Because the nose has such a prominent position on the face, it’s often one of the first things we notice about people when we meet them. Unfortunately, not everyone is happy with the appearance of their nose, and can feel self-conscious in social situations. For those who dislike the size and shape of their nose or have a functional issue, rhinoplasty can sometimes be the ideal solution. Rhinoplasty is a popular nose reshaping surgery that is often known as a “nose job.” The surgery is extremely versatile, offering patients either subtle or dramatic results, depending on their goals. Dr. Peter Hilger and Dr. Sofia Lyford-Pike, board certified facial plastic surgeons at Hilger Facial Plastic Clinic in Minneapolis, MN, offer patients beautiful, natural-looking results from both primary and revision rhinoplasty.
In an ideal world, of course, every rhinoplasty procedure would meet or exceed patient expectations. Unfortunately, that is not always the case. No matter what the reason, some rhinoplasty procedures don’t go as planned, and these patients develop aesthetic or functional defects after surgery. These can include problems such as a drooping tip, nasal collapse, obstruction, or over/undercorrection. In these cases, patients may need to undergo an additional surgery—a revision rhinoplasty—to correct the unsatisfactory results of a prior rhinoplasty.
Primary rhinoplasty is difficult enough, but revision rhinoplasty is still more complex and challenging. The original structure of the nose has changed, and there will be scar tissue inside the nose that the surgeon will have to work with. On top of that, revision rhinoplasty patients are understandably nervous about the process. Some patients do not have enough cartilage left in the area, and additional material must be harvested from the ear, rib, or a tissue bank.
The good news is that a skilled facial plastic surgeon with extensive experience can typically turn these unfortunate situations around. Patients who come in worried about their results leave feeling more confident, and typically end up with a good result, assuming they have chosen a skilled revision surgeon. While it is best to prevent the need for revision, patients who need it can get help when necessary.
The Rhinoplasty Procedure
Most patients who undergo primary or revision rhinoplasty are put under general anesthesia or local anesthesia with sedation. This is to ensure the patient’s safety and comfort during the surgery. Once anesthetized, the surgeon will make small incisions in the nose. These may be made either inside the nose (a “closed” rhinoplasty) or in the the columella, a strip of skin separating the nostrils (an “open” rhinoplasty). The type of incision will be determined by the patient’s needs and the surgeon’s preferences.
Through the incisions, the surgeon will carefully reshape cartilage in the nose, add cartilage grafts (from cartilage taken from inside the nose, behind the ear, or, more rarely, the rib area), and even break or file down the nasal bones to straighten them or resolve a nasal “hump”. This is a complicated and custom process that requires the use of several different surgical techniques.
At the end of the procedure, incisions will be closed, and a splint will typically be placed on the nose to support the tissues as they heal. Nasal packing is almost never necessary. Patients can be driven home by a friend or family member the day of the surgery, once they have been cleared by staff.
*Each patient is unique and individual results may vary.
Who is a Candidate?
Good candidates for rhinoplasty are healthy adults who want to make permanent changes to the size, shape and/or function of their nose. Teenagers are often interested in rhinoplasty, but as the nose does not stop growing until the late teens, an ethical surgeon will not perform the surgery until the patient’s features have matured. Revision rhinoplasty candidates must allow adequate healing time (usually 6-12 months) between their original surgery and a revision procedure, to avoid unexpected changes in the nose.
Patients on certain medications or those who have certain conditions may not be candidates for rhinoplasty. In addition, patients should have realistic expectations for the surgery, and need to understand the limitations of the procedure. Studying before-and-after photos is a good way to get an idea of the kinds of results that can be expected from rhinoplasty and revision rhinoplasty.
Each patient must be evaluated individually for candidacy, as there are many different factors surgeons must consider before recommending the procedure to a patient.
Benefits of Rhinoplasty
People seek nose jobs for a number of reasons. However, the overall goals tend to be the same: improved facial aesthetics or nasal function. A rhinoplasty can help bring balance and beauty to the face by making the nose more consistent with the other facial features, altering the ratios, and correcting any nasal defects. It can also help patients breathe more easily by opening up obstructed airways and correcting problems in the nasal structures.
Each rhinoplasty procedure is completely customized to the patient’s needs. Depending on the goals of the procedure, patients can see subtle or dramatic differences that not only balance out the face and improve facial aesthetics, but also often boost the patient’s confidence and self-esteem dramatically. Partly due to this customization, the surgery itself is extremely complex, requiring the skill and artistic vision of a trained facial plastic surgeon to yield consistently good results. Both functional and cosmetic rhinoplasty can be life-changing for the right patients.
What Can Rhinoplasty Accomplish?
Because each nose is unique, patients have a wide range of concerns that rhinoplasty can help address. Some patients feel their nose is overly large or small. Others have a prominent bump or hump on the bridge of the nose, or some degree of crookedness. These types of issues can be genetic, or they can be the result of trauma and injury. While a large number of rhinoplasty procedures are performed for cosmetic reasons, others are intended to correct breathing problems from a deviated septum or other issue. Some of these functional rhinoplasty patients elect to have cosmetic changes made to the nose at the same time.
Recovery and Downtime
Patients should expect to take about a week or two off work following the procedure to recover. During the first few weeks, swelling and bruising will be at their most intense. Residual swelling will resolve gradually, a process that can take up to 12 months to complete fully. Revision rhinoplasty patients may experience swelling for even longer—up to 18 months.
After the procedure, patients will be given care instructions which should be followed closely to prevent complications and ensure optimal healing. Typically patients, should sleep with their head elevated, following icing instructions, and take prescribed medication as directed to control discomfort and excess swelling. After about five days to a week, the splint and/or stitches may be removed. Patients should not blow their nose or sneeze during the recovery process as this can harm the nose. Exercise must also be postponed for several weeks after the surgery. Patients who wear glasses must switch to contacts temporarily or find another solution that does not put pressure on the nose during healing.
The Rhinoplasty Consultation
Before the surgery can be scheduled, patients must schedule a consultation in Minneapolis with one of our board certified facial plastic surgeons. During this consultation, Dr. Hilger or Dr. Lyford-Pike will perform an examination and discuss the patient’s goals. Using 3-D imaging, patients can get an idea of what their results might look like after surgery. There will also be a review of the patient’s medical history, medications and herbal supplements, and other factors that help determine candidacy. Once the surgeon has ensured the patient is a good candidate, they will answer any questions or address concerns the patient may have about the surgery. Patients should have everything they need to make an informed decision by the end of the consultation, and may schedule their surgery at that point or after considering their options.
Although the surgery is overall very safe when performed by a reputable facial plastic surgeon, all surgery carries some risks. Bleeding, infection, anesthesia complications, unfavorable scarring, numbness, nosebleeds, hematoma, nerve damage, and poor aesthetic outcome are all possible complications. Experienced surgeons like Dr. Hilger and Dr. Lyford-Pike know how to minimize these risks during surgery, and patients should follow postoperative instructions carefully to further minimize risk.
Because the swelling can take many months to subside fully, patients will need to exercise some patience after the surgery. Typically, the nose will look worse before it looks better, and the majority of the swelling will have subsided after about 4 months. At this point, semi-final results will be apparent, and residual swelling will disappear between 6-12 months on average.
During the surgery, patients will be anesthetized and feel no pain. After the surgery, pain medication will help to control any discomfort during the recovery period.
Injectable fillers have been used off-label for non-surgical rhinoplasty. While this is a good option for some patients, it comes with several drawbacks. First, the procedure is temporary. The results typically last no more than 6-12 months. It is also not appropriate for fixing many of the problems patients are concerned with. Only subtle changes can be made. Finally, there are some risks for unfavorable scarring. During your consultation, if you are interested in non-surgical rhinoplasty, be sure to discuss the option with your surgeon, as they will be able to advise you based on your individual case.
Most patients aren’t ready to go back to work for 10-14 days. It is important to get enough rest during the recovery period, so don’t try to do more than you feel up to for the first few weeks. After the initial healing period, makeup can often be used to hide any residual bruising.
Depending on the extent of the changes, most rhinoplasty procedures last 2-4 hours. Some revision procedures may take even longer.
Understandably, many revision rhinoplasty patients are nervous about their second (or third) procedure. While there are no guarantees, choosing a board certified plastic surgeon you trust will set you up for success, and you are likely to end up with a great results. Dr. Hilger and Dr. Lyford-Pike are known for their expertise in this difficult procedure, and about 1/3 of the rhinoplasty procedures they perform each year are revision cases referred to them.
All surgery produces scarring. However, internal incisions will not be visible, and external incisions tend to heal very well and become nearly invisible over time.
Cosmetic rhinoplasty is almost never covered by health insurance. Some plans cover functional rhinoplasty, or the functional portion of a combination procedure. Be sure to check with your insurance company for their specific policies before proceeding.
Your decision on who will perform your procedure is the most important decision you’ll make in the rhinoplasty process. You should choose an expert, board certified plastic surgeon with whom you have rapport and trust. Online reviews, before-and-after photos, and an in-person consultation can help guide you in this difficult decision. Never make a decision before you’re sure!
Dr. Hilger, I'm so glad I thought about getting a recommendation from Dr. Brian Zelickson for my nose and chin, and you were his only recommendation. My nose wasn't something I disliked, but something I wanted to tweak. My double chin however, I never liked. I told you I wanted to have a more refined, elegant look and you gave me a more refined and elegant look. I know I have 11 more months before I see the final shape, but I am so very pleased. Thank you for being a good listener, for being so skillful and talented, and for being so kind. I feel blessed to have had you operate on me. Sincerely,
Dr. Peter Hilger and Dr. Sofia Lyford-Pike are both board certified facial plastic surgeons renowned for their skill in both rhinoplasty and revision rhinoplasty, and other surgeons often refer difficult cases to their practice. Patients can feel at ease with the experts at Hilger Facial Plastic Clinic in Edina, MN. To schedule your consultation, call (952) 844-0404 today.