Rhinoplasty (Nose Surgery) – San Diego
Rhinoplasty (or in lay terms, nose job) is a technically demanding plastic surgical procedure that’s one of the oldest and most popular plastic surgery procedures in the world. While the basic goal is to reshape the nose into a more balanced and proportional form, it can be customized for patients of certain ethnic backgrounds, like Middle Eastern (Arab, Persian), African-American, Asian and of course, Caucasians.
Because the nose is such an essential focal point for facial aesthetics, it is important to select a surgeon who’s not only comfortable with cosmetic nose surgery, but who has the vision and capabilities to achieve balanced, natural looking results—like San Diego based Dr. Tim Sayed.
Dr. Sayed has enjoyed world-class training and experience in rhinoplasty. Before he moved to San Diego and opened his boutique solo plastic surgery practice, he was as a resident in UCSF, where he was mentored by one of the world’s leading experts, Dr. Ronald Gruber. While at UCSF, Dr. Sayed even co-authored papers on this procedure with findings from his own medical research and clinical observations. Dr. Sayed’s interest in surgery of the nose stems from his aspiration to create symmetry, balance and facial harmony for his patients. While most of his patients elect to undergo nose surgery for cosmetic purposes, some patients seek out nose surgery for functional reasons. Here are some of the common goals for cosmetic nose surgery:
- Adjustment of the width of the upper bony part of the nose to create a thinner look
- Correction of crookedness, including treatment of deviated septum
- Improvement of breathing difficulty
- Narrowing of the base of the nose (especially common for certain ethnic tendencies)
- Reduction of the bony/cartilaginous bump on the top of the nose (dorsal hump reduction)
- Refining of the cartilaginous tip of the nose
- Revision of previous surgery (secondary rhinoplasty)
- Supporting the tip with cartilage grafting
- Treatment of contour irregularities with grafts and/or fillers
View real patient before & after results in our photo gallery.
The evaluation for rhinoplasty begins with an assessment of the patient’s anatomy and aesthetic goals. The 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).
This diagram shows some of the areas we look at during a consultation.
Considerations for rhinoplasty include the takeoff of the nose from the forehead, the straightness or prominence of the dorsum (the bridge of the nose), the width and symmetry of the nostrils, the tip definition, and other factors.
Rhinoplasty Technique Options – Open or Closed Tip
Rhinoplasty may be performed through an open or closed tip technique, depending on the cosmetic findings (basically, your nose’s aesthetic flaws), whether we need to revise a previous procedure, the patient’s bony and cartilaginous anatomy, and other factors. In a closed tip approach, incisions are hidden on the inside of the nostrils. In an open tip approach, these are joined across the bottom of the nose with an additional incision that allows the surgeon to “lift up the hood” of the nose. The advantage of an open tip is that there is more exposure of the cartilage structures in the tip, and it is easier to perform stitching or place grafts, when needed. There can be additional swelling with the open tip approach.
Dr. Sayed performs closed nose surgery on select patients who simply need straightforward reduction of the bony hump (dorsal reduction). Most patients, however, require a more comprehensive approach that we feel is better accomplished through open tip rhinoplasty. Dr. Sayed believes the additional exposure provided by an open approach is helpful for patients with more complex nasal cosmetic and functional issues. 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 Planning and Projected Outcomes
Rhinoplasty requires a keen eye and good preoperative planning. Even the most experienced specialists need to perform touch-ups on occasion (the published rate is up to 15%), so we do our best to plan your procedure well. This also means that before your procedure you should have a reasonable concept of what you are hoping to achieve. To help you get a good sense of your rhinoplasty, we can aid you through 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 San Diego 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 treatment can achieve. While it won’t be representative or a complete depiction of your projected final result, it is certainly a great educational tool and helps lead to very satisfied patients!
Keep in mind: getting the result you want is not as simple as finding a picture of the celebrity nose you like best. Despite the advertising prowess of many in the cosmetic surgery industry, “designer nose jobs” 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 the consultation in order to provide you with proper recommendations during your consultation. A rhinoplasty is more about planning and determining what changes to make that will create balance and harmony with your face. We do not want to detract from your natural facial characteristics. We aim to enhance your image, not completely change your image. Most of us are familiar with examples of celebrities who have undergone nose surgery with notorious results: terrible repeat nose jobs 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 results we avoid, and that do not represent our expectation of Aesthetics Done Right™.
Frequently Asked Questions About Rhinoplasty
Some of our selection criteria to include you as a 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 with the rhinoplasty 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 with rhinoplasty.
- 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 your exciting journey
- Reasonable expectations of how much youthful restoration is possible with specific techniques
Most procedures are between 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 techniques. Some simple dorsal hump reductions may take an hour or so, but most rhinoplasty 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 surgeries both involve incisions on the inside lining of the nose, which allow Dr. Sayed enough access to reshape the nose and septum. Some surgeons use this approach in all rhinoplasty surgeries, but Dr. Sayed selects the approach for each patient based on specific needs. For patients seeking reshaping of the tip of the nose, or who have breathing difficulties and other functional problems in the nose, 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 the consultation regarding the recommended approach based on your aesthetic goals and the selected techniques.
Our rhinoplasty surgeries are performed under general anesthesia in an outpatient basis in a local San Diego AAAASF-certified operating room, meaning the facility is up to very high standards of accreditation. 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 about their procedure, 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 technique used. 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 your rhinoplasty. 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 for rhinoplasty surgery can include bruising and swelling, mild pain, slight headache, some nasal congestion, and some mental adjustment to the process of healing. Usually, the most significant swelling subsides within a week and bruising is either resolved or easily concealed within 10 to 14 days of the recovery. Most rhinoplasty 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 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.
For most patients, the results 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 surgeons, revisions to optimize or improve the result are performed on a small minority of patients (our rate is less than about 5%).
- 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
- 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 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 treatment.
It’s essential that only patients with noses that have fully matured undergo rhinoplasty; typically, girls’ noses have matured by 16 and boys’ have matured after the age of 17.
For the first couple days of your recovery, it’s essential that you keep your head elevated—even when you’re sleeping. To help achieve that, you can sleep on an incline pillow or merely prop yourself up. It’s also essential that you don’t sleep on your stomach after your treatment (for obvious reasons!), so one thing you can do is place pillows by your sides to prevent you from turning over.
A rhinoplasty should never change how you look—it should just being your facial features into harmony. By reshaping the nose so that it’s more proportional to your face, a rhinoplasty can help you look more balanced and aesthetically appealing.
The majority of the swelling from should subside after two weeks, but residual swelling might take up to a year to resolve.
During your recovery, you should NOT:
- Wear glasses for up to a month once the cast is removed
- Sleep on your side during the first 2 weeks
- Blow your nose for the first 3 weeks
- Take a shower while still wearing your cast—a bath is okay as long as the cast is kept dry
- Engage in strenuous activity for the first 2 weeks
We don’t like to publish the cost of rhinoplasty in San Diego as it is subject to market changes and dependent on the types of procedures you consider. Review our Pricing page to build a “wishlist” and get estimated pricing on rhinoplasty or a combination of procedures. We also have a fee schedule available in the office after your consultation. Feel free to contact our San Diego office for a pre-consultation and we are happy to provide more information.
Contact us today!
If you’re in the San Diego or Newport Beach areas and have any questions or wish to schedule a consultation on rhinoplasty with Dr. Sayed, please contact our office.