty?
You are a good candidate for a nose job if you are over 16 years of age and otherwise healthy. Facial growth and maturity should be complete. Many patients will seek out a consultation for reasons related to trauma and some patients will come in for breathing difficulties. Most patients, however, have cosmetic concerns about the natural appearance of their nose.
Common Complaints About the Nose and Their Treatments
Nasal hump – A nasal hump is one of the most common complaints of patients coming in for evaluation for a nose job. People usually prefer a straight or a slightly scooped nasal tip. The nasal hump is more of a middle eastern feature, made up of bone and cartilage. The hump is usually taken care of by introducing a rasp through a closed rhinoplasty procedure if a nasal tip surgery is not needed and an open rhinoplasty of the nasal tip is required.
Shallow nasal height – A flat nose is often a feature of Asian patients or patients of color. Their nasal bones are shallow and their nasal tips tend to be broad or bulbous. Non-surgical rhinoplasty can often be useful in these patients. Injectable fillers, including Juvederm or Voluma, can be injected directly onto the nasal bone to provide the nose with more height. Filler can also be delicately placed over the nasal tip cartilages to give the tip more definition. A more permanent solution would call for a nasal implant or cartilage graft. Either of these materials can be used to be placed over the nasal bones to give it more height.
Bulbous nasal tip – A bulbous nasal tip is caused by wide and separated nasal tip cartilages. A wide nasal cartilage can be made more narrow and separated nasal tips cartilages can be sutured together in the midline. Intercartilaginous and intracartilaginous sutures can be placed to provide more narrowing and more definition. These delicate maneuvers are better performed using an open rhinoplasty technique where the cartilages can be directly visualized.
Large or wide nostrils– Wide or flaring nostrils can be treated with a Weir excision. This procedure takes a wedge out of the base of the nostril arch. The nostril is brought into the nasal crease to hide the scar and narrow the circular edge.
Wide nasal bones– Wide nasal bone are fixed by breaking the nasal bones at their base followed by pushing them together toward the midline. This is performed with a narrow chisel through a very small and almost invisible incision. Lowering the nasal hump and narrowing the nasal bones are the two major reasons why the external splint is needed after a rhinoplasty.
Hanging columella – A septoplasty is a procedure to fix a deviated septum. The septum is the cartilage that separates the two nasal cavities. The septum is naturally straight but it can deviate with time or after a traumatic injury. The deviation can sometimes result in closing off of one of the nasal cavities, making it difficult to breath. If this is the case, the part of the septum that is curved or causing the breathing problem can be removed.
Approach to Cosmetic Nose Reshaping Surgery
This Section Describes Dr. Chang's Strategy For
Treating A Nose Cosmetically
The goals of a nose job is to reshape the nose to give a more pleasing appearance. This can be performed non-surgically using injectable fillers or surgically through either an open rhinoplasty technique or a closed rhinoplasty technique. Most surgical procedures are performed at the surgery center under general anesthesia. Some minor issues can be treated in the office under local anesthesia.
Close to 50 percent of patients may not actually “need” surgery. Their cosmetic concerns can be addressed using a nonsurgical nose job using fillers. This option will be discussed later on this page.
The 3 Cosmetic Options To Treat A Nose:
- A Nonsurgical Nose Job (Also known as a liquid nose job)
- Open Rhinoplasty
- Closed Rhinoplasty
The choice of procedure depends on several factors including: defining the features that you want to have addressed, your willingness to have a less than permanent result, and your tolerance for the complications and recovery for surgery. When you come in for your consultation, the first thing that we will do is discuss your cosmetic complaints. The nature of the complaints will determine whether a nonsurgical option is possible. And if it is, you will need to decide whether you would prefer to have a nonsurgical nose job or a surgical nose job. And if you would prefer to have a surgical nose job, we will discuss the benefits of whether you would benefit more from an open rhinoplasty or a closed rhinoplasty.
How To Know If You're A Candidate For A Nonsurgical Rhinoplasty
- You are open to a result that will last only 1-2 years (fillers will last up to 2 years).
- You have a flat nasal bridge.
- You have a broad or bulbous nasal tip.
- You have a cleft nasal tip.
- You have a minor bend or depression of the nasal cartilage as is seen after some nasal surgeries.
Before Nonsurgical Rhinoplasty
After Nonsurgical Rhinoplasty
How To Know If You're NOT A Good Candidate For Nonsurgical Rhinoplasty
- You are looking for a permanent solution to your cosmetic nose complaints
- Your main complaint is a nasal hump or bump over the nasal bridge
- Your main complain is a very broad or bulbous nasal tip
- You are looking to narrow the nasal bones or nostrils
You Are A Better Candidate For A Surgical Rhinoplasty Option If:
- You are looking for a permanent solution to your cosmetic nose complaints.
- You are open to a recovery that will require you to be out of work for at least a week.
- You are open to the surgical recovery and potential complications.
- Your main complaint is a nasal hump or bump over the nasal bridge.
- Your main complain is a very broad or bulbous nasal tip.
- You are looking to narrow the nasal bones or nostrils.
Cosmetic Options To Address the Appearance Of Your Nose
Non-surgical rhinoplasty – Non-surgical rhinoplasty is a technique that Dr. Chang pioneered in Virginia in 2001. He is an expert injector who has treated thousands of patients using this technique. It is ideal for patients with flat nasal bones, small nasal humps, small depressions, and wide nasal tips. The procedure is performed by strategically injecting fillers and provides immediate results that can last up to 2 years. In many cases, this procedure allows patients with minor issues to avoid the time, risk, and expense of surgery. See our page on non-surgical rhinoplasty procedures.
Closed Rhinoplasty – The two major surgical techniques for performing a nose reshaping procedure are the closed and the open rhinoplasty techniques. Dr. Chang performs both depending on the nature of your issues. Closed procedures have no visible external scars. An incision is placed inside the nose and all the work is performed using this incision. This procedure is ideal for patients who do NOT need work on their nasal tip cartilages. It is ideal for patients who only need work to either reduce a nasal hump or narrow the nasal bones.
Open Rhinoplasty – The two major surgical techniques for performing a nose reshaping procedure are the closed and the open rhinoplasty techniques. Open rhinoplasty procedures are performed using incisions inside the nose that extends to a surface incision at the bottom of the nose on the columella. This incision is used for patients who require work on their nasal tip cartilages either to refine the tip, narrow the tip, or to make it smaller. The nasal bones can also be addressed through this incision.
Nostril Narrowing (Wier Excision) – This procedure is performed to reduce a large or flaring nostril.
Septoplasty– A septoplasty is a procedure to fix a deviated septum. The septum is the cartilage that separates the two nasal cavities. The septum is naturally straight but it can deviate with time or after a traumatic injury. The deviation can sometimes result in closing off of one of the nasal cavities, making it difficult to breath. A septoplasty can be performed to remove the part of the septum that is curved or causing breathing problems at the same time of your rhinoplasty.
What are the steps to performing a Surgical Rhinoplasty?
STEP 1. SURGICAL CENTER
Surgical rhinoplasties are performed at the surgery center under general anesthesia.
STEP 2. ANESTHESIA
A long-acting anesthetic (Marcaine) is directly injected to provide long pain relief even at home.
STEP 3. INCISIONS
Incisions are made inside your nostrils for a closed rhinoplasty and joined for an open rhinoplasty.
STEP 4. HUMP REDUCTION
The dorsal hump is reduced mostly with a rasp (similar to a nail file).
STEP 5. HUMP REDUCTION
The nasal tip is reduced and narrowed for broad or bulbous tips.
STEP 6. SIDES JOINED
The two sides of the nasal tip cartilage are joined in the middle to narrow the width of the tip.
STEP 7. BONES BROKEN
The nasal bones are broken to narrow the width of the bones if they are too wide.
STEP 8. SEPTOPLASTY
Septoplasty is performed if necessary.
STEP 9. EXCISION
Wier excision is performed to narrow the nostrils if they are too wide.
STEP 10. MORE MEDICINE
More numbing medicine is injected to give prolonged pain relief at home.
STEP 11. SPLINT PLACED
External nasal splint is placed to keep all the pieces in place and reduce swelling.
STEP 12. PACKING
Internal packing is placed.
*** The nose will look acceptable in 1-2 weeks
*** Final results will not be seen for 6 months to a year
*** Revisions may be required in up to 10-20 % of patients. Revisions will not be performed until at least 6 months to a year.
Examples of Dr. Chang's Work:
A 23 year old female who came in for a general consultation looking for options. Her main concern was that her nose was “too big.” Upon examination, it was revealed that she had a large over all size, a long nose, a dorsal hump, and a very prominent nasal tip cartilage with a cleft between the left and right cartilages. In addition, she also had a deviated septum. Her corrective surgery included both cosmetic and medical techniques.
She had an open rhinoplasty, dorsal hump reduction, reduction of the nasal tip cartilage as well as joining the left and right cartilages (inter and intracrural sutures), elevation of the nasal tip by adjusting the septal tip angle and height as well as adding a columellar strut graft, and straightening the nasal dorsum with spreader grafts. Her splint came off after 9 days. You can see the visible improvement in the size and shape of her nose in the before and after photos. The procedure was performed in our Leesburg, Virginia Surgical Center under general anesthesia.
What I loved most about the surgery was that I performed the exact same surgery on her twin sister.
20 year old woman from Leesburg, Virginia. This patient was unhappy with the size of her nose as well as the nasal hump. An open rhinoplasty was performed to reduce the size of the hump and crease a sloping nasal profile that fits the size of her face better. Lateral osteotomies were performed to narrow the nasal bones, the tip cartilage was narrowed, and the tip was elevated. The splint was removed after just 5 days. She was thrilled with her result and how minimal the downtime was.
Why Dr. Chang and Aesthetica?
Dr. Chang Is Nationally Recognized As One Of The Best Plastic Surgeons By The Washington Post And Loudoun Times Mirror
- Voted Top Doctor and Best Plastic Surgeon in Northern Virginia
- Lectures on Facial Aging and Mini Facelift Techniques
- Published and contributor to New Beauty Magazine
- Board Certified by the American Board of Plastic Surgeons
Ask Dr. Chang About Surgical Rhinoplasty:
The cost of rhinoplasty varies based on what technique is used and how complex your procedure is. Before estimating costs, Dr. Chang will listen to your concerns and goals to help develop your custom treatment plan. When this is done, he can discuss costs for the facility, anesthesia, and more. For your best results, it’s important to focus on selecting an experienced surgeon, like Dr. Chang, instead of the lowest cost.
The cost of a rhinoplasty depends on the technique Dr. Chang chooses for you. The prices listed below are subject to change. Combined procedures are often discounted dramatically. (Please keep in mind facility center fees are only estimates.)
- Surgeon’s fee – Open rhinoplasty – $7,500
- Surgeon’s fee – Closed rhinoplasty – $6,500
- Surgeon’s fee – Nostril reduction – $2,000
- Surgeon’s fee – Cartilage graft from the ear – $2,000
- Surgeon’s fee – Septoplasty – $2,000
- Surgery Center Fees – $ 2,000
- Combined procedures are usually discounted
- VIP Members may have a discounted rate
We do not accept insurance at our office. However, functional rhinoplasty that is medically necessary to improve your breathing may potentially be covered. If you may be applying for reimbursement from your insurance, please tell Dr. Chang in your consultation. We can help you submit any needed information and paperwork to your insurance to process your claim.
If you want to smooth lumps and bumps on your nose, a wrinkle filler (like Juvéderm) might be an option. A filler can temporarily improve minor imperfections, which might help you decide to get a rhinoplasty. Nose surgery is better for larger changes, long-lasting results, and to adjust the internal structure for better function. At your consultation, Dr. Chang can tell you more about nonsurgical nose reshaping.
Ethnic rhinoplasty is about improving the nose while still keeping your cultural identity. This is often a concern if you are African-American, Asian, or Middle Eastern. In your consultation with Dr. Chang, you can talk about what you want to keep and what you want to change. This will allow him to personalize your treatment plan to give you the best results.
Some patients think about combining rhinoplasty with another procedure, like cheek or chin augmentation. Having multiple surgeries for a dramatic result can be reviewed during your consultation with Dr. Chang. Once he understands your goals, he can help you choose which procedures will be in your custom plan. Rhinoplasty can help your whole face appear more balanced, so we advise that you should wait to see your results before getting another procedure.
“Rhino” means nose, and “plasty” means to shape, mold or form. So rhinoplasty is a procedure that reshapes the nose to improve facial balance and appearance.
The two major surgical techniques for performing a nose reshaping procedure are the closed and the open rhinoplasty techniques. The scars or incision are placed inside the nose and all the work is performed using this incision. Closed procedures therefore have no visible external scars. This procedure is ideal for patients who do NOT need work on their nasal tip cartilages. Closed Rhinoplasty is ideal for patients who only need work to either reduce a nasal hump or narrow the nasal bones.
An open rhinoplasty is most appropriate for patients looking to change the appearance of the nasal tip. This would be true for patients wanting to address a “bulbous” nasal time or tip that is too pointed or crooked. The procedure uses the internal incisions used for the closed rhinoplasty but that are joined in the middle under the columella. This very small incision allows the surgeon complete and dramatic visualization that is not possible with a closed rhinoplasty. As mentioned above, a closed rhinoplasty is mostly a “blind” procedure performed by touch and feel.
Direct visualization of the nasal framework allows maximum diagnostic accuracy as well as precision for modification. This approach is especially useful for patients who require complex changes or those with challenging anatomy such as revision rhinoplasty, where the tissues have been previously altered. The trade-off is that open rhinoplasties require longer healing times as the nasal tip will swell for longer.
As you can see, both procedures have their pros and cons. Dr. Chang performs both procedure depending on your exact needs.
As with any surgery, there are associated risks. Only you can decide whether a nose job can achieve your goals and if the recovery and risk profile are acceptable to you. National statistics show that revisions after nose reshaping is required in 10-20 percent of all patients. Fortunately, most revisions are minor. The most common complications are problems with delayed healing, infection from the stitches, minor tissue loss in areas of delayed healing, and widened or thickened scars and the need for more surgery.
Although infrequent, the risks and complications of plastic surgery after nose job can include:
-Bleeding, hematoma, or bruising
-Infection particularly from the absorbable sutures
-Change in sensation
-Widened or thickened scar especially in patients of color
-Delayed wound healing or tissue necrosis
-Under-correction or Over-correction
-Unsatisfactory results that may require additional procedures (Patients are responsible for any associated facility fees)
Although patients will look presentable almost immediately, final results of nose reshaping are not usually seen for at least 6 months to a year. This is particularly true of the nasal tip. The nose will continue to change until the tip cartilage feels soft to the touch.
-Moderate swelling for up to 3 months
-Mild swelling for 6-12 months
-Revisions are NEVER performed except under special circumstances (only performed up to 12 months of procedure)
Recovery after rhinoplasty surgery or nose reshaping surgery comes in different stages. The elements include:
- Most patients will be “mentally capable” of work in 3-5 days
- External splint ( if needed ) is removed in 7-10 days
- Internal splint ( if needed ) is removed in 7-10 days
- Nasal packing is removed in 2-3 days
- External sutures are removed in 7-10 days
- Internal sutures are absorbable by may need to be addressed in 7-10 days
- Clean suture line with peroxide IF there is crusting and then apply ointment 2-3x per day
Recovery after a nose job depends on what kind of procedures were performed. Contrary to popular belief, nose reshaping procedures are not particularly painful and most patients will only need narcotic pain medication for more than a day or two.
- If a nasal hump or osteotomy ( to narrow the nasal bones ) is performed, an external splint is on for 7-10 days.
- If a septoplasty is performed, internal septal splints are placed for 7-10 days.
- If a septoplasty is not performed, the nosed is packed with a non-stick dressing for 2-3 days.
- Some minor bleeding is expected for 1-3 days.
More Pages On Facial Rejuvenation Topics
Forehead and Temple Lift
Forehead and Temple Lift procedures are designed to elevate the brows. Falling brows contribute to the heavy feeling in the upper eyelids which may also close off the eyelids
Neck lift surgery elevates the neck. Common concerns include the extra skin below the chin, the platysma muscle bands that split in the front of the neck, and neck fat. The procedure is commonly, but does not have to be, performed with a facelift surgery
Nose reshaping is often called a nose job. The medical term for nose job is a rhinoplasty. The the nose can be reshaped surgically or may often be performed with facial fillers. Common concerns include the nasal hump and a large nasal tip
Facial fillers are injection products that can add volume to areas that are lost with aging. Common options include Juvederm, Voluma, Sculptra, Radiesse, or your own fat for transfer.
Are you ready to talk about your nose?
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Finding The Best Plastic Surgeon in Virginia
Dr. Phillip Chang is a leading plastic surgeon in Loudoun County who specializes in surgical and nonsurgical cosmetic procedures for the breast, body, face, and skin. He is board certified in plastic surgery by the American Board of Plastic Surgery and is the founder of Aesthetica Cosmetic Surgery & Laser Center in Leesburg, VA. Dr. Chang believes combining attentive care and minimally invasive techniques is the best avenue for achieving beautiful, natural-looking results.
Visit his office in Leesburg, Virginia in Loudoun County or fill out the contact form below for more information on how we can help you with your plastic surgery plans.
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