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Home/Facial Plastic Surgery/Rhinoplasty

Rhinoplasty or Nose Reshaping can take the form of reconstructive surgery, aesthetic surgery or a combination of both. The cosmetic aspect of rhinoplasty surgery usually involves the appearance of the nose, including changing the tip and/or dorsum and their relative proportions. The reconstructive component is correction of a nasal septal deformity or nasal turbinate surgery.

If you are considering surgery to change the shape of your nose, the current options are much greater than ever before. Rhinoplasty surgery has advanced in recent years, giving both plastic surgeons and patients many more options.  Computer imaging has greatly enhanced the ability to customize cosmetic rhinoplasty surgery. Dr. Miguel Delgado can give you a realistic “before and after” image of the proposed outcome. This is an excellent communication technique. Through an analysis of facial proportions and angles, one can better fit one’s nose to the facial anatomy. Today, the emphasis is on individual customization. All noses should not look the same.

Procedure What It Does Surgery Recovery Results
Rhinoplasty
Changes the shape and size of the nose
Yes
7-10 days, avoid certain activities for 4-6
Long-lasting*
Chin Implants
Improves facial symmetry and defines jawline
Yes
7-10 days
Long-lasting*

*Results may vary.

The advancement of the “open approach” to nasal surgery has greatly improved the outcome of nasal surgery. With this technique, one is able to see the anatomy that needs to be changed as opposed to operating with the skin sleeve attached and distorting the anatomy. However, closed rhinoplasty continues to be a popular technique for more simple and straightforward procedures.

Indications

Rhinoplasty, or nasal reconstruction surgery, can be performed in men and women at almost any age. It is usually recommended that young people wait until their facial growth is complete, usually about 18 years old.

You may be a candidate for rhinoplasty if you have any of the following conditions:

If you have had past rhinoplasty surgery and are not happy, you may be a candidate for secondary revision. The issues related to a primary rhinoplasty can be under- or over-resection of tissue. The initial surgery may produce breathing difficulties. Many techniques exist today to reconstruct the nasal anatomy, both for function and aesthetic reasons.

OPERATIVE PROCEDURE

The operative procedure for rhinoplasty is probably the most challenging aesthetic surgery. All cases are customized. The surgeon must foresee many steps to achieve the desired outcome. The operative procedure I describe is the most general to help your understanding.

The most common technique is the “open approach.” This technique provides greater exposure and more accuracy in the reconstructive process. An incision is made at the root of the nose. This gains access to all of the nasal anatomy. Once the skin is elevated from the cartilage and bone, the nasal tip cartilage is trimmed. The nasal bone is reduced, enhanced and/or narrowed. The nasal passage, at this time, will be addressed, if necessary. The nasal tip is further refined with suture techniques and cartilage-sparing procedures. The incisions are closed and an external cast is molded into place. The procedure is complete and the patient is taken to the recovery room.

Makeup may be applied after one week.

Most patients return to work or social activities after ten to fourteen days. Strenuous physical exercise should be avoided for four to six weeks following surgery as it can trigger swelling.

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BEFORE RHINOPLASTY

A personal consultation is the first step for every patient considering rhinoplasty. During this appointment, Dr. Delgado will ask you to discuss your concerns about your appearance and if there are any breathing difficulties. Dr. Delgado will use computer imaging to discuss the external appearance of your nose and examine the quality of the nasal passage. The computer can add, subtract, or alter the configuration of existing nasal tissue. This can greatly enhance your visual understanding.

The nose that is in balance with your face is important to create visual harmony. For example, the nasal profile is a prominent anatomical feature. If the chin is small, it greatly impacts the balance and can make the nose look larger or out of proportion. For this reason, nearly 50% of rhinoplasty patients have chin implants at the time of rhinoplasty surgery. The computer can also help with angles, lengths, widths and proportions. For example, a measurement is taken from the bottom of the nose to the bottom of the chin. This distance represents X. For the “ideal” facial/nasal proportion, the length of the nose should also equal X. The projection of the nose should equal 0.67X and the bridge of the nose should equal 0.28X. In planning for surgery, these values are compared with the actual and this is a starting point of the surgical plan. During the actual surgical procedure, Dr. Delgado has these measurements outlined in graphic form as well as having your actual photographs in the operating room for a reference point.

The aesthetic for male and female nose re-shaping is very similar.  Even though, each nasal case is customized, there are basic similarities between male and female.  The male nose has a fuller or higher nasal profile and the angulation is much more subtle. The female nasal tip has slightly more elevation than the male. These are a few subtle differences of the male and female nose.

Dr. Delgado provides a precise preoperative booklet that provides pre- and post-operative instructions, including medications in advance of your surgery. All aspirin and aspirin-containing products, including anti-inflammatory products, must be stopped two weeks before and two weeks after surgery. Dr. Delgado’s preoperative instructions will have a complete list of the medications to avoid. However, Tylenol (acetaminophen) can be safely taken during this time.  However, do not exceed 1 gram over 4 hours or 4 grams per day from all sources since this can cause liver damage.

Also, you will be given a list of homeopathic preparations as well as vitamins to take prior to and after surgery. This is done to promote healing and limit bruising.

DAY OF NOSE SURGERY IN SAN FRANCISCO

Dr. Delgado performs rhinoplasty at Marin Cosmetic Surgery Center, a private surgery suite, located in his Marin County office on the Sutter Marin County Community Hospital campus near Santa Rosa. This allows Dr. Delgado to offer his patients private, concierge medical care, while providing the extra measure of safety and reassurance afforded by the surgery center’s contiguous location to the hospital.

ANESTHESIA

Most rhinoplasty surgeries are performed under general anesthesia. This procedure is usually performed in an outpatient surgery center or a hospital.

AFTER RHINOPLASTY SURGERY

The first hours are spent in the recovery room, until you are fully alert. At this time, you are able to go home. It is of paramount importance that you keep your head and back elevated at 45-60 degrees. This will greatly reduce the amount of swelling.

There is very little pain associated with nasal surgery, but the nose feels swollen and stuffy. Pain medications and antibiotics are prescribed. The sutures and nasal cast are removed in five to seven days. Makeup can be applied when the cast is removed. You can return to work or social activities within one week and drive as soon as you are off pain medications. Strenuous exercise should not be done for 4-6 weeks due to enhanced swelling and discomfort. Contact lenses can be worn after a few days. If you wear glasses, they can be worn gently for short periods of time, initially. A subtle degree of swelling will persist in the tip, anywhere between 6-9 months.

RISKS AND COMPLICATIONS

As with any operation, there are risks and complications. However, with a board-certified plastic surgeon, well-trained surgical team and a board-certified anesthesiologist, complications are unusual. Like all surgeries, the risks of bleeding, infection, or anesthetic problems are present. In approximately 15% of rhinoplasty cases, there are minor deformities present and corrective surgery is usually minor in nature.

RESULTS

The result is an improvement in the aesthetic balance of your nose and your face. The airway may be significantly improved as well. The result should create a better balance between your nose and your facial features. Dr. Delgado may suggest a chin implant to better balance your face. This is done in conjunction with rhinoplasty in over 50% of cases nationwide. It is very important that the nose looks natural, well balanced and without an artificial or surgical appearance. This is the case for both male and female noses. Dr. Delgado is an expert in the precision that is required for the aesthetic differences between the sexes.

Amazing experience! Perfect work, extremely professional, very happy. Would highly recommend to anyone thinking about going to Dr Delgado. I was treated extremely well from beginning to end and have been astonished by the quick recovery and the look so far. I can’t imagine anyone not loving their results. 20/10!!

Rosalva G.

Frequently Asked Questions

Who is a good candidate for rhinoplasty or nasal reconstructive surgery?

Any person who has difficulty breathing through their nasal passages is a good candidate for a septoplasty surgery. This is commonly due to a deviated septum. In addition, anyone who is dissatisfied with the appearance of their nose is a good candidate for cosmetic nose reshaping.

The most common cause of breathing difficulties is a deviated nasal septum. This can occur at birth or can be the result of a traumatic injury.

The most common aesthetic concerns are an enlarged nasal dorsum (nasal hump on the profile) or a wide or bulbous nasal tip.

Dr. Delgado utilizes computer imaging to aid himself and the patient in visualizing the patient’s goals. From this mutual understanding, Dr. Delgado constructs a surgical plan.

Will my nose be broken?

The nose will be broken if there is a bump or prominence on the top of the nose, as seen on profile. This is an important procedure to narrow the dorsum of the nose. This causes temporary bruising around the eyes.

Do I need general anesthesia?

Most nose reshaping procedures are performed under general anesthesia. Dr. Delgado prefers to perform nasal surgery requiring bone reshaping and nasal septal surgery under general anesthesia. This requires the services of a board certified anesthesiologist who is experienced the particular challenges and risks associated with rhinoplasty procedures.

If nasal tip surgery, nasal tip-plasty, is the procedure of choice, then local anesthesia can be sufficient and appropriate.

How do I prepare for surgery?

Dr. Delgado provides a comprehensive, informative booklet on how to prepare for nasal surgery. You will be advised as to which drugs to avoid before surgery and how to prepare for your post-operative period.

How long will I be off work?

Nose reshaping surgery that requires fracturing of the nasal bones usually causes bruising around the eyes. The bruising will be present for 10-14 days. A nasal splint, much like a cast, will be worn for one week. When the cast is removed, moderate swelling and bruising will still be present. You will feel able to go to work within a week, but may not be entirely comfortable for a full two weeks, when bruising has completely resolved.

When can I drive and exercise?

You can drive within days, or as soon as you have stopped taking pain medications. Exercise should be avoided for four to six weeks, as increased blood pressure will aggravate nasal swelling. Easy walks are permissible.

How long will there be swelling?

Eighty percent of the swelling is gone in four to six weeks, but the remaining 20% gradually resolves over the next five to nine months. You will notice slight changes in swelling from day to day, depending on your activity.

Is the surgery risky?

Rhinoplasty surgery has the same serious risks that all surgeries carry. These risks are minimized to the fullest extent possible when a patient chooses a surgeon and an anesthesiologist who are both American Board certified and a state-of-the-art, accredited outpatient surgery center, particularly one that has the advantage of being contiguously located to a full-service hospital. Add these qualifications to the fact that both Dr. Delgado and his anesthesiologist have numerous years of experience in their specialties. As an accredited outpatient surgery center, Marin Cosmetic Surgery Center is fully staffed with state licensed and ACLS (Advanced Cardiac Life Support) certified Registered Nurses, state certified Operating Room Technicians, and other specially trained support personnel. These are the types of qualifications for which you should look when choosing where to have your surgery.

What is the cost of nose reshaping rhinoplasty surgery?

The cost of a rhinoplasty varies depending on the complexity of the case. The cost ranges from $8,000-$10,000. This includes the professional services of Dr. Delgado and the anesthesiologist, and use of Marin Cosmetic Surgery Center.

What happens if I do not like the results of my surgery?

Through the process of discussion and computer imaging, we develop a clear understanding of your goals. A 15% revision rate is to be expected, regardless of a surgeon’s skill and experience. If you are not satisfied with your results, Dr. Delgado will waive his professional fee for a revision surgery. The cost of anesthesia and use of the surgery center for revision surgery would still be the responsibility of the patient. Sometimes, minor revisions can be done in the office at no further cost to the patient.

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