The nose is the central structure of a person’s face and pivotal to a person’s identity. So it is understandable that rhinoplasty (nasal cosmetic surgery) is the most frequent surgery performed in facial plastic surgery. Despite beyond the aesthetic component of the nose, it is important for essential functions, such as, breathing and smelling to be maintained or improved.

Surgeons dedicated to nasal surgery are often faced with patients that have undergone previous nasal surgery (either rhinoplasty or septoplasty) or have had nasal trauma (accidents usually occurring in childhood) requiring surgical intervention.

Revision surgery is challenging, mainly because the previous technique is unknown and how much of the natural nose is present is also unknown. Scar tissue and changes to normal anatomy and vascular pathways also increase the degree of difficulty.


One of the key raw materials for rhinoplasty is cartilage from the nasal septum. However, in a first intervention this cartilage is discarded, making it hard in revision surgery to obtain the necessary material for aesthetic surgery. In revision surgeries alternative sources of cartilage derive from the ear or rib cage. The former is called auricular cartilage (leaving an imperceptible scar behind the ear without changes to the appearance of the ear). The latter is mainly used in extremely challenging revision surgeries where the cartilage needs to be stiffer, therefore using rib cartilage (leaving a small scar 2 to 3 cm).

Nasal deformities secondary to trauma are also one of the major challenges in rhinosseptoplasty. In addition to the external deformity, there is usually also a functional compromise relatively to large deviations of the nasal septum. These injuries may have occurred both in childhood and in adulthood. In these cases, too, the use of atrial cartilage or costal cartilage is frequent, since as a consequence of the trauma there may be almost total destruction of the septal cartilage, as well as large asymmetries of the nose that require the use of cartilage as support or as a disguise technique.

This procedure is really complex and the above questions are some of the most frequently asked questions in a rhinoplasty consultation. However, if you still have doubts, ask your doctor directly.

Frequent Questions

Which noses can be operated on? Can you improve function and aesthetics in the same surgery?

Each nose is unique. The nose may be long, short, deviated, flat, fallen, upturned, have thin skin or thick skin, be large or small. Virtually any change (large or small) can be made to the nose. However, this requires a very specific knowledge on anatomy and physiology of the nose as well as individual analysis. It should be reminded that the nose is part of the face and the final goal of facial plastic surgery is getting the most natural and harmonious nose possible, concordant with the persons face and identity. It is as much or more important to have a beautiful but also functioning nose.

Who performs rhinoplasties? The plastic surgeon or the ENT/ORL surgeon?

This question is controversial. Although specialties of medicine are usually dedicated to distinct areas, there are border areas where two or more specialties can perform the same type of surgery. In this case both plastic surgeons as well as ear, nose and throat (ENT) surgeons can perform rhinoplasties, as long as they master the nose as a whole. In most rhinoplasties it is necessary to master and correct the nasal septum to be able to correct the deviation. The deviated septum other than causing nasal obstruction will also affect the shape of the nose and may be necessary for grafts. Rhinoplasties are often called rhinoseptoplasties resulting from the union of the aesthetic and the functional component.

I have chronic rhinitis and/or sinusitis. Can I have a rhinoplasty and treat my sinusitis / rhinitis as well?

The answer is yes; sinusitis / rhinitis is usually the result of internal lateral nasal wall pathology which can be corrected in the same surgery. These types of functional disorders are the focus of the ENT surgeon and can be simultaneously treated with rhinoplasty.

I would like to have a rhinoplasty but I am afraid it might make my nose ugly

This is the greatest fear of people who want to have a rhinoplasty. This surgery is a huge challenge even for the most experienced of surgeons. No nose is like the other, which is why a very clear conversation between the doctor and the patient is important, to manage expectations and discuss the problem at hand. Often what the patient perceives is the issue is not the main problem but rather a consequence of another. Sometimes simulation programs (Photoshop ®) are an excellent tool helping bridge communication between the doctor and the patient. However, keep in mind, even after a detailed and individualized plan, an average of 10% of operated noses may need minor adjustments or retouching after one year.

How is the post-operative period? Is it very painful?

The operation is nearly painless and well tolerated by the patient. In almost every rhinoplasty it may be normal for some bruising or swelling to occur around the eyes and discomfort occurs in the first week, the latter related to the temporary nasal obstruction and nasal secretions/crusting. Generally, an external splint is used for protection during the first week. The final form of the nose can sometimes take years, but normally after two months most of the swelling subsides.

How is the surgery performed? Will I have any scars?

There are two approaches to rhinoplasty, the “closed” and “open” approach. In the closed rhinoplasty, no skin incisions are visible and the nasal structures are dissected from inside the nostril. In open rhinoplasty, a millimetric incision is made in the columella to expose the nasal structures. However, this heals beautifully, becoming unnoticeable after 15 days. Nowadays, the choice between which technique to choose is dependent on the accessibility to provide the most satisfactory result and on the surgeons’ preference.

Will I need general anesthesia?

Surgeries are usually performed under general anesthesia for the patients’ convenience, although surgery can also be performed under local anesthesia with sedation.

What is a Functional rhinoplasty?

These are procedures that improve the nose appearance by changing its shape while also allowing for better breathing. These usually relate to the tension nose (very long nose with narrow nostrils), nose with lower alar cartilage malpositioned or narrowing of the nasal valve (nose that collapse with inspiration). These concepts reinforce the need to approach the nose functionally as well as aesthetically.

This procedure is complex and the previous issues answered here are some of the most frequently asked questions in a rhinoplasty consultation. If you have any more questions ask them directly to your doctor.

What is Ultrasonic Rhinoplasty?

One of the components of the nose to be worked on in Rhinoplasty is made up of bone (namely the hump and bones of the nose). In the classic technique, coarse scrapings and a hammer with a chisel and ostentatious were used to work on the nasal bones. With ultrasonic rhinoplasty, all this work is carried out using a delicate piece of equipment called piezo directly on the bone. As a result, a much more precise and less traumatic job can be done. Consequently, the ecchymoses are practically non-existent, the edema is much smaller and the recovery period is faster.

This procedure is complex and the previous issues answered here are some of the most frequently asked questions in a rhinoplasty consultation. If you have any more questions ask them directly to your doctor.

What is the price of Rhinoplasty?

Deciding with whom to have your ultrasonic rhinoplasty is not an easy step. The information is so much and so vast that consultation for the evaluation of each case (ideally in person) is very important. Values ​​can vary greatly from surgeon to surgeon. As in most things in life, in Rhinoplasty, the cheap can be very expensive. For the rhinoplasty to go well there cannot be a time limit, there cannot be a limit on consumables and the use of Piezzo (Ultrasonic Rhinoplasty) is fundamental, as it is a time-consuming surgery (3 to 5 hours). A good surgeon, in turn, surrounds himself with a hand-picked team and operates in a Hospital with all the technical conditions and which provides maximum safety for the patient.

This procedure is complex and the previous issues answered here are some of the most frequently asked questions in a rhinoplasty consultation. If you have any more questions ask them directly to your doctor.

Rhinoplasty: Postoperative