Rhinoplasty (Nose Reshaping)

Introduction

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Often referred to as a ‘nose job’, Rhinoplasty is not only popular with Hollywood celebrities, but is an established procedure for anyone wishing to improve the appearance or function of their nose. Rhinoplasty is one of the oldest facial plastic surgery operations, first described in Indian medical texts dating back to 500 B.C. It is also one of the most difficult to master.¹

Rhinoplasty surgeon Dr. Lawrence Tong has extensive experience performing primary Rhinoplasty (first-time Rhinoplasty), secondary Rhinoplasty
(revision Rhinoplasty, and treating complications related to Rhinoplasty. He can guide you through the various options and work with you to establish the most appropriate treatment plan for your unique concerns and goals.

Rhinoplasty Benefits

Rhinoplasty is a procedure that can improve both the appearance and the function of the nose. The procedure primarily involves reshaping the cartilage and bone to achieve these goals.

Rhinoplasty may be performed to remedy a wide range of perceived cosmetic imperfections to the nose, such as:

• The nose looks too large: the overall nasal dimensions can be made to look smaller
• A hump exists on the nasal bridge: the bridge is made straight
• The nasal tip is too large, rounded, or undefined: the tip is made thinner, sleeker, and more defined
• The nose is wide: the nasal bones are thinned, nostrils made less wide
• The nose sticks out too much: the nose is deprojected for better facial proportions
• The nasal tip points downward: the tip is elevated and slightly upturned
• The nose is crooked (naturally or from an accident): the nose is straightened

The main benefit of functional Rhinoplasty is improved air flow, which may be caused by:

• Deviated septum (remedied via septoplasty)
• Trauma, injury, or birth defect
• Narrow or collapsed nasal valves
• Previous Rhinoplasty

Open vs. Closed Rhinoplasty

There are two methods of performing Rhinoplasty: open and closed. These terms refer to the way in which the underlying cartilage, bone, and soft tissue are exposed to allow for the procedure to be conducted.

When you come in for a Rhinoplasty consultation, the following will occur:
Dr. Tong will review your medical history, including any prior nasal surgery
Dr. Tong will ask you about and listen to the specific concerns you want to address
Dr. Tong will examine and evaluate your nose
Dr. Tong will explain the various surgical maneuvers to the nose that will help achieve your goals
Dr. Tong will present any other surgical maneuvers that he feels may enhance your rhinoplasty outcome and incorporate them based upon your input
Dr. Tong will give his recommendation about which technique would be best for your goals
Dr. Tong will go over the surgery process, recovery process, and the potential risks and complications of surgery
The staff will provide you with a quote based on his recommendations and information regarding the logistics to having your surgery

Details of the Rhinoplasty Procedure

Dr. Tong can perform the Rhinoplasty procedure under two types of anesthesia: general anesthesia or IV sedation (twilight) anesthesia. Patients under general anesthesia are asleep and entirely unaware of their surroundings for the duration of the procedure, while patients under twilight anesthesia may be aware that they are undergoing surgery from time to time during the procedure. patients should feel little if any pain or discomfort. Surgery is conducted in a private surgery centre within walking distance of Dr. Tong’s plastic surgery office, also located in Yorkville.

To begin the open Rhinoplasty procedure, Dr. Tong makes small nasal incisions to expose the underlying nasal cartilage and bone. Maneuvers are then performed as needed in order to remove the hump, refine and elevate the tip, decrease (or increase) the projection, and reduce the width of the nose. The surgical maneuvers vary, depending on the individual case.

The hump is removed by shaving cartilage and bone. The appearance of the nasal tip is altered to improve definition by removing, stitching, or adding cartilage in the tip area. The septum is straightened, as needed (again through removal, bending, scoring, or reinforcing the cartilage). The nasal bones are often repositioned slightly to achieve a thinner, more elegant look.

Once Dr. Tong is satisfied with the results, the Rhinoplasty incisions are carefully stitched and the patient is placed in a special protective dressing (nasal splint) before being gently awakened from anesthesia.³

Recovery after Rhinoplasty

Immediately following Rhinoplasty, our nurses will monitor you in the post-anesthesia recovery area. You will be allowed to go home once the effects of anesthesia have worn off, accompanied by your friend or family member.

Once at home, you need to relax and protect your nose from being injured. You may perform non-strenuous activities, such as watching television and reading. You should expect your nose to feel very stuffy, and most patients will breathe only through the mouth during the first week. Pain after Rhinoplasty is typically mild to moderate. Pain medication will be prescribed, and may be used during this time. The face and areas around the nose will be swollen. You may have bruising around the eyes in the first 1-2 weeks. The majority of patients return to work (non-strenuous) at 7-10 days.

Dr. Tong will see you one week after your Rhinoplasty procedure to check your progress and remove your stitches and dressing. You will likely be allowed to start light exercise (e.g. walking) at 2 weeks after surgery. Avoid strenuous activity until 4-6 weeks after surgery, especially avoiding sports where you could be hit in the face (e.g. hockey, basketball). After the initial post-surgical visit, you will have follow-up visits with Dr. Tong at 6 weeks, 6 months, and one year after surgery. Post-operative photos will also be taken at these visits.

It is important to stress that the nose may look fairly swollen initially after Rhinoplasty. This is entirely normal, and it takes between 6-8 weeks for a majority of the swelling to resolve. Even beyond this, full resolution of the swelling usually takes 12 months or more. As the swelling subsides, you will notice that the nose gradually becomes thinner and smaller, with the tip taking the longest to fully settle. Patients usually like the look of their nose right after surgery, but the appearance will still slowly continue to improve as time goes on until it reaches its final form.

As with any surgery, there are risks involved with Rhinoplasty. Although the procedure has a low risk profile, Dr. Tong will make sure to go through the pertinent potential problems associated with Rhinoplasty at the time of your consultation.

Asian and Ethnic Rhinoplasty

When Rhinoplasty is performed on a patient who is non-Caucasian, it is termed an ethnic Rhinoplasty. (Note that the term ‘Caucasian,’ as it is applies to this discussion, refers to patients of European ancestry.) Ethnic Rhinoplasty differs from non-ethnic (i.e. Caucasian) Rhinoplasty, as it requires consideration of two important aspects: cultural factors and anatomic factors.

Cultural Factors

Differences in concepts of beauty exist between cultures and must be taken into account when performing ethnic rhinoplasty. For example, in Asian Rhinoplasty, creation of a higher bridge is often requested; however, the desired height is typically much less than the height of a Caucasian nose. This example illustrates the essential concept of maintaining the ethnic character of the patient when performing ethnic rhinoplasty. Equally important, however, is determining whether or not a particular patient wishes to follow these cultural perspectives. Communication with each individual considering nose surgery is key to success in ethnic rhinoplasty. It is also imperative that the surgeon is familiar with different cultural perceptions of beauty for patients of every descent.

Anatomic Factors in Ethnic Rhinoplasty

Ethnic Rhinoplasty differs from Caucasian Rhinoplasty because the anatomy is often quite distinct. For example, in African American Rhinoplasty, we often see thicker skin, a wider alar base, and less intrinsic cartilage support. In Asian patients, it is common to see a low bridge, minimal tip projection, a rounded/bulbous appearing tip, and a wide alar width with flaring. The nasal bones in ethnic patients are usually quite different from Caucasian patients as well. These anatomical differences alter the way that a surgeon needs to approach the Rhinoplasty. Surgeons performing ethnic Rhinoplasty must be aware of these differences and understand how to deal with the distinctions, as the correction is frequently unique and distinct from Caucasian Rhinoplasty.

Revision Rhinoplasty

Sometimes individuals who have undergone a previous Rhinoplasty do not achieve the results they had originally envisioned and are disappointed with the outcome of their initial procedure. If a primary Rhinoplasty failed to correct the cosmetic or functional concerns you sought to improve, Dr. Tong can perform revision Rhinoplasty in an effort to enhance the outcome of your nose surgery. This intricate procedure involves working with the bones, cartilage, and structures of the nose that have already been operated on, necessitating the advanced experience of a qualified revision Rhinoplasty surgeon to achieve the ideal outcome.

During a consultation, Dr. Tong will closely examine the appearance and anatomy of your nasal framework to assess how your results can be improved within the context of your goals. He will listen closely to your concerns and surgical objectives to ensure a mutual understanding of the desired outcome is achieved.

Dr. Tong generally recommends waiting at least 10 to 12 months after the initial procedure before undergoing revision surgery. After Rhinoplasty, the appearance of the nose may still change during the first year and even afterward. These changes are related to the very slow and gradual resolution of edema (swelling), as well as the softening of internal scar tissue. Due to the changes that occur after Rhinoplasty procedures over time, there are multiple reasons to delay performing revision surgery:

• A revision procedure may be avoided altogether if the nose is afforded time to heal and settle. As the nasal edema continues to resolve and scar tissue progressively softens, the appearance of the nose will change and the problem area(s) in question may correct on their own. This is especially true in the nasal tip region, as the edema in the tip takes the longest to subside.
• Evaluation of the nose in the first 10 months after the initial surgery may not be accurate, therefore it can be difficult to judge the ‘true result’ of your Rhinoplasty. Even if the problem area(s) are not expected to resolve on their own, it’s still important for Dr. Tong to have an accurate picture of the anatomy that is not muddied by unresolved edema and scar tissue. An incorrect picture of the anatomy may lead to a sub-optimal surgical plan.
• Performing a revision surgery too early is more difficult. The scar tissue will be too firm, and the nature of the scar will make it difficult to differentiate and dissect between planes of tissue. These factors lead to a higher risk of failure in correcting the problems in question, and may even create new concerns.
• In general, the longer a patient waits to pursue revision Rhinoplasty, the greater the likelihood that the surgery will be successful.

Please don’t hesitate to contact our practice for a revision Rhinoplasty consultation with Dr. Tong to discover how we can help you fulfill your original reasons for surgery.

How to Choose the Best Plastic Surgeon For You

Rhinoplasty FAQs

How Much Does Rhinoplasty Cost?

The cost of Rhinoplasty in Canada starts at $15,700 + HST, depending on the type of anesthesia utilized and the geographic location where the procedure is performed. In comparing plastic surgery costs, having the surgery performed under sedation (when appropriate) usually costs less than general anesthesia. Similarly, undergoing the surgery in a larger city usually costs more when compared to smaller cities. While the above figure can serve as a general cost estimate, the price of Rhinoplasty will ultimately depend on factors unique to your procedure, such as:

• The nature and extent of surgical work to be done
• The technique used during surgery (open vs. closed)
• Whether your Rhinoplasty is a revisional procedure

Will I Have Visible Rhinoplasty Scars?

Any surgical procedure will leave some type of scar. Dr. Lawrence Tong specializes in forming the least visible scars possible and putting them in the most inconspicuous places. The incisions for open Rhinoplasty are all inside the nose, except for a 2-3 mm incision across the base of the columella (the central tissue that separates the right and left nostrils). It hides well because of this location, and the single scar tends to be almost invisible once healing is complete.

The closed technique of Rhinoplasty only utilizes internal incisions, leaving no visible scarring after the procedure.

Dr. Tong will discuss the best ways to care for your incisions, and thereby minimize the resulting scars after your procedure. In general, scars tend to heal better when incisions are kept clean and sun exposure is limited post operatively. Keeping the area clean in the first week plays a key role in reducing the chances of infection, which can lead to poor scarring. Applying sunscreen on the scar starting one week after surgery can provide the necessary protection against UV rays that have the potential to darken immature scars.

In addition to sunscreen, patients should avoid active or direct tanning of the area. If you plan on being outdoors for an extended period of time, you should wear a hat that will sufficiently cover the nose. Most men and women find their Rhinoplasty scars are virtually undetectable once they heal. Patients should be aware that all scars will evolve and mature as they heal, initially starting with a light pink colour and gradually fading to closely match the surrounding skin. Every person has a different timeline for scar maturation, but most patients have a fairly minimal scar even at 6 weeks after surgery. If the scar is visible to some extent while the scar is healing, patients can use makeup to hide it until it ultimately fades.

Is a Non-Surgical Nose Job Possible?

A non-surgical Rhinoplasty can be performed using volumizing dermal fillers to change the appearance of the nose. In contrast to a surgical Rhinoplasty, non-surgical Rhinoplasty is more limited in scope. The best and most common use of minimally invasive nose alteration is on the nasal dorsum to augment the bridge, or hide small nasal bumps. In Asian patients, fillers are often used to elevate the height of the bridge. This can dramatically change the appearance of the nose and create a much more balanced profile. Patients with a small hump on the bridge can also have it minimized or hidden by placing some filler above and below the bump to smooth the out the shape of the bridge.

Fillers can also be placed in areas to correct asymmetries or contour irregularities from prior trauma, surgery, or normal growth. Occasionally, fillers are used in the tip to augment size or slightly increase projection. This application is limited as fillers cannot make the tip look thinner. The tightness of the tip skin and the viscosity of the filler usually create a fuller tip appearance when compared to a thinner one. One unique advantage regarding fillers in the nose is that they tend to last much longer than application elsewhere on the face. In the bridge, it is not unusual to see results lasting for one year or more. A surgeon with experience performing ‘liquid Rhinoplasty’ can provide the best advice.

Can I blow my nose after Rhinoplasty?

You should avoid blowing your nose for at least one to two weeks after Rhinoplasty since the nasal framework will be very fragile during the healing process. Patients who had a deviated septum repaired may need to wait longer before blowing their nose. Internal pressure caused by premature nose blowing can cause bleeding, damage to the soft tissues, and may alter the final outcome. Feeling congested after nose surgery is normal, but you can use a saline nasal spray to clear the nostrils. Congestion is usually the result of internal swelling of the mucosal lining. As the swelling resolves, the nasal passages start to open and breathing should improve. Patients are encouraged to sleep with their back propped up with extra pillows during the first week (or more) after surgery, as this is the best method to accelerate resolution of the internal and external edema (swelling).

How long after Rhinoplasty can I wear glasses?

As the nasal bridge is healing, wearing glasses—including sunglasses—should be avoided for four weeks to prevent excessive pressure on the nasal bones and tissues. If you use prescription lenses, Dr. Tong recommends switching to contact lenses until he gives you clearance to resume wearing glasses. Alternatively, wearing glasses is permitted by using a piece of tape at the central portion of the glasses to suspend the glasses from the forehead, thereby taking pressure off the nasal bridge.

How can I reduce swelling after Rhinoplasty?

It is common for swelling to linger for months after Rhinoplasty, but you can accelerate the rate of healing by limiting consumption of salty foods and alcohol. Sleeping with the head elevated (above heart level), as well as using nose tape, can also help reduce swelling. The most important factor, however, is time. You must be patient with the healing process, as swelling and its resolution are part and parcel of the Rhinoplasty procedure. Dr. Tong will provide you with more detailed instructions after your operation.

How do I clean my nose after Rhinoplasty?

For the first few days after surgery, you can use a cotton-tipped swab to gently clean the nasal passages, limiting cleaning to the rim and just inside the rim. Be careful to avoid inserting the swab too deeply into the nasal passages during the first one week. Irrigating the nose with a saline rinse can also help clear the airways of any deeper blood or mucous.

Dr. Tong encourages patients to apply a thin layer of petroleum ointment on the incision line and sutures using a cotton-tipped swab to help soften any dried blood. Dried blood should be gently cleaned as it becomes soft. Having a clean incision line will make removal of the stitches much more comfortable for you. The nasal bridge should not get wet when the nasal splint is in place. During the initial week, you may wash your face carefully with a face towel, being careful to keep the splint dry. You may wash your hair in the shower provided your back is facing the stream of water and you only let the water run down the back of your head, keeping the splint dry. The splint is removed at the first post-operative visit, one week after surgery. After the splint is removed, you may wash your face normally but should avoid placing excess pressure on the nose.

How long will it take for the nose to fully heal after Rhinoplasty?

While most swelling subsides within three months after surgery, it can take one year or often more for the nose to heal completely. This means that you can expect your nose to continue to change and improve during the first several years. In cases of revision Rhinoplasty, it may take even longer for inflammation and scar tissue firmness to fully dissipate. Most patients see the majority of their final results after a few months, with the outcome continuing to refine over the first year after surgery and beyond.

Your Rhinoplasty Consultation

At Yorkville Institute of Plastic Surgery, it is our goal to ensure patients are fully educated about their options so that they can make confident decisions about both their plastic surgery and the surgeon who performs it. To this end, please plan for your initial consultation with Dr. Tong to last for at least 45 minutes.

To prepare for your Rhinoplasty consultation with Dr. Tong, you should think carefully about what you would like to change about your nose. Based on this, Dr. Tong will work with you to formulate a personalized Rhinoplasty strategy, and can even provide computer imaging to give you an idea of potential surgical outcomes. (It is important to note that computer imaging is an estimation of what might be accomplished surgically, and should not be taken as an implied or explicit guarantee of results.)

Dr. Tong may also recommend a chin implant or other procedures that he feels will help you meet your aesthetic goals.

To learn more about how Dr. Tong can help you improve the appearance and/or function of your nose, schedule a Toronto Rhinoplasty consultation with Dr. Tong by giving us a call at (647) 492-0648. Alternatively, let us give you a call; just fill out our contact form and we will call you on the same or the next business day. No physician’s referral is needed.
See Dr. Tong’s work in our Rhinoplasty before and after photos.

¹ Meyer H, Eldredge J, Hogan R. Venus Envy: A History of Cosmetic Surgery. JAMA. 1998;279(24):2006. doi:10.1001/jama.279.24.2006. Accessed July 10, 2020.
² American Society of Plastic Surgeons. Rhinoplasty candidates. Available: https://www.plasticsurgery.org/cosmetic-procedures/rhinoplasty/candidates. Accessed July 13, 2020.
³ American Society of Plastic Surgeons. Rhinoplasty procedure. Available: https://www.plasticsurgery.org/cosmetic-procedures/Rhinoplasty/procedure. Accessed July 13, 2020.