Rhinoplasty (nose job)

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About the procedure

A rhinoplasty, or nose job, is a plastic surgery procedure that patients in Los Angeles use to improve the appearance of the nose. There are a variety of nose shapes that cause people to seek improvement of their nose appearance. Some patients desire improvement of the front of the nose (nasal dorsum), especially if they have a prominent bump. Other patients have concerns about the appearance of the tip of their nose, especially if it is poorly defined or bulbous. Frequently, patients may have had a prior rhinoplasty procedure and would like additional correction of the appearance of their nose during a revision rhinoplasty.

In general, rhinoplasty can be thought of as a cartilage and bone shaping procedure. The nose is composed of a cover (skin), lining (mucosa), and support (cartilage and bone). The underlying nasal cartilage and bone tents the nose open and gives the nose its shape. Therefore, in order to change the shape of the nose, the shape of the cartilage and bone needs to be changed, either with suture techniques or adding cartilage grafts or removing excess or misshapen cartilage or bone. 

Prior to performing a rhinoplasty procedure, Dr. Hirsch will perform a careful history and physical examination in order to identify the specific areas of concern that can be addressed during the procedure. A standard part of this examination is an evaluation of the nasal airway and nasal septum to identify structural abnormalities that could interfere with breathing. Dr. Hirsch will often perform rhinoplasty under general anesthesia, although the procedure can be performed under sedation if desired. Depending on which parts of the nose need improvement, Dr. Hirsch will either perform a closed (no external scar) or open (external incision across the underside of the nose) rhinoplasty. 

During this procedure, Dr. Hirsch will first lift the skin of the nose is off of the cartilage and bony framework. Next, the underlying framework is inspected and then the cartilage and bone are reshaped using suture techniques, excision of cartilage, or addition of cartilage as necessary. Occasionally, it is necessary to use cartilage from the rib, nasal septum, or ears in order to shape and support the modified nasal framework. Common grafts that Dr. Hirsch uses are the columellar strut graft, spreader grafts, lateral crural strut grafts, alar batten grafts, and septal extension grafts. 

After surgery, depending on what was performed, a nasal splint (on the outside of the nose) or nasal stent (on the inside of the nose) may be used for 3-7 days to help minimize swelling after surgery. Rhinoplasty patients may experience swelling of the nose and occasionally bruising around the eyes and cheeks for 1-3 weeks following surgery. Swelling of the nose, expecially in revision rhinoplasty when extensive reshaping is performed, can take several months to resolve. However, pain after rhinoplasty is usually mild, and patients are able to resume normal activities 1-2 weeks after surgery.

For existing patients, please download post operative instructions.

Frequently asked questions about rhinoplasty:

There are specific things about my nose that I would like to improve. Is this something that I should bring up at my first consultation?

It is always better to have specific parts of your nose that you would like to improve with rhinoplasty surgery. In fact, before Dr. Hirsch will schedule your surgery, he will ask you to pick 2-3 areas of your nose that you would like to improve. For example, common features that patients would like to improve are the appearance of the dorsum (a dorsal bump is a common complaint), the tip (often bulbous or under rotated), and the width (commonly the nose is too wide). Dr. Hirsch can then focus on these areas during the surgery to ensure that he delivers your ideal result. It is very helpful to have specific areas of improvement than to have a general complaint about nasal appearance.

Is a rhinoplasty covered by insurance?

In general, rhinoplasty procedures are not covered by insurance as they are considered to be cosmetic. However, septoplasty and other breathing improvement surgeries are typically covered by insurance.

Will a rhinoplasty improve my breathing?

A rhinoplasty is considered to be a cosmetic procedure and is intended to improve the appearance of the nose, rather than the breathing. Dr. Hirsch also performs functional rhinoplasty and breathing improvement surgery, so if you are having difficulty breathing through your nose, you can schedule a consultation with Dr. Hirsch and he will evaluate your nasal breathing.

Where is the scar from an open rhinoplasty located?

The scar from an open rhinoplasty is located across the columella on the underside of the nose. This area generally heals well and the scar is typically not very visible.

When can I shower after a rhinoplasty?

If a splint is present on the outside of your nose, you should avoid getting it wet because that may cause it to fall off. It is ok to sponge bath and rinse your hair without getting your nasal splint wet, if possible.

Additional resources about rhinoplasty

Feel free to browse the following links to learn more about rhinoplasty

https://www.plasticsurgery.org/cosmetic-procedures/rhinoplasty
https://www.smartbeautyguide.com/procedures/head-face/nose-surgery/

Dr. Hirsch not only specializes in rhinoplasty, he is also an expert in breast augmentation, breast implant revision, and breast reduction.