What is rhinoplasty?
Rhinoplasty is surgery of the nose in which the bony structures of the nose and the cartilages are modified to achieve a more aesthetic and functional result. Other words for rhinoplasty are nose job, nasoseptorhinoplasty, and nasal surgery.
Your nose is the most defining feature of your face, and one of the first things people notice about you. Rhino comes from Greek word rhino meaning “nose” and plasty comes from the Greek word plastos which means formed or molded. When you put these words together you get rhinoplasty.
Should I get a nose job?
The nose is perhaps the most defining feature of the face. When the nose is in balance with the entirety of the face, the nose disappears into the background. However, when the nose is not proportionate to the features of the face, it stands out.
When you look at the picture on the left, you focus on this patient’s nose. The nose is crooked, it is wide over the bridge, the tip is twisted, and the overall size of the nose is large. We make these judgements based on the features of this patient’s face. She has an overall small face with highly defined cheek and midface features.
This patient had a rhinoplasty. The nose was made smaller, more feminine, and more proportional to the patient’s facial features.
The nose blends into the background, and the patient’s eyes and mouth draw attention. This is an actual rhinoplasty patient of Dr. Athre.
A rhinoplasty or nose job is a surgery based on proportions. The balanced, proportional nose should fade away and just not be noticeable. If your nose is big, round, fleshy, undefined, or droopy, it may attract attention to your face. A rhinoplasty can help make it more balanced.
Thus far, we have only discussed cosmetic indications and criteria for why someone should get a nasal surgery. There are also functional reasons for a rhinoplasty.
In Dr. Athré’s words, a beautiful nose looks AND works well. A nose that does not work just is not worth anything to anyone. Functional reasons for a rhinoplasty include prior nasal fractures and trauma, and difficulty breathing through your nose. A rhinoplasty procedure can correct all of these issues.
The nose: A brief discussion of anatomy
The nose consists of skin, bone, and cartilage. Five cartilage structures and the nasal bones come together to form the structure of the nose. Skin and soft tissue then drape over this triangular structure. The soft tissue envelope is the combination of the skin and the thin layer of underlying fat.
Under the soft tissue envelope are the bony and cartilage structures. The main cartilage structure that supports the structure of the nose is the septum. The septum is that tissue you can feel between your two nostrils when you stick a finger within each nostril (everyone has done it ;)).
The nose tip is made of the two lower lateral cartilages. The bridge consists of the septum, upper cartilages, and nasal bones.
Rhinoplasty surgery involves manipulating and reshaping the:
- Nasal bones
- Nasal cartilages
- The nasal soft tissue elements
The goals are to improve breathing, straighten the nose and air passages, and enhance the aesthetic appearance of the nose.
Different types of rhinoplasty surgery
Many adjectives can describe types of rhinoplasty. Brief descriptions of each type of rhinoplasty is described below. For more information, please click on the specific link.
Primary rhinoplasty patients are those patients that have never had nasal surgery in the past.
Revision rhinoplasty patients are those patients that have had prior surgery of their nose.
Closed rhinoplasty procedures use incisions that are completely within the nose. No external incisions are used.
Open rhinoplasty are those surgeries that have a small external incision over the columella. In open rhinoplasty, the surgeon makes incisions for closed nasal surgery and an external incision on the columella (base of the nose).
Structural rhinoplasty is the standard procedure that most surgeons use to do a rhinoplasty surgery. Structural rhinoplasty removes a hump by cutting excess cartilage/bone and reshaping the nose to improve its appearance.
Ultrasonic rhinoplasty, also known as piezorhinoplasty or rhinosculpture, is an offshoot of structural rhinoplasty. Ultrasonic rhinoplasty uses a small powered handpiece called a piezotome. This instrument vibrates at a rate greater than 10,000 rpm. This allows the surgeon to literally slice through bone and cartilage with almost no bleeding. The result of this type of rhinoplasty is less bruising, less swelling, and quicker recovery time. Dr. Athre was the first surgeon in Houston to adopt the softer, smoother ultrasonic technique. You can understand why it is called rhinosculpture because the piezotome allows you to almost sculpt the nose like a statue.
Dorsal preservation rhinoplasty is one of the newest techniques in the rhinoplasty realm. Dorsal preservation rhinoplasty “preserves” the structures of the nose by collapsing the hump within the nose. It involves less cutting of cartilage, less dissection, and less disruption of tissues. Patients who have dorsal preservation rhinoplasty heal faster and may go to a restaurant on the same night.
Types of noses: Patients often use terms like Barbie nose or Roman nose to describe a shape of nose.
Ethnic rhinoplasty is a specific type of nasal surgery dedicated to the differences in anatomy of different ethnicities. Examples include Turkish rhinoplasty and African-American rhinoplasty.
Dr. Athré & Rhinoplasty: Training, Mantras, Philosophy
Dr. Athré’s own words:
“Rhinoplasty is a passion of mine. It is the most difficult surgery, and perfection is the impossible result.
I love the challenge. Nasal surgery is not a series of steps that can be memorized and executed.
It also is not a rubber stamp solution where one size fits all. Each patient has to be analyzed completely to find the nose that will work for them. Then their individual anatomy has to be modified to achieve that result.”
Dr. Raghu Athré is one of the foremost facial plastic surgeons in Houston, Texas. Dr. Athre specializes in primary and revision rhinoplasty procedures.
Patients travel from all over Texas, the southern United States, even travel internationally to have surgery with Dr. Athre. The farthest a patient has come to see Dr. Athre being over 8,000 miles (13,000 km).
As a rhinoplasty surgeon, Dr. Athré’s pedigree and training are unmatched. Dr. Athré trained with Dr. William Silver in Atlanta, Georgia. Dr. Silver’s uncle, Dr. Abe Silver, MD, was actually one of the first modern rhinoplasty surgeons in the United States.
Dr. Athre continued further education with Dr. Teoman Dogan of Istanbul, Turkey, and Dr. Olivier Gerbault of Paris, France.
Dr. Athre is one of the most respected names in rhinoplasty surgery. He was the first to utilize a piezotome for ultrasonic rhinoplasty in Houston. He continuously innovates his rhinoplasty surgical techniques.
This attention to detail does not stop with just his technique. Dr. Athre believes that every step from consultation to after care is extremely important in achieving the most soft, natural, and exact nose that fits on your face.
Here are the words of one of his patients on a Google review.
“…By the way if it’s anything you should know about me for this review is that I am a very particular and picky person especially when it comes to my mind body and health.
Anyhoos, once I had done my research which was based on doctors qualifications, reviews, and before and after pics etc. I started booking consultations based on my list. In all I had about 10 consultations, and at the end trusted my research and gut and chose Dr. Athre.
My top reasons for choosing him was that he was double board-certified, he specializes specifically in facial plastic surgery and during our consultation he was very thorough and explained everything to me.
He basically checked all the boxes I needed to give my mind ease that the right decision was made….and thanks again to Dr. Athre and team, your hands are truly gifted and keep up the amazing work.”
Nasal Surgery FAQs
How long does a rhinoplasty last?
A rhinoplasty is permanent.
Careful planning is necessary to achieve this result. Factors such as these are carefully evaluated before surgery and the surgical plan is created:
- The cartilage type
- The cartilage strength
- Thickness of the skin envelope
- Quality of grafting cartilage
For example, someone with very weak/soft cartilage will require thicker grafts. This patient might need a double layer graft to make sure that everything stands the test of time. Dr. Athre’s experience with nasal surgery ensures that your rhinoplasty will last a lifetime!
How much does a rhinoplasty cost?
In our office, the rhinoplasty cost starts at approximately $5,500.
The price of a rhinoplasty varies according to many factors. First, there is a geographical price difference in nasal surgery. Rhinoplasty surgery is more expensive in New York City, for example, than here in Houston, TX.
Second, the price of the rhinoplasty is directly related to the amount of work required. The simplest rhinoplasty is a young, healthy patient with a simple hump. Contrast this to a person who has had many prior nasal surgeries, needs revision surgery and possibly additional cartilage.
A primary rhinoplasty will likely take approximately 2 hours. Revision rhinoplasty may take 4-5 hours. Hence, the revision surgery will be significantly more expensive.
Rhinoplasty surgery is usually done under general anesthesia. The fees for the anesthesiologist and the facility fee for the hospital/surgery center must be added to the fees.
A rough approximation of these fees is about $3,000 for a simple rhinoplasty. This brings the total approximate estimate for a rhinoplasty to approximately $8,500-9,000, here in Houston, TX.
Is a rhinoplasty major surgery?
From a surgeon’s perspective, rhinoplasty is not major surgery.
Major surgery is a subjective term. Some patients feel that removing wisdom teeth is major surgery. Other patients feel that surgery such as a hysterectomy is minor surgery.
The majority of rhinoplasty surgeries are:
- Performed in under 2.5 hours
- Patients go home the same day
- 99% of patients are able to return to normal daily life activities within 24 hours of surgery.
Therefore, I feel that rhinoplasty surgery is an “easier” surgery on the patient than most other surgical procedures.
However, it is a surgical procedure. Proper preparation before surgery and attention to post-operative instructions is important.
What is the healing time for rhinoplasty surgery?
The final results for a rhinoplasty is approximately 6 months. This is how long it takes for all the tissues to completely heal.
Most patients see their results within 3-4 weeks. They can resume full activity including working out within 3 weeks.
Patients with little work necessary such as a small hump tend to heal quickly. Patients with thicker skin, more surgery to the tip of nose, major surgery or trauma in the past take longer to heal.
The second major variable in the healing process is the surgeon and surgical technique used. The first technique used by Dr. Athré was the open structural technique. Patients needed approximately 10-14 days to return to normal activities.
The latest revision of Dr. Athré’s technique uses a dorsal preservation approach with minimal incisions and an ultrasonic piezotome. This has brought that post-operative healing down to less than 6 days. Most of Dr. Athré’s patients are able to return to work in less than 6 days.
What is the right age for a rhinoplasty?
The starting age for a rhinoplasty is usually around 14-15 in girls and 18 in boys.
There is no “correct” age for cosmetic nasal surgery. The variables Dr. Athre looks for are:
- The beginning of puberty
- Attaining of maturity with respect to cranial growth
- Emotional maturity
The top end has no age limit. The primary variable in determining if a patient is a good candidate for rhinoplasty surgery is their overall health and medical history. An 85 year old patient in excellent health is still a good candidate for rhinoplasty surgery!
What are the risks of rhinoplasty surgery? What happened to Michael Jackson regarding rhinoplasty surgery?
All surgeries have risks. The basic risks of all surgeries include bleeding, scarring, and infection. This is a broad category and does not really apply specifically to rhinoplasty surgery and most facial plastic surgery.
The main risks of rhinoplasty surgery are:
- Difficulty breathing through your nose after surgery
- You do not like the cosmetic outcome of your nose
- The tissues of your nose do not heal well
All of these risks can be combined into a revision risk. The revision risk is the risk that you need another surgery in the future.
An accepted revision rate is approximately 10%. Meaning that rhinoplasty is successful in 85-90% of cases the first time. The revision rate at Athré Facial plastics for primary rhinoplasty surgery is less than 2%. The reason for this is experience, training, dedication, and passion.
It is important to note that all patients that request a revision may not need a revision. Michael Jackson is an excellent example of this.
Michael Jackson had a very good result after his primary surgery. Michael Jackson chose to pursue a revision surgery. Revision surgery carries inherent risks, and the continuous chain of revision surgeries led to the development of Michael Jackson’s nasal problems. Patients need to be evaluated carefully with respect to revision surgery to determine the risk/benefit ratio of revision surgery and see if revision surgery is the right option for the patient.
What is the difference between a rhinoplasty and a nose job?
There is no difference. Rhinoplasty is the scientific term that describes a procedure that modifies the functional AND cosmetic attributes of the nose to achieve a more balanced, cosmetically appealing, and better functioning nose. A nose job is just the colloquial way of saying rhinoplasty.
Will I have packing in my nose after a rhinoplasty?
Dr. Athre does not use packing in the nasal passages. Dr. Athre also does not use a splint.
Every surgeon is different when it comes to packing and splints. Originally (15 years ago), Dr. Athre used a custom-formed plastic splint on the outside of the nose, approximately 6 inches of packing inside each nasal passage, and surgical steri-strip tape on the external skin of the nose.
That is the past!!!! With newer techniques including piezo-ultrasonic rhinoplasty and dorsal preservation rhinoplasty, Dr. Athre does not use any packing!!!
The current dressing is simple tape affixed to the skin envelope of the nose for 5 days. No splint. No packing. Patients are happier, have less bruising, less swelling, and less discomfort. A win for everyone!
Is it hard to breathe after a rhinoplasty?
The change in post-operative dressings has reduced the feeling of stuffiness and blockage after a nasal surgery.
In the first generation of rhinoplasty nose surgery with nose packing and a splint, patients were 100% required to breathe through their mouth after surgery.
With Dr. Athre’s current methods, patients have no packing in their nose and are able to breathe through their nose immediately after surgery.
By about post-operative day 3-4 when swelling sets in, patients have mild, TEMPORARY nasal blockage for about 5 days. The feeling that most patients describe is similar to a mild cold.
“Dr Athre did an amazing job on my nose. His staff treated me like family and I felt very comfortable getting the work done. He was very intuitive on what I was trying to accomplish and knowledgable enough to work through the issues involved to get the result I wanted, especially considering it was a revision surgery. The whole experience was great and helped me so much!”