Dr. Nassif as a world-renowned facial plastic and reconstructive surgeon is Trusted with Noses Worldwide ™. He performs hundreds of Beverly Hills rhinoplasty surgeries at his office. Generally, the surgery is performed under general anesthesia or local anesthesia with sedation in our outpatient state licensed surgery center. No overnight stay is required.
What is rhinoplasty?
Every year, half a million people who are interested in improving the appearance of their nose seek consultation with Beverly Hills plastic surgery doctors. Some are unhappy with the nose they were born with, and some with the way aging has changed their nose. For others, breathing may be a problem, or an injury may have distorted the nose. A slight alteration of the nose can greatly improve one’s appearance.
Rhinoplasty (reshaping the nose) could improve one’s looks, self-confidence or health. As with all facial plastic surgery, good health and realistic expectations are prerequisites. The goal of rhinoplasty is to improve the nose aesthetically (without creating a "surgical" look) in order to create harmony with other facial features. Additionally, many patients have a chin augmentation in conjunction with rhinoplasty to create a better balance of features.
Our Los Angeles rhinoplasty is usually performed under general anesthesia. In some cases, it may be performed using local injections of anesthesia with intravenous sedation.
What’s involved if I get a nose job?
Typically most nose jobs performed by Dr. Nassif in his Beverly Hills practice involve making the majority of incisions inside the nose, where they are invisible. However, in some cases, an incision is made in the area of skin separating the nostrils. Certain amounts of bone and cartilage are then removed or rearranged to provide a newly shaped nose.
If the patient has a deviated septum (cartilage and/or bone causing obstruction inside the nose), a septoplasty may be simultaneously performed. Occasionally, a chin implant may be needed to bring the nose and chin into proportion to facial features; Dr. Nassif will consult with you as to whether or not you’ll need a chin implant.
Indications you may need a nose job
How do know if you should get a nose job? Ask yourself the following questions:
- Do you feel your nose is too big, too little, too sharp, or curved?
- Do you feel that your nose doesn’t "fit your face" whether due to birth, trauma or disease?
- Do you have problems breathing from either of your nostrils or just one side?
- Do you suffer from breathing problems associated with cartilage and/or bone obstruction inside the nose (deviated septum)?
- If you’ve answered ‘yes’ to any of these questions, you should consider getting a nose job.
Should you get a rhinoplasty from Dr. Nassif in Beverly Hills?
Even though rhinoplasty is one of the most common procedures performed by facial plastic surgeons, you’d think the surgical method would be perfected and produce outstanding results each time; however, this simply isn’t true. Actually this surgery is among the most difficult head and neck operations.
Before your Beverly Hills rhinoplasty surgery, much discussion and planning will take place. When you tell us what type of results you want, we’ll think about how to get complete synchronization of all your facial features by considering the distinction of your cheeks, jawline, the depth and quality of the skin, and the overall proportions of your nose. By improving your nose’s current features, Dr. Paul Nassif can aesthetically change your entire face.
Dr. Paul Nassif will give you a thorough exam and tell you how he can, if necessary, improve your problematic breathing with surgery. During your evaluation, Dr. Nassif will discuss factors that may influence the outcome of the surgery, such as skin type, ethnic background, age, and degree of nasal deformity.
The Surgery
Whether you choose to be asleep under general anesthesia or awake under sedation, the surgery for cosmetic or functional rhinoplasty can take two to three hours. The majority of cuts are located inside the nostrils, however in some situations a tiny incision may be made on the underside of the nose between the nostrils. The incisions heal fast and the scars are almost invisible. A cast will be put on your nose after the surgery and soft dressing may be placed inside the nostrils if there is any bleeding and could be removed on the same day or the next. In several days, if you had the stitches placed in your natural crease, they will be taken out. And typically after a week the cast is removed.
Rhinoplasty age-related issues
Individual considerations are taken for the elderly, teenagers and children.
The elderly
There are no age restrictions for rhinoplasty surgery, that is assuming the individual is in good health and has reasonable expectations. Even so, the majority of patients receiving rhinoplasty are in their 20’s and 30’s. Individuals in their 40’s and 50’s, however, may have wanted to have it when they were younger but choose to have it later on as they got older.
The youths
Rhinoplasty can usually be performed on patients 15 years of age and older. If the operation is done before their ideal age, then the nose may grow in an erratic manner. The nasal growth can destroy the proportions that were made during surgery and create an unbalanced nose. Younger children may not be ready to face the emotional trauma of cosmetic surgery, so each individual needs to be reviewed alone.
What to expect from rhinoplasty recovery
Rhinoplasty, or a "nose job" as it is more commonly known, is one of the most frequently performed cosmetic surgery procedures today. If you are considering undergoing rhinoplasty it is important to consider all aspects of the procedure, including what you can expect during your immediate recovery period so you can make an informed decision.
In general, after rhinoplasty you can expect to experience some throbbing pain and headaches. Most of our Beverly Hills rhinoplasty patients only require a couple of days of a narcotic for pain relief. After that, most report that over-the-counter pain relievers such as Tylenol are more than sufficient to relieve their discomfort. The majority of patients are pleasantly surprised how the level of discomfort is less than expected. Most bruising and swelling will resolve within 7-10 days after surgery.
The most uncomfortable aspect of the recovery is probably not being able to breathe through your nose during the first week after surgery. This is due to swelling from the surgery itself, and sometimes from small silicone splints that Dr. Nassif and Dr. Yoo place inside the nose to aid the healing process. Nose blowing should be avoided for the first two weeks, and instead nasal saline irrigation and sprays should be used to help keep the inside of the nose moist and clean. As the swelling resolves, your breathing will be dramatically improved compared to before surgery.
Dr. Nassif and Dr. Yoo see their patients the day after surgery, then one week after surgery. At the one week post-op visit, the cast and sutures are removed and a light, nude colored tape is applied. Light cardio exercise may resume 2 weeks after surgery, and full workouts may resume 4 weeks after surgery.
About 3-6 months after your surgery the vast majority of the swelling will have resolved though your nose may still feel a bit numb. Healing will continue for a full year after surgery. You’ll also be able to fully appreciate the aesthetic results of your surgery at this point, which will make the minor discomfort experienced immediately post-op entirely worth it.
Rhinoplasty FAQ
No, there are no alternatives for cosmetic purposes. You can use strips that open the airways if you have problems breathing, but they are only a short term solution.
The cost of rhinoplasty depends on the situation for having the surgery. Insurance will not cover it if the reason is simply cosmetic, however they may cover it if the reason is to help with breathing problems.
According to Dr. Nassif, "Getting Botox a month and a half after Rhinoplasty should be fine. You can have Botox anywhere after surgery, especially if it is a rhinoplasty procedure."
A patient asks, "As a kid my parents told me that my up-turned nose (which makes me look like a pig) would fix itself over time. It hasn’t and now that I am 18 I want my nose to finally look normal. Is it possible to fix a "pig nose" with a nose job?"
Dr. Nassif replies: "It is possible to lower the nasal tip and fix the appearance of a nose as you describe. To give you the best advice, I really need to see photographs and/or perform an examination. Please feel free to call my office at 310-275-2467 if you wish to schedule a consultation. Thank you and good luck!"
According to a patient, "I am a 43-year-old woman and I want to get a blepharoplasty to fix the bags under my eyes. I also want to get a nose job and I would like to get these at the same time. Is it possible to get both surgeries during the same appointment?"
Dr. Nassif: "Yes, it is definitely possible to have both surgeries performed at the same time. It is important to do your research and choose a skilled surgeon who has a great deal of experience performing both procedures, and has performed both of them at the same time in the past. Please feel free to ask me any specific questions you have regarding either procedure and I would be happy to answer them for you."
During the initial consultation you should ask the surgeon if they are Board Certified, how many rhinoplasties they perform in a year, do they make any cuts outside of the nose, will they pack your nose and for how long, and when will the cast be taken off?
On the day of your surgery clothing that snaps in the front or back should be worn (avoid slipover sweaters, T-shirts and turtlenecks). The morning of the surgery, be sure not to eat or drink anything (water included). Anything valuable should be left at home (no jewelry). Make-up of any kind (including nail polish) should not be worn. Do not wear contact lenses, but you may bring your sunglasses to go home in. You may keep your dentures in.
Rhinoplasty may take place in a surgeon’s office-based facility, an outpatient surgical center or a hospital.
Rhinoplasty is typically performed as an outpatient procedure and does not require an overnight stay.
Closed rhinoplasty refers to procedures in which the incisions are confined to the inside of the nose. Open rhinoplasty refers to procedures in which an additional small incision is made between the nostrils on the underside of the nose. Closed rhinoplasty results in no visible scarring while open rhinoplasty results in a well-concealed, fine-line scar. Open rhinoplasty is often preferred when doing tip work and can also produce excellent symmetry, while closed rhinoplasty is preferred for nasal hump reduction.
Any incisions made on the outside of the nose generally heal fast and the resultant scars are almost invisible.
Patients are often surprised by the minimal amount of pain after rhinoplasty. Some discomfort can occur and you will be unable to breathe through the nose during the first few days. Nasal packing can be an uncomfortable experience but it is not often required and is typically removed within one to two days. If necessary, pain medication can be prescribed.
Every individual needs to make the decision on whether they want their ethnic features touched up or if they want them totally gone. The majority of ethnic noses have qualities of their nose’s main components (skin, bone and cartilage) that limit the possibilities of results. Dr. Nassif can retain the features that identify your ethnicity by lightly refining the ethnic nose, but those wanting to get rid of the ethnic features to get an entirely different appearance can be dissatisfied with the outcome. Those types of people need to keep in mind the surgery limits.
There are some medications to stay away from before your surgery. Prior to your scheduled surgery, ask Dr. Paul Nassif’s office for a list of those medications.
Following a rhinoplasty, which usually includes a turbinoplasty and septoplasty, there will be debris in the nose. The doctor won’t usually let you start blowing your nose for two weeks following surgery. Usually, the doctor will help you remove whatever debris that are inside the nose during your post operative appointments.
According to Dr. Nassif, "I have patients start taking Arnica capsules, three times a day, right after their rhinoplasty surgery. However, I don’t recommend taking arnica before surgery, as it can cause platelet breakdown, which can increase the bleeding."
According to Dr. Nassif, "We ask patients to stop taking Accutane for about three months after a rhinoplasty procedure. This is because we want to be sure there is not decreased activity of the sebaceous gland and maybe even some decreased healing of the nasal tip. This is the reason why I like to wait the three months."
It’s best to make arrangements for someone to drive you home after surgery.
After rhinoplasty, it’s often best if someone can stay with you for the first twenty-four hours.
Nasal packing is a soft dressing that is placed inside of the nostrils if there is any bleeding. It is typically removed on the same day or the day after surgery.
Patients are typically able to resume work and other normal activities in about a week after surgery.
The stitches may be removed within several days to a week after surgery.
With revision rhinoplasty, you’re likely to achieve the results that you were expecting but were not given with your first surgery, if done the right way.
Here are some simple exercises that can decrease swelling. Usually, we have the patient put the soft part of the index finger along the sides of their nose; then gently put pressure on the nose to help decrease swelling. We usually have the patient apply gentle pressure on the nose for about one minute every hour while awake, during the first few weeks after rhinoplasty.
Rhinoplasty, or a "nose job" as it is more commonly known, is one of the most frequently performed cosmetic surgery procedures today. If you are considering undergoing rhinoplasty it is important to consider all aspects of the procedure, including what you can expect during your immediate recovery period so you can make an informed decision.
Keeping your head elevated using numerous pillows or wedge pillows is very important after rhinoplasty surgery. Some patients sleep in a recliner to keep their head elevated. The goal is to have your heart lower than your nose because that will help decrease some of the swelling. So, after rhinoplasty surgery, you’ll want to sleep elevated for at least for a couple of weeks.
A turned up nose is not uncommon after rhinoplasty surgery. In time, the nasal tip will droop. Sometimes, the nose is over-elevated in the beginning, since the nasal tip will fall with time.
According to Dr. Nassif, "One of the other areas that I will really pay attention to is the supratip break, which if you look at the profile, is the area just before the tip starts to elevate. You want to make sure you have a nice smooth supratip break especially in females. For the male patients, you want to have a straight nasal line. The infra-tip lobule is an extremely critical aspect of the nose, which prevents the nose from shortening following rhinoplasty. In many cases, I’ll place loose cartilage in the infra-tip following the rhinoplasty."
You should stop smoking before your rhinoplasty procedure and for a minimum of six weeks after your surgery. However, if you start smoking at six weeks after surgery, it could decrease healing and prolonged swelling. Nicotine in the tobacco constricts blood vessels. This delays both the healing process and getting the blood supply to the nose. To really give your nose time to heal, you should wait three months before smoking again. If you do this, hopefully, stop smoking all together.
If you wear glasses be sure to tape them to the head after rhinoplasty so there is no pressure on the nose. Glasses can leave indentations or bumps on the nose soon after a rhinoplasty procedure.
Ask your surgeon about the possible complications, such as bleeding, infection, nasal obstruction, unexpected outcomes, and asymmetry.
Though rhinoplasty is one of the most common of cosmetic surgery procedures, it is also one of the most difficult operations performed in the area of the head and neck. As such, it’s essential that patients find a qualified and experienced plastic surgeon who is certified by the American Board of Facial Plastic and Reconstructive Surgery (ABFPRS).
Inverted V deformities usually happens because the trauma to the nose caused by removing a hump and fracturing the nasal bones leads to destabilization of the upper lateral cartilages.
According to Dr. Nassif, "What I do to prevent this is place spreader grafts. Spreader grafts are small pieces of cartilage usually obtained from the septum that is placed in between the upper lateral cartilage and the septum following a reduction. This stabilizes the middle vault of the nose. The negative thing about placing spreader grafts is that it does cause a slight increase in width in the middle vault of the nose, however, this will usually correct itself any time from six months on out. The grafts are usually only approximately one to two millimeters in width. However in patients with short nasal bones and a long middle vault, the chance of having an inverted V deformity is quite high."
According to Dr. Nassif, "When we take the hump on the bone down with a rasp, we usually rasp the cartilage. Then, after we remove the hump, you’re going to have an open roof deformity. This deformity is like the top of a house, if you rasp it, there will be an opening in the nasal bones. So, you have to fracture the bones with a medial and lateral osteotomies. Then, you’ll re-fracture the bones to bring the bones back together to reduce that open roof deformity, after you’ve taken down the hump."
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