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Rhinoplasty (Nose Surgery) by Dr Maas

San Francisco rhinoplasty surgeon Dr. Corey Maas specializes in reconstructive and cosmetic surgical techniques in rhinoplasty, resulting in enhanced symmetry, proportion and alignment of the facial anatomy. Approximately 40 percent of the surgeries Dr. Maas performs are rhinoplasty procedures, including revision rhinoplasty requested by patients that were not completely satisfied with their initial operation. With extensive experience in this area, Dr. Maas understands the intricacies of the nose regarding both form and function and strives to achieve a result that is natural, proportionate and beautiful.

Dr. Maas knows that any surgical correction of the nose is a very personal choice that should be made by the patient first, but involves the expert input of the plastic surgeon as well. It requires exceptional anatomical knowledge, surgical skill and the eye of an artist to create the outcome a patient truly wants. An experienced plastic surgeon like Dr. Maas will take the time to understand your unique aesthetic goals and determine the best techniques and procedures to meet those goals.

What is Rhinoplasty?

Rhinoplasty or cosmetic nose surgery is a procedure used for the changing the appearance of the nose by altering the shape, size or proportion in relation to the rest of the facial features. Also referred to as a “nose job,” this procedure can have a profound impact on the entire appearance of your face, which is why rhinoplasty is such a significant surgery for some patients. While rhinoplasty alone can substantially impact your appearance, it can also be combined with other procedures like chin augmentation to enhance your facial contour further. Rhinoplasty can also be used to improve the function of the nose in some cases, such as straightening a crooked (deviated) septum to enhance both the form of the nose and your ability to breath easier. However, the primary focus of the surgery is cosmetic.

You might consider rhinoplasty if you have any of the following concerns:

  • Nose is too big or too small
  • The nasal bridge is too wide, narrow or crooked
  • The nasal tip is droopy, hooked, too pointed or too broad
  • There is a hump or a concave on the bridge
  • Nostrils are too wide, too small or asymmetrical
  • Your nose is not in proportion with the rest of your face

Dr. Maas will discuss your concerns in detail, as well as your goals for surgery, so you can decide whether rhinoplasty is the right choice for you. Rhinoplasty tends to produce the best results in patients that are in generally good health and do not smoke. If you do smoke, Dr. Maas may recommend you quit for a few weeks before and after your procedure to prevent potential complications and achieve the best possible outcome.

Choosing the Right Rhinoplasty Technique

If you decide surgical rhinoplasty is the right option for you, there are two different ways Dr. Maas might perform your procedure:

Open Rhinoplasty

During this procedure, Dr. Maas will make incisions both inside the nasal passages and across the columella – the narrow area of tissue underneath the nose between the nostrils. If this incision is used, Dr. Maas will create a W-shape to minimize visible scarring after surgery. It is unlikely your resulting scar will be noticeable by anyone once it fully heals. The additional incision provides further access into the interior of the nose that is sometimes necessary to perform all the correction needed to produce the results you want.

Closed Rhinoplasty

This procedure only requires incisions inside the nose, so there is no external scarring after the procedure. Access using this technique is restricted somewhat, but if you do not need an extensive amount of correction, this method can be sufficient.

Dr. Maas will discuss the two different approaches at your initial consultation and help you understand which technique will work the best for you. You should have an idea of how your surgery will be performed before the day of your procedure.

Procedure Overview

nose job patientA rhinoplasty can be performed right in our office at the Maas Clinic on an outpatient basis. These procedures usually last from two to three hours, depending on how extensive the correction will be. Because minimal anesthesia is generally required for rhinoplasty, patients tend to feel relatively alert after the procedure. However, rest assured you will be completed comfortable and relaxed during your surgery. Dr. Maas will discuss your anesthesia options at your initial appointments, so you know what to expect when you come in for your operation.

No matter which incisions are made, Dr. Maas will use them to carefully separate the soft tissues of the nose from the underlying cartilage and bone. Excess bone and cartilage are adjusted appropriately to give a balanced, harmonious appearance to the face. The most common areas he will address during a rhinoplasty procedure include the septum (the cartilage that divides the nose into two separate passages) and the nasal bones that lie above, and the cartilage that makes up the nasal tip. If graft material is required, which is more familiar with revision rhinoplasty, Dr. Maas will take the donor cartilage from an ear or rib for this purpose.

When rhinoplasty is performed to relieve obstructions inside the nose, or in conjunction with surgery to reconstruct the nasal passages, the procedure is called septorhinoplasty. During this procedure, the obstruction is removed through internal incisions, and the interior of the nose is restructured. Because this procedure is often performed for medical reasons, insurance coverages may be available for at least a portion of the surgery. Patients can include cosmetic changes to the nose during this procedure as well, although insurance will not cover that part of the operation.

What Happens After Rhinoplasty

Most patients worry about post-surgical pain and stuffiness, but when you choose surgery with Dr. Maas, you’ll be able to enjoy recovery at a reasonably good comfort level. Although you will likely experience some mild discomfort for a short time after your rhinoplasty, significant pain is very rare. While pain medication will be prescribed, most of our patients find that Tylenol at most is sufficient to take care of any discomfort. After your rhinoplasty, Dr. Maas will place a cast or splint on the external nose to hold it in position during the early days of recovery. A light internal dressing called Telfa will also be applied. You can expect to have some swelling of your nose and eyelids after the procedure. Initial swelling usually subsides within the first several days although residual swelling can linger for a few months. Bruising gets better within a few weeks.

Bleeding is another common concern after rhinoplasty. as the nose is a very vascular structure. The nose has many blood vessels, which can lead to significant bleeding after surgery if the nose is bumped during the healing process. We encourage patients to use extra caution around children and pets during those first few weeks to prevent any potential impacts to the nose that could lead to bleeding. Dr. Maas and his staff will also instruct you on post-operative activities and exercises to avoid. There should be no bending, lifting or straining exercises for 2 weeks after the surgery, but taking a walk and doing gentle aerobic exercises can help swelling go down more quickly.

Patients also experience some stuffiness after surgery, but rest assured this will improve in a matter of days in most cases. Dr. Maas will encourage you to do nasal washing with saline to clean out the passages and relieve stuffiness. You should also not blow the nose too hard during this time since that can risk bleeding to the surgical area.

We will also provide you with instructions on what you can do after your procedure to enhance your results. For patients coming in to correct a twisted or crooked nose for example, Dr. Maas will teach you techniques for counterforce massaging your nose in order to overcome the natural “memory” that the nose cartilage possesses. Over 25 years of experience has shown Dr. Maas that such techniques can play a big role in ensuring the underlying cartelginous memory does not bend the nose again.

The majority of our patients return to their normal activities within two weeks after the procedure. However, Dr. Maas may restrict your more strenuous exercise much longer to ensure your nose has time to heal fully and you don’t run the risk of prompting more bleeding from the surgical site. Since you will see Dr. Maas and his team for follow-up appointments after your procedure, he will be able to monitor your progress and advise you accordingly as to when it is safe to resume your full schedule. 

Rhinoplasty Results

Once your results from rhinoplasty become final, which may take several months, your new look should be permanent. You should not need any additional procedures unless you are not completely satisfied with the outcome of your initial surgery. Even subtle changes to the nose can profoundly impact the proportions of your face, as well as your facial profile. If you would like to learn more about your choices in rhinoplasty or find out if this procedure is a good option for you, contact the Maas Clinic today at 415-567-7000.

What is Revision Rhinoplasty?

Revision rhinoplasty is effective in correcting concerns left behind by a previous procedure and producing the final aesthetic results the patient was initially hoping to achieve.

About half of all the rhinoplasty procedures Dr. Maas performs are revision rhinoplasties. These procedures may be requested for purely cosmetic reasons or because the original surgery affected the function of the nose and now correction is needed to restore more comfortable breathing. In either case, the revision procedure is often more complex than the original surgery, which is why it is critical to choose a plastic surgeon like Dr. Maas that has extensive experience in revision techniques and is qualified to take all of these factors into account to help you achieve the results you want.

Revision surgery may be a more challenging process for a variety of reasons. First, there may be scar tissue from the initial procedure that has to be addressed to ensure the revision surgery produces the best possible results. Second, there may be less bone and cartilage to work with during the revision procedure, which may necessitate grafting from another area of the body to provide sufficient support for the nose after revision surgery. Only a surgeon experienced in revision techniques will be able to handle these factors efficiently, creating a result that does not belie the fact that multiple procedures were performed to get the look the patient wanted.

Revision rhinoplasty results could take a bit longer to see, which may be distressing if you were unhappy with the results of the first procedure and anxious to look at the corrections take shape. While you will see preliminary results within about two weeks once the cast comes off, there can still be significant swelling for many months that can prevent you from seeing the outcome. Most patients will see those results within 12 to 18 months, once the nose has fully healed from the subsequent surgery.

What is Non-Surgical Rhinoplasty?

Some patients that are apprehensive about the idea of surgery might benefit from a non-surgical rhinoplasty to achieve some enhancement without incisions or anesthesia. During this procedure, Dr. Maas uses a variety of dermal fillers injected into strategic locations on the nose to add volume, correct asymmetries and adjust minor imperfections. It is particularly useful if you have a small concave or saddleback on the bridge of your nose, or if you have a weak nasal bridge you would like to strengthen.

Dr. Maas performs non-surgical rhinoplasty within a matter of minutes in his office, without the need for anesthetic in most cases. Results of this treatment can be seen right away and typically last for many months. It is a temporary fix, which means you will need to schedule periodic touch-ups to maintain your positive results. Some patients decide after successfully undergoing non-surgical rhinoplasty to move forward with surgery to achieve similar results on a permanent basis. Call (415) 567-7000 or contact us by email to make an appointment.

The information about rhinoplasty was reviewed by Dr. Corey Maas. If you have any questions, please don’t hesitate to contact us using our contact form on the sidebar.

Frequently Asked Questions

Can Rhinoplasty Reduce Nostril Flare?

When we’re doing alar base or nostril base reduction, it is extremely important to keep the very nice curvature of the outside part of the nose or the nostril, intact. We call this the ala and by rotating the ala inward toward the center portion of the face, we’re able to maintain that very nice curvature. There are number of techniques that take out wedges and other things that make the nostril look very straight up and down. Michael Jackson was a very good example of the wedge technique, which just looks very unnatural. So I would summarize by just letting everyone know that’s interested in alar based reduction or narrowing the nose that it’s very important preserve the curvature of the ala.

Do Celebrities Get Better Nose Jobs?

The answer to this question is simply “No”. In a good practice with good surgeons what you’ll find is that we’re trying to achieve perfection in every patient that we treat, whether they are a celebrity or not a celebrity. Anatomy doesn’t change with celebrity patients versus any other patient and so as we address the nose and the structural architecture of the nose and we refine it.

Help! I Bumped my Nose After Rhinoplasty

The simple answer is that with light bumps it’s unlikely, but with bigger bumps the nose is. With nasal bones, the nose is relatively susceptible to injury so we’re careful in our practice to keep a nasal cast on for the first week, and we’ll return that cast to the patient if they’re doing a lot of activities. If they’re going to be outside or in a place where they might be bumped, you can place the cast which doesn’t prevent the nose bones from being dislocated, specifically, but it does defuse any pressure that’s applied directly to the nose or specifically to an area of the nose. So there are some nice preventative ways to avoid injury post-rhinoplasty.

What is a Non-Surgical Nose Job?

Really, there’s been a lot of media attention with it, a lot of internet traffic about non-surgical nose jobs, and actually I have some examples of non-surgical rhinoplasty or nose jobs on my website at maasclinic.com. So if you want to visit and see that that would be a good way of, we getting a sense of it. But basically, it’s a very limited number of patients who are candidates for non-surgical nose jobs and they’re typically patients who either have a saddle depression of the bridge of their nose where (it) goes down slightly, or they have a very weak bridge of the nose and we can use and injectable filler product to improve the height of the bridge of the nose and to some extent the tip of the nose.

Post Rhinoplasty Dos and Don'ts

Dos

  • Be very careful – it doesn’t take a lot of pressure or a big bump of the nose to cause bleeding. Gentle touches can be done with care, and laughing is of course acceptable too.
  • Engage in some gentle aerobic exercises. Do what your body tells you is safe and comfortable, like going for a walk. This helps you heal faster.
  • Make sure the cast on your nose stays on for a week, to secure the bone and cartilage in the right place. Getting it wet might cause it to come off suddenly, so keep your head out of water.
  • Use nasal saline to wash out the nose when you feel congested, and keep nose blowing gentle and to a minimum.

Don’ts

  • Avoid any exercises that involve bending, lifting or straining for 2 weeks after the surgery. Bending over for yoga increases blood pressure in the head, which ups your risk for bruising. Weightlifting is also not a good idea.
  • When it comes to bodies of water, avoid hot tubs for 2 to 3 weeks after the procedure, and swimming in public pools for a month. Scuba diving masks also place direct pressure on the nose, and since it takes about 2 to 3 months for the nasal bones to stabilize completely, it is best to avoid diving for a minimum of three months post-procedure.

What is the Ideal Age For a Nose Job?

There is no ideal age for a nose job, but when it comes to rhinoplasty in younger patients, it is very important to ensure that the patient is mature enough, can intelligently participate in the decision process, and is not being pushed into getting the procedure. Dr. Maas typically recommends that rhinoplasty not be performed on patients younger than 14.

Am I a Candidate for a Non-Surgical Nose Job?

While there has been a lot of media attention on non-surgical nose jobs, it is not a procedure for every patient. Patients who would be candidates include those who have a saddle depression of the bride of the nose (where it goes down slightly), or have a weak nose bridge. In that can, an injectable filler product can be used to improve the height of the bridge of the nose, and to some extent define the tip of the nose as well.

For the right patient, this procedure can create clearly evident improvement to their facial contours. While the results are not permanent, they can be quite long lasting.

How Long Will it Take to Recover From a Rhinoplasty?

Dr. Maas tells all his patients that rhinoplasty recovery is a 3 stage process.

During the acute first stage right after the procedure, most patients will avoid social events for two weeks due to a degree of bruising and swelling. 2 to 8 weeks post-surgery, when we remove the cast and splints, and clean out the nose, most patients do see a resolution of noticeable swelling and bruising. Around the 6 to 12 month mark, the nose will near its completed healing phase, and patients will be able to enjoy the final results of their procedure.

For revision rhinoplasty patients, or patients who previously experienced significant nasal trauma, the recovery period may be a little longer, but a vast majority will be able to see their optimal results 18 months post surgery.

Planning a wedding or to be photographed at a major life event? Make sure you leave yourself sufficient time to fully recover. We recommend scheduling your rhinoplasty at least 6 to 12 months before.

Is My Skin Too Thick For Rhinoplasty?

First of all, what causes thick skin when we talk about nose surgery, and what can be done?

Thickening of the nasal tip skin in particular is common because there are many sebaceous or oil glands that are located in the nasal tip. For most patients with thick skin on the tip of the nose, it has to do with glandular tissue. In no way does this preclude you from having nasal surgery. During surgery, Dr. Maas can in fact thin the nasal tip skin from underneath to help refine the tip and give it more contour.

Patients with very thick bulbous noses often have a combination of thick skin, very thick cartilages and soft tissue underlying between the skin and cartilage itself, and all three of those areas can be addressed during surgery to get the best overall results in contour for the nasal tip.

Post-surgery, using the right skin care and going for pore cleansing skin treatments will keep the sebaceous or oil glands located in the nasal tip clean and refined, reducing the ticketing of the nasal tip skin.

For patients whose thicker nose tips are caused by Rhinophyma, an extreme form of rosacea, medical treatment is necessary.

Should You Quit Smoking Before Rhinoplasty?

Yes. It is critically important to stop smoking well in advance of any type of surgery, as smoking reduces the oxygen carrying capacity in your blood stream, which has a negative impact on your body’s ability to heal post-surgery. We recommend patients quit smoking for a month before and after their procedure.

It is never too late, To be what you might have been.- George Eliot