Rhinoplasty (Nose Surgery) By Jim Lowe, MD on October 31, 2016





Will my nose look better?

The vast majority of nose surgery involves small internal incisions to allow for skin undermining and reducing deep structures. The structures of the nose are difficult to control or position through internal incisions and the surgery is often performed blindly. The airway may need to be opened to improve breathing and the bones may need to be broken to straighten the nasal base. This limited procedure touted by many as the modern nose job is supposed to provide a natural nasal enhancement.  The technique is anything but modern and at times it has failed to give consistent results.

The typical nose job is popular because it is sold as fast and simple.  It is so simple that even an untrained plastic surgeon can perform. There is only one problem.   The long term results tend to be unpredictable and patients often do not look better, but may actually look worse or just “weird.”    Most nasal deformities do not just improve with a simple closed rhinoplasty technique. Nasal cartilage is like soft wood it can warp, displace, or stretch over time.  The structures of the nose have memory and tend to return to their original shape.  It is difficult to see significant improvement in nasal size and shape unless the deep structures of the nose are addressed directly.  The nose is like a tent and the nasal structures are the support and the skin is the overlying cover.  So what do you do?  You can undergo multiple small treatments to improve irregularities or get an open rhinoplasty.  A good rhinoplasty or nose job usually takes months to fully recover.  The nose will swell the skin redundancy takes time to contract.

Do minor surgical procedures make sense?

Nasal surgery like life sometimes requires compromise.  Fillers or other agents can be used to conceal nasal deformities.  This works by temporarily filling defects on the surface of the nose. These procedures are often used after nose jobs to hide defects or minor scars. As patients age these agents are not permanent but can provide significant improvement in shape and breathing. 

Fillers allow patients to continue non-surgical treatments for some time but not indefinitely. Permanent fillers such as fat transfer can provide good long term solution in limited situations. 

Removing or repositioning deep structures of the nose provide lasting results in most patients.  Minor procedures such as isolated nasal hump removal can often be performed in less than two hours under light anesthesia.  This is often the best option for patients who are only unhappy with one area of the nose.  Secondary rhinoplasty is far more complicated than the first nose job. Certain medical issues can such as drug use or nasal trauma can make surgery more complicated.  The need for an open nose job is usually obvious, but in others it can be a difficult clinical and cosmetic decision.  Patients should carefully weigh the pros and cons of rhinoplasty with a skilled board certified plastic surgeon such as Dr. James Lowe

There is a better way.

The nose has important supporting structures and muscles that secure and support the nasal shape and airway.  These structures hold things in place while allowing for good nasal breathing.   As patients age these structures droop and the shape of the nose may become worse or bigger.   Past nasal trauma may cause progressive airway obstruction or nasal deformity.  In order to reliably address nasal shape and breathing the nose is best opened at the base.  This allows for detailed examination and repair of structures under direct vision.  The surgery is not blindly performed like other techniques.  Although open techniques require a small scar, the clinical results and recovery are highly reliable.

Open rhinoplasty is usually best because details matter in rhinoplasty.  However, the recovery is not several weeks, but several months.  Patients feel OK at the end of a week, but do not fool anyone for at least 3 weeks.   Patients will have a good idea of the final long term results by 3-4 months.  Not only will their nose look better long term but the nasal airway will not be compromised.   

Unfortunately, good rhinoplasties are like everything else in life.  If you want more, you have to put more into it – meaning, you may have to undergoing more surgery and more recovery for a good long term result.  Nose jobs can be combined with other minor surgical procedures such as upper eyelid tucks, soft tissue fillers, or liposuction. The plastic surgeon’s goal is to individualize patient care to ensure the nose looks the way the patient wants it to look.    Dr. Lowe has never done a perfect rhinoplasty but will take the time to give each patient the best results.  

How do I avoid looking “operated” on?

Rhinoplasties or nose jobs are not for everyone. Just because a patient has a large nose or a large nasal hump does not mean they will look better after nasal surgery.  The wrong procedure, performed by the wrong surgeon, in the wrong patient, for the wrong reason, causes the wrong result.  Simple and quick is good in fast food, but is rarely better in nasal cosmetic surgery.  It can be difficult to embrace a good rhinoplasty performed the right way by the right surgeon. After a full recovery, good nose job is subtle and difficult to identify.  Great nose jobs are performed on patients who simply look better but not different.  These patients rarely admit to the nasal surgery and why should they?    

Getting through a cosmetic procedure safely relies a great deal on medical science; the way a patient looks is pure art.  Rhinoplasty surgery performed by different surgeons can be very different.  The difference is not merely the price and service, but the approach and artistic skill of your surgeon. The artistic goal is not to remove every hump or hook from your nose, but to improve the region in a natural way.  Much of the structures of the nose must be maintained to allow for adequate nasal breathing. Although some nasal structures will be reduced or moved during nasal surgery, the vital structures of the nose are preserved and protected to ensure function and shape.   

Dr. Lowe’s goal is to make each patient better without looking like a different person.  He believes that nasal deformities and obstruction can result in a great deal of patient suffering. A good rhinoplasty should first and foremost address patient desires.  The approach is individualized base on the patient’s unique features, concerns, and expectations.  A good nose job procedure attempts to significantly improve both form and function.  For further information check out our website or other helpful links at www.drjlowe.com


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James B. Lowe, MD, FACS

Lowe Plastic Surgery

Dr. Lowe is a triple board-certified surgeon with over 20 years of experience providing comprehensive cosmetic and reconstructive care. He is affiliated with several prestigious organizations:

  • American Society of Plastic Surgeons 
  • American Society for Aesthetic Plastic Surgery
  • American Board of Plastic Surgery
  • Fellow, American Association of Plastic Surgeons
  • Fellow, American College of Surgeons 
  • American Society for Surgery of the Hand 

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