Information about Completely Natural Rhinoplasty

January 4, 2009

What You Need to Know About Rhinoplasty
Reviewed and edited by Eric M. Joseph, MD,

Maybe you have been unhappy with your nose for as long as you can remember, or perhaps you are having difficulty breathing; either way, a rhinoplasty or nose reshaping may be an option for you.

A rhinoplasty can change many things about your nose, including your nose size (in relation to your face), nose width at the bridge, the size and position of the nostrils, and nose profile (by downsizing visible humps, bumps or depressions on the bridge).

A rhinoplasty can also reshape the nasal tip, improve the appearance of large, wide or upturned nostrils and correct nasal asymmetry. From a functional standpoint, a rhinoplasty can correct certain breathing difficulties such as those due to a deviated septum. Rhinoplasty is also an option for certain birth defects or noses that have been injured in car or sports accidents

Here’s what you need to know now about rhinoplasty:

Rhinoplasty Defined:
A rhinoplasty or nose job is a surgical procedure designed to reshape the nose. It can be done to correct a structural deformity (such as a bump or hook), provide subtle changes to nose size and shape to improve your appearance or to correct a functional problem (such as difficulty breathing due to a deviated septum).

The septum is the wall between the two nostrils. Composed of cartilage and bone, it divides the nasal cavity into halves. The ideal nasal septum is straight, separating the left and right sides of the nose into passageways of equal size. In contrast, a deviated septum occurs when the septum is severely shifted away from the midline. In severe cases, a deviated septum may cause difficulty breathing through the nose.

Are you a candidate for rhinoplasty?

Preparing for Rhinoplasty:

Dr. Joseph will likely give you a list of instructions before you undergo a rhinoplasty. In general, there is no eating or drinking after midnight on the evening before.

Smoking cessation should occur before rhinoplasty. Dr. Joseph will be able to provide tools to help you quit. In addition to all the other negative health affects associated with smoking, it severely compromises blood flow to the skin. This means there is less oxygen to aid in wound-healing, and necrosis (death) of skin can occur. Drinking alcohol in the week before rhinoplasty is also discouraged, as alcohol can also impair the healing process.

Dr. Joseph will discuss discontinuing certain medications in the days or weeks leading up to your rhinoplasty. For example, non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can increase the risk of bleeding. While considered natural, certain vitamins and herbal preparations such as Vitamin E, gingko biloba, omega-3 fatty acids and green tea can also increase bleeding risk. Tell your surgeon about everything that you are taking, even if it seems harmless. Never stop taking any medications without first discussing it with your doctor.

Dr. Joseph may prescribe homeopathic therapies before your rhinoplasty, such as arnica (an herb that can minimize bruising). In addition, mega-doses of vitamin C may also help aid clotting and wound healing. You may also receive steroids before a rhinoplasty to decrease the initial swelling.

Rhinoplasty stats.:

In 2007 there were 285,000 rhinoplasty operations performed in the United States, down 7 percent from 2006, according to statistics compiled by the American Society of Plastic Surgeons.

Rhinoplasty is one of the top five cosmetic plastic surgery procedures performed each year.
Rhinoplasty Risks:
Breathing issues (nasal obstruction)
Dissatisfaction with cosmetic results
Additional touch-up surgeries
Septal perforation. In these cases, there is a small whole in the septum, causing turbulence that results in a whistle when a person speaks or sings.
Anesthesia complications
Types of Rhinoplasty:
Primary rhinoplasty is a nose-reshaping plastic surgery. Two types of primary rhinoplasty include “open” and “closed”. Dr. Joseph nearly always performs Rhinoplasty with an open-approach.

Open Rhinoplasty. For major nose reshaping, the incisions are made in the vertical strip of skin separating the nostrils. This is called the columella. The skin and soft tissue are then elevated off the underlying structures of the nose so the surgeon can see the nasal anatomy.

Closed Rhinoplasty. For minor reshaping, many surgeons make incisions within the nose. The skin of the nose is then separated from the bone and cartilage, which form its supporting framework. Once exposed, bone and cartilage can be removed, reshaped, augmented or rearranged to achieve the desired new shape.

Secondary Rhinoplasty is also called revision rhinoplasty. This is performed to correct problems that persist or develop after a previous rhinoplasty. Although the problems may be minor and easily corrected, often the problems are major, which makes the secondary rhinoplasty more difficult. Secondary rhinoplasty can also be done as an open or closed procedure.

Non-surgical Rhinoplasty. This involves the use of injectable fillers to fill depressions, smooth out sharp angles or change the angle of the tip of the nose, restoring symmetry and making your nose appear smaller and more attractive. Instead of removing a bump, a surgeon would use an injectable filler to even it out. Dr. Joseph usually recommends Silikon-1000 which is pain-free and gives completely natural, permanent results.

CDC Warns Against Cosmetic Charlatans
ATLANTA, May 2008 — The federal Centers for Disease Control and Prevention is warning consumers against undergoing cosmetic surgery by unlicensed providers.

Three women in North Carolina developed kidney failure after they received soft-tissue filler injections in their buttocks. The women received the injections from an unlicensed provider, who was arrested and charged with practicing medicine without a license.

Evaluating Your Nose
An evaluation with Dr. Joseph is the first step in your decision to undergo rhinoplasty. During this meeting, Dr. Joseph will likely take photographs of your nose at varying angles. He will also talk to you about your expectations to make sure that yours are realistic.

It may be a good idea to bring photographs of noses that appeal to you, to aid in the dialogue about expectations as well as give Dr. Joseph a better idea of what you want out of your rhinoplasty. In addition, Dr. Joseph can show you photos of other rhinoplasty patients with similar nose shapes, which can help you better understand the likely results. Computer imaging will be used to show how your nose wil look after rhinoplasty.

If you are having rhinoplasty, you may also need to consider other facial procedures to achieve balance and proportion. For example, chin augmentation is often performed with rhinoplasty.  Check out some before and after pictures from Dr. Joseph’s Gallery.

The Rhinoplasty Procedure:
Most rhinoplasties are performed on an outpatient basis in a hospital or surgical suite. Exactly how long the procedure takes depends on the type of rhinoplasty that is performed. For example, a primary rhinoplasty normally requires one to three hours in surgery, while a secondary rhinoplasty can take much longer. A Non-Surgical Rhinoplasty can take just 30 minutes.


Dr. Joseph will likely recommend  general anesthesia for your rhinoplasty. A Non-Surgical Rhinoplasty requires just topical anesthesia.

The Incision.

Surgery of the nose is performed either using a closed procedure (where incisions are hidden inside the nose), or an open procedure (where an incision is made across the columella). Dr. Joseph then raises the soft tissues that cover the nose through these incisions. This provides access to reshape the structure of the nose.

The reshaping.

Dr. Joseph can reduce or augment nasal structures with cartilage grafted from other areas of your body. These pieces of cartilage can come from the septum or occasionally from the ear or the rib cartilage. If the septum is deviated, it is now straightened, and the projections inside the nose are reduced to improve breathing.

Closing the incisions.

Once the underlying structure of the nose is sculpted, the nasal skin and tissue are redraped and the incisions are closed.  These incisions usually heal without leaving a visible scar.

Recovering From rhinoplasty.
You will probably be excited, if not anxious, to see your new nose, but patience is key after rhinoplasty. Complete results are not immediate and can take up to one year to be fully evident.

You will be able to breathe through your nose immediately since Dr. Joseph does not routinely use nasal packing. There will be some pain that is typically well controlled with pain medicine like hydrocodone. Most people who undergo rhinoplasty will stop pain medication after 48 hours. Some people feel nauseated after the surgery.

You may experience limited bleeding during the first few days. Dr. Joseph will also have you  apply a cold compress to your eyes and forehead (frozen peas in a zip-lock bag) to reduce swelling and to elevate your head for the first 48 hours. It is important to avoid any trauma to the nose during the first week after surgery. Blowing your nose is not permitted after rhinoplasty while the dressing is on for the first 7 days after your procedure. This can be tough, as you may feel stuffy.

You will  be asked to return in seven days so Dr. Joseph can remove the stitches. On day seven, the cast is removed. Your nose will still be swollen, but after two weeks much of the swelling will have decreased.  A splint may be placed over the outer part of your nose to protect your nose as well as help it hold its new shape during the healing process. By one month, 85 percent of the swelling will have gone down. The remaining swelling may take up to one year. For these reasons, Dr. Joseph will monitor your progress regularly over the first 12 months after surgery.

Rhinoplasty Cost
The cost of cosmetic surgery tends to comprise Dr. Joseph’s fee, anesthesia fee and operating room fee. The anesthesia fee and facility fee may be covered by your health insurance plan. If you have no insurance, the anesthesia ans facility Cosmetic Surgery Fee at the Ambulatory Care Canter at At. Barnabas, Livingston, NJ is approx. $1,750 for a 2 hour procedure. Dr. Joseph’s fee is around $4900, depending upon the circumstance.

According to the American Society for Aesthetic Plastic Surgery, the national average for plastic surgeon fees for rhinoplasty is $4,277. Secondary rhinoplasty can cost up to three times as much, due to its complexity. A Non-Surgical Rhinoplasty costs five hundred dollars, when Silikon-1000 is used, and results are beautiful and permanent.

If you decide you need an additional facial procedure later (such as chin augmentation), the two procedures may be more expensive than if you have them at the same time. Dr. Joseph will help you decide what’s best for you.

Consult a Qualified Plastic Surgeon
Before deciding on rhinoplasty, be sure to discuss treatment options with a board-certified facial plastic surgeon, like Dr. Joseph.  Dr. Joseph did his residency training in ENT-head-and-neck surgery, followed by an advancwd fellowship in facial plastic surgery.  Facial plastic surgeons, like Dr. Joseph, should be certified by the American Board of Facial Plastic and Reconstructive Surgery. Board certification is your assurance of extensive training and knowledge of the latest technology and techniques to give you the nose of your dreams.

About Eric M. Joseph, MD
Dr. Joseph is a Dual-Board-Certified ENT and Facial Plastic Surgeon in private practice in northern New Jersey since 1999. He specializes in cosmetic facial enhancement that minimizes or eliminates downtime. Learn more About Dr. Joseph.
To Attend a Free Seminar on Rhinoplasty, Please Contact:

Eric M. Joseph, MD
1500 Pleasant Valley Way ste. 206
West Orange, NJ 07052
Tel:   +1 973 325 1155  


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