Rhinoplasty

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Rhinoplasty (Nose Job) Newport Beach

Rhinoplasty (or in lay terms, nose job) is an extremely popular and technically demanding plastic surgical procedure. Rhinoplasty is particularly commonly requested by patients of certain ethnic backgrounds, like Middle Eastern (Arab, Persian), African-American, Asian and of course, Caucasian patients. Because of the central visibility of the nose, it is important to select a surgeon comfortable with rhinoplasty who has the vision and capabilities to achieve satisfactory results. Dr. Sayed has a particular interest in rhinoplasty, so much so that he co-authored a few papers on the subject from research he conducted while still a resident at UCSF, where he learned rhinoplasty skills from one of the world’s leading experts, Dr. Ronald Gruber.

Rhinoplasty procedures may involve one or more of the following components:

  • Reduction of the bony/cartilaginous bump on the top of the nose (dorsal hump reduction)
  • Refining of the cartilaginous tip of the nose
  • Narrowing of the base of the nose (especially common for certain ethnic tendencies)
  • Correction of crookedness, including treatment of deviated septum
  • Adjustment of the width of the upper bony part of the nose to create a thinner look
  • Supporting the tip with cartilage grafting
  • Revision of previous rhinoplasty results (secondary rhinoplasty)
  • Improvement of breathing difficulty
  • Treatment of contour irregularities with grafts and/or fillers

Rhinoplasty may be performed through an open or closed tip technique, depending on the cosmetic findings, the need for correction of prior results, the patient’s bony and cartilaginous anatomy, and other factors. Dr. Sayed performs closed rhinoplasty on selected patients who primarily need straightforward reduction of the bony hump (dorsal reduction). Most patients require a more comprehensive approach that we feel is better accomplished with the option to perform open tip rhinoplasty. Dr. Sayed feels this gives additional exposure that is helpful in many patients. The incision across the bottom of the nose usually heals with a barely perceptible scar in most patients. Unless you spend your time walking around with your nose upturned to the world, most people won’t even know a scar might be there!

Rhinoplasty requires a keen eye and good preoperative planning. Even the most experienced rhinoplasty specialists need to perform touchups on occasion (the published rate is up to 15%), so we do our best to plan your procedure well. This requires that you have some reasonable concept of what you are hoping to achieve. This can often be aided by using computer-assisted imaging and drawing tools, which Dr. Sayed has available. In fact, Dr. Sayed was involved in the development of the electronic medical record program that he uses in his own office, which includes sophisticated image drawing and anatomic education tools. You can see examples of the anatomy, typical incision approaches, and some correction of your preop findings to give you a sense of what rhinoplasty can achieve. While not representing a complete depiction of your projected final result, it is certainly a great educational tool and helps lead to very happy rhinoplasty patients!

Getting the result you want is not so simple as finding a picture of the celebrity nose you like best. Despite the advertising prowess of many in the cosmetic surgery industry, “designer nosejobs” are largely a marketing concept. Each patient has unique genetic and environmental factors that impact the appearance of the nose, and these must be considered during consultation in order to properly counsel the patient. It’s about finding harmonious changes that match the individual patient’s face and don’t detract from self-identity. Most of us are familiar with examples of celebrities – who you would think have access to great educational resources, counseling, and the best plastic surgeons here in Southern California — who have undergone rhinoplasty with notorious results: terrible repeat nosejobs with thinning of the skin, super angular bony reshaping that looks unnatural, or even aesthetically acceptable results that otherwise made the patient unrecognizable in a career-damaging way. These kinds of things do not represent our expectation of Aesthetics Done Right™.

If we can mutually agree on reasonable expectations of improvement and you meet Dr. Sayed’s stringent requirements of a rhinoplasty candidate, the stage should be set for an exciting transformation!

Rhinoplasty 101

Rhinoplasty evaluation starts with assessment of the patient’s anatomy and aesthetics goals. This diagram shows some of the areas we look at during a rhinoplasty consultation. Considerations include the takeoff of the nose from the forehead, the straightness or prominence of the dorsum, the width and symmetry of the nostrils, the tip definition, and other factors.

This so-called “surface anatomy” gives us clues about the internal bony and cartilage structures that define the shape of the nose. The balance of the nose’s position with respect to the chin and other structures is also considered. The nasal anatomy includes the septum, upper and lower lateral cartilages, nasal bones at the upper portion, and the relationship to the cheek portion of the skull (maxilla).

Rhinoplasty FAQ’s

1. How do I know if I am a candidate for rhinoplasty surgery?

Some of our selection criteria to include you as a rhinoplasty candidate include:

  • Cosmetic nasal dissatisfaction with objectively identifiable findings – if Dr. Sayed can’t see it, he can’t fix it. If you don’t know what bothers you, how will we? This is about matching your goals to what we can accomplish so we have to be able to communicate on the same page on this. Thankfully, we have lots of tools to help us identify your concerns and discuss how to address them.
  • Anatomic findings like a prominent hump, a big nose, a crooked nose, a long nose, an asymmetric nose, big nostrils, too much or too little sloping, etc. which you can articulate
  • Sufficient findings that fillers or other options are unlikely to give you the result you seek
  • General good health, meaning you do not have major uncorrected cardiovascular, respiratory, kidney or other major organ conditions and you are able to get medically cleared by your primary care doctor or a designated internal medicine physician who will perform a comprehensive physical examination and review preoperative laboratory studies. We also need to know if you have a history of breathing difficulties in your nose or a history of frequent sinus infections
  • Nonsmoker or willing to commit to NO NICOTINE IN ANY FORM for at least 3 weeks preop and for the duration of your recovery
  • Available support system of friends, family, caregivers or others who can help you to keep your appointments, complete your preop and postop tasks, and emotionally bolster you through this exciting journey
  • Reasonable expectations of how much youthful restoration is possible with specific techniques

2. How long does rhinoplasty surgery usually take?

Most rhinoplasty procedures are 2 to 3.5 hours in duration, depending on whether you are having grafts, an open tip or closed tip procedure, correction of a deviated septum, revision of prior work, or other maneuvers. Some simple dorsal hump reductions may take an hour or so but most patients need some work on their tip or other areas so we counsel patients to expect closer to a three hour course of surgery.

Rhinoplasty may be performed under either a closed or open tip technique, and surgery time will vary depending on the appropriate method chosen. Closed and open tip rhinoplasty both involve incisions on the inside lining of the nose, which allows a surgeon to perform many maneuvers to reshape the nose and septum. Some surgeons use this approach in all rhinoplasties, but most surgeons (including Dr. Sayed) believe there is better exposure and control over the tip cartilage and the overall shape by adding an incision across the columella (the skin and cartilage bridge between the nostrils), which allows the surgeon to “look under the hood” by pulling the skin of the nose up to reveal the cartilage from the front, as opposed to delivering it through the inside incisions for manipulation. Dr. Sayed will advise you during consultation regarding the recommended approach based on your aesthetic goals and the selected techniques.

3. What is recovery from rhinoplasty surgery like?

Most rhinoplasty are performed on an outpatient basis in a AAAASF-certified operating room, meaning the facility is up to very high standards of accreditation, under general anesthesia. There are some options for sedation without general anesthesia, but Dr. Sayed is highly selective regarding candidates for this. Patients usually spend up to a couple hours in the postoperative suite before being discharged in the care of a companion, family member or friend. Dr. Sayed gives a 24 hour phone number to all patients who can reach him for urgent questions, and we also issue access to a patient engagement application that allows the patient or companion/caregiver to send SMS messages, photos, video and other content to our team in a secure, private digital format. This keeps us mutually informed on your recovery and allows us to update your instructions while requiring a respectful number of face-to-face visits in the office.

You can expect to wear a firm splint (plaster, plastic or other material) on the nose for 7 to 10 days depending on the procedure. Dr. Sayed also routinely uses special internal splint devices called Doyle splints which help keep the septum straight and allow for air passage during the first days after surgery. You will be prescribed medications for pain, antibiotics, and additional medications to reduce swelling and other symptoms. You may be asked to clean the area of the nostrils gently with some hydrogen peroxide and apply antibiotic ointment. A small amount of drainage is normal for a couple of days after surgery but significant bleeding is rare, as are infection or other complications.

Early postop recovery findings can include bruising and swelling, mild pain, slight headache, some nasal congestion, and some mental adjustment to the process of healing which most patients undergo. Usually the most significant swelling subsides within a week and bruising is either resolved or easily concealed within 10 to 14 days. Most patients are advised to take 10-14 days out of social circulation and to give a good 3 weeks from surgery before expecting to be really in the public eye. Stitches are removed at 7 days for most open rhinoplasties. Internal sutures on the inside of the nose will dissolve on their own. Full resolution of swelling after rhinoplasty can take many months, and we counsel patients that “final” outcomes may not be fully realized until about a year after surgery. Touchups are sometimes advised or requested and will be discussed on a discretionary basis.

We ask that you abstain from exercise for 2 weeks and then return to light fitness routines after that. Dr. Sayed and his team provide close postop care in the office and with our remote engagement tools.

4. How long do rhinoplasty results usually last?

For most patients, the results of rhinoplasty are apparent fairly soon after the splint is removed and get better with time over the first year or so. We expect bony and cartilage changes, once stable, to be long lasting. Most patients who undergo rhinoplasty do not have to have it repeated years later, although Dr. Sayed does see a fair number of patients who have had surgery done elsewhere who ask for a revision by him. We are also honest in saying that like most experienced rhinoplasty surgeons, revisions to optimize or improve the result are performed on a small minority of patients (our rate is less than about 5%).

5. How can I prepare for my rhinoplasty surgery?

  • Have a reasonable expectation of what surgery can accomplish
  • Look at before and after photos and understand what kinds of techniques you are interested in
  • Write down specifically what it is about your nose you might like to alter and be as detailed as you’d like
  • Identify whether you have upper respiratory symptoms, a history of repeated sinus infections or difficulty breathing through one side or the other of your nose
  • Don’t smoke or take nicotine in any form for at least 3 weeks and ideally longer before (and after) surgery
  • Stay well rested and well hydrated and eat a nutritious diet balanced with plenty of protein
  • If your diet is lacking in vitamins, take vitamin C and zinc supplementation but ask Dr. Sayed about other supplements. We have a list of ingredients we ask you to avoid in the immediate preop phase to optimize healing and minimize bleeding risk.
  • Designate a caretaker who can help you through the first 5 to 7 days after your facelift.

6. How much does a rhinoplasty cost in Southern California or South Florida/Miami?

We don’t like to publish pricing as it is subject to market changes and dependent on the types of procedures you consider. We do have a fee schedule available in the office after your consultation, and we can give you an estimate through virtual consultation tools available on this site like our Zwivel® page. Feel free to contact us for a pre-consultation and we are happy to provide more information.