Rhinoplasty is a procedure designed to improve the appearance of your nose. A large nose can be made smaller; a small nose can be made larger. A big hump can be removed, a wide tip narrowed or a crooked nose straightened. Dramatic changes can be made or simple reshaping may be the patient’s request. Changes to the outside appearance of the nose is many times performed in conjunction with surgery on the inside of the nose to improve a patient’s ability to breathe (septoplasty) and to improve the symptoms of sinusitis (balloon sinuplasty).

During a rhinoplasty consultation, Dr. Rachel will meet with you and discuss your goals and review your desired changes. Recommendations will be made based on your exam and your expectations. We will provide you with the personal attention needed before surgery so that you feel comfortable and educated about your decision. Rhinoplasty, septoplasty and balloon sinuplasty can be performed at our surgery center or in the hospital depending on the patients’ wishes. The procedure can be performed under local anesthesia, twilight sedation or general anesthesia. Most patients can return to work in 1 week with minimal bruising and swelling and can return to daily activities within 3-4 days.

The experienced cosmetic surgeons at MetropolitanMD approach the outpatient surgery with the goal of balancing the face with proportionate facial structures and maintain or improve your ability to breath. Rhinoplasty reflects each patient’s unique personality, while enhancing the facial silhouette at every angle.

Current Concepts in Rhinoplasty:

There are many approaches available when performing nasal surgery. A closed rhinoplasty describes the technique used when the incisions to access the nasal structures are all internal and no external incisions are visible. This approach is commonly employed in patients who have a limited deformity of the tip and are interested in changes to the dorsum of the nose. An open rhinoplasty is commonly performed in more complex nasal surgery where there is more significant changes needed in the tip and dorsum with the possible need for osteotomies and cartilage grafts. A small incision is created on the columella and connected to intranasal incisions to provide unparalleled access to the nasal skeleton and soft tissues.

Cartilage grafts are commonly used in nasal surgery to enhance the aesthetic results and to improve and maintain nasal function. Available sources of cartilage include the nasal septum or the ear. The grafts can be used to support weak tissues, to improve the angles of the nose or to augment the dorsum.

Osteotomies are performed during rhinoplasty to change the alignment of the different bones in and around the nose. This can be done with precision to straighten a crooked nose or to reduce the size of a nose.
Revision rhinoplasty is a term used to describe nasal surgery on a patient who has had 1 or more previous surgeries on their nose. The tissue planes have been disrupted and careful consideration for interaction between the skin, cartilage, bone and scar tissue need to be addressed. An open technique with cartilage grafts and osteotomies are commonly employed.

Chin augmentation may be indicated when performing rhinoplasty. The strength and projection of the chin influences a patient’s profile. A chin implant is inserted thru an incision either under the chin or inside the lip. There are a variety of implants available to properly enhance the results.

Functional considerations:

Nasal obstruction and inflammatory conditions of the sinuses can be addressed concurrently with rhinoplasty. A septoplasty is a procedure to improve a deviated septum. This combined with an inferior turbinectomy can be helpful to relieve obstructive symptoms. Patients with chronic or recurrent sinusitis may benefit from balloon sinuplasty to open the sinus passages.


Rhinoplasty can be one of the most satisfying procedures for both the patient and the surgeon. Patience, however, is needed following a nasal procedure as the tissue takes time to heal. Swelling of the dorsum, tip and intranasal structures will slowly diminish to reveal the final results. Depending on the extent of the surgery, it may take up to a year for the nose to completely heal.


Fortunately, with proper counseling and safe surgical technique, complications are rare. Complications associated with nasal surgery can be similar to any surgery such as adverse effects with anesthesia, bleeding and infection. Some risks inherent to surgery of the nose and sinus include injury to the surrounding structures such as the eyes and the brain. Its possible to obtain a lack of improvement in the appearance and/or function of the nose and additional surgery may be indicated. A septal perforation or saddle nose deformity are conditions that may be related to previous nasal surgery or trauma.

Get your free cosmetic surgery consultation with Dr. John Rachel, a board certified cosmetic surgeon.

American Board of Cosmetic Surgery FACS American Board of Facial Plastic and Reconstructive Surgery Alpha Omega Alpha Accreditation Association for Ambulatory Health Care American Board of Otolaryngology Phi Beta Kappa American Academy of Facial Plastic Surgery