Rhinoplasty (Nose Job)

• Dr. Linkov is a double board-certified by the American Academy of Facial Plastic and Reconstructive Surgery and the American Board of Otolaryngology-Head & Neck Surgery.
• He is a dual Ivy League-educated facial plastic surgeon who completed an accredited American Academy of Facial Plastic and Reconstructive Surgery fellowship.
• He has an artistic background paired with an Ivy League medical education, granting him a unique combination of skill and talent tailored for the field of facial plastic surgery.
• He is a prolific clinical researcher with over two dozen publications that have had a significant impact on the fields of Tissue Engineering, Head and Neck Cancer, and Facial Plastic Surgery.
• He is proud to be an adjunct assistant professor at New York University teaching rhinoplasty.
• He is included in the prestigious Super Doctors New York, Rising Stars™ listings and was featured on the Dr. Oz Show.

As a best-in-class NYC rhinoplasty specialist and a frequently sought-after expert in the media, Dr. Gary Linkov specializes in the most challenging nasal reconstructions. He utilizes the most recent advancements in rhinoplasty, medical technology, and equipment in his state-of-the-art surgical facility on Madison Ave in Manhattan.

Rhinoplasty specifically describes nose plastic surgery that alters the bone, upper lateral cartilage, and/or lower cartilage of the nose. Dr. Linkov recommends both functional and aesthetic rhinoplasties at the same time. When combined, a rhinoplasty procedure can address several medical conditions at once, including:

• A breathing or sinus issues
• Deviated septum
• Imperfections from a skin cancer cure
• Breaks that weren’t set properly

While many techniques can reshape and improve nasal functions, Dr. Linkov relies on advanced methods that have proven to be more effective. He’s completed additional training in these new procedures, and he’s performed them numerous times. When you call on a talented surgical artist like Dr. Linkov, your results are stunning, and your altered nose improves your health.

The best candidates for rhinoplasty in New York are non-smokers in good health who want to look their best. If your nose has matured or stopped growing, you can benefit from Dr. Linkov’s cosmetic nose reshaping. You can get a rhinoplasty as early as your adolescent years, although anyone under the age of 18 requires full parental consent. You have to be old enough to understand the risks, consequences and benefits of the procedure. In general:

• Girls can be as young as 15 or 16 years old;
• Boys can be as young as 17 or 18 years old;
• There’s no maximum age for a rhinoplasty, but you must be medically and emotionally able to proceed with a surgical procedure.

Changing the appearance of your nose is a significant decision, one you shouldn’t take lightly. You must have a strong desire for change, as well as the maturity to make the decision wisely. You shouldn’t have a rhinoplasty nose job if you:

• Take blood thinners that you can’t stop taking;
• Have a medical condition prohibiting general anesthesia;
• Don’t have enough nasal cartilage;
• Have poor overlying nasal skin;
• Suffer from active vasculitis or Wegener’s disease that affects your nose;
• Have unrealistic expectations.

Prior to committing to rhinoplasty, Dr. Linkov schedules two initial consultations, which can take up to 12 hours total. During your first rhinoplasty consultation, he covers a wide range of topics that may potentially disqualify you, such as:

• Your health history;
• Medications you currently take;
• Any current health disorders;
• Current lifestyle habits, such as smoking and exercise routines.

During your second appointment, you need to explicitly outline your goals for surgery. Here’s your opportunity to voice any cosmetic or functional imperfections you want to address. Dr. Linkov conducts an in-depth facial evaluation that includes an assessment of the six parameters of your nose to determine whether your goals are realistic. Additionally:

• Your surgeon takes pictures of your nose from eight different angles with digital imaging computer software.
• You can see, in a 3D simulation, approximately what your nose will look like after the surgery.
• To avoid a strong mental fixation on a projected outcome, you aren’t given any pre-operative simulated images before the surgery. The computer image isn’t a guarantee of your result after surgery, but rather a guide for Dr. Linkov during surgery.
• You and your surgeon decide on which approach to take: an open rhinoplasty or a closed rhinoplasty.

There are multiple types of cosmetic nose surgery, but the two primary types of rhinoplasty include “open” and “closed”. The best approach for rhinoplasty depends on your particular case and on the goals and preferences you and Dr. Linkov define. The differences between the two procedures include:

Closed rhinoplasty is called an endonasal approach.

• Involves no visible incisions. Dr. Linkov makes the incisions inside your nose.
• Limits what your surgeon can see, which is why this technique has become less popular.
• May allow your surgeon to better judge the outcome during the surgery because the nasal skin remains in place.
• Often causes nasal tip swelling if the tip is manipulated.

Open rhinoplasty uses an external approach, with a small incision made at the mid-columella, close to the base of your nose, with a few internal incisions.

• Allows for a more complex reconstruction.
• Provides greater visibility for your surgeon.
• May leave more swelling after surgery.
• Has a rare risk of poor scarring at the external incision site.

Dr. Linkov, a top NYC Rhinoplasty specialist, is a double board-certified and Ivy League-trained facial plastic surgeon; he considers every possibility when weighing the evidence.

While rhinoplasty has a near-perfect safety record, proper anesthesia with complete airway control is essential. The bleeding must be controlled by a skilled, preferably board-certified plastic surgeon, such as Dr. Linkov. He can ensure the procedure’s effectiveness while also guaranteeing that no complications occur. Potential risks and complications of rhinoplasty are:

• Bleeding
• Infections
• Poor healing or scarring
• Dorsal irregularities
• Skin discoloration

Because rhinoplasty can cause a variety of complications, it is important to select the best-in-class plastic surgeon who understands these risks and has strategies in place to avoid them.

Once you’ve decided to undergo nose plastic surgery, Dr. Linkov gives you instructions to prepare for your procedure.

To get the best results before the procedure, he advises:

• Avoiding certain medications and supplements that may thin your blood, such as aspirin, ibuprofen, naproxen, vitamin E, garlic, ginger, ginseng, St. John’s wort, ginkgo and black cohosh
• Stopping smoking at least two weeks before surgery, as tobacco products decrease blood flow to your skin, compromising how quickly your surgical site heals
• Stopping all nasal sprays two weeks before surgery, except for saline, which you can continue
• Picking up the prescribed medications you’ll need after surgery, such as an antibiotic and pain medication
• Arranging for someone to accompany you home and stay with you for at least the first night

On the day of your nose job surgery, you:

• Cannot eat or drink six hours before the procedure
• Change into a surgical gown
• Take a pregnancy test if you’re a woman of child-bearing age
• Plan to spend about an hour for the intake process

Dr. Linkov performs a complete reshaping of your nose while you’re under twilight or general anesthesia. Simpler procedures, like a nostril reduction, can be performed with local anesthesia only. Anesthesia ensures that your:

• Comfort level is maximized
• Movement is limited
• Airways are protected

The surgery takes two to four hours. You spend another hour in recovery. The major steps of the surgery include:

• Exposing the underlying structures. Your surgeon makes certain incisions, safely exposing the necessary cartilage and bone without disrupting the blood supply and without injuring these underlying structures.
• Sourcing cartilage as a building material. Grafting materials used in a nose job can be obtained from one of four sources:
  • Autografts, from somewhere else on your body;
  • Homografts, from another compatible human donor;
  • Xenografts, from another species;
  • Alloplasts, from a synthetic source.

  The cartilage building material typically comes from your own nose, ear or rib. In general, infection rates are lower — and the graft more stable —if you use your own body tissues.

• Grafting. Dr. Linkov expertly carves and places the necessary grafts into your nose’s inner structure to suit your needs.
• Manipulating the bones. Your doctor makes controlled cuts in the nasal bones and parts of the cheekbones that allow him to reset the structures. The cuts help straighten your nose, providing a solid and aligned foundation for your new nose.
• Closing up. Once your surgeon has made all the required changes to the bone and cartilage, the skin and soft tissue envelope are re-draped over your nose and sutured closed. Dr. Linkov uses a combination of dissolvable and non-dissolvable sutures.

Your recovery time depends on the extent of your rhinoplasty procedure. A short-term healing phase follows your surgery before you enter the long-term healing phase. How long you spend in each phase is determined by a variety of personal factors.

The short-term healing phase occurs in the first few days to weeks after your rhinoplasty procedure. More complicated surgeries require two to three weeks of recovery while the swelling and bruising subside. Common, anticipated conditions occur in the short-term phase, all of which usually resolve after a couple of days or over the first few weeks.

Some of the anticipated post-rhinoplasty conditions are:

• Bruising
• Redness
• Swelling
• Bleeding
• Nasal obstruction
• Some pain

During the short-term healing phase, take several precautions to ensure the best result and minimize bleeding, including:

• Applying an antibiotic ointment and scar gel on your external incision;
• Keeping the external cast dry;
• Sneezing with your mouth open to avoid excessive force in your nose;
• Using a nasal saline spray five times a day, starting 48 hours after surgery;
• Not blowing your nose for the first week;
• Avoiding vigorous exercise for at least one week after surgery;
• Refraining from participating in contact sports for at least six weeks;
• Attending a follow-up appointment as directed to remove the sutures, splint and cast.

The long-term healing phase occurs in the weeks to months following your rhinoplasty surgery. How long you spend in this phase depends on your health characteristics and the extent of your surgery.

You must follow your surgeon’s instructions during this period to maintain the results of your surgery. In general, you can expect:

• Final results about one year after your surgery;
• Your doctor to schedule follow-up appointments to monitor your progress;
• To have to wait the longest to see swelling improve in the tip of your nose;
• Steroid injections to be used if needed to control the swelling.

The aging process can also impact your long-term rhinoplasty results. As you age, the tip of your nose tends to weaken, sometimes resulting in a droopy appearance. Dr. Linkov, a top-rated rhinoplasty specialist, uses various methods to more permanently secure the tip during surgery to limit its ability to droop.

The cost of nose surgery in NYC is a combination of several factors, including a surgeon’s fee, facility fee, and anesthesia fee. These are sometimes reported as a combined fee in certain offices. In other cases, these are broken down into their components. In New York, the current range for rhinoplasty is between $5000 to $25000, plus the additional fees for the operating room and anesthesia.

Revision rhinoplasty surgery costs are typically 20% to 30% higher for the surgeon’s fee.

The cost of a nose job will vary by:

• Location
• Experience of the surgeon
• Demand for the surgeon
• The anticipated complexity of the surgery

Cosmetic improvements alone are never covered by insurance, but breathing issues — medical reasons for a nose job — may be. Insurance companies are less and less likely to cover a rhinoplasty in New York City. You may need to endure a three-month waiting period to even get a decision from your insurance company. Often, doctors’ appeals are necessary to secure coverage.

Photos often need to be sent to the insurance companies to justify the need for a functional nose job. Many surgeons are strictly out-of-network, including Dr. Linkov. That means your policy has to include out-of-network benefits to get any reimbursement for a nose surgery from your insurance carrier. Regardless, surgeon fees are often required upfront, before your surgery.

As an alternative to surgical rhinoplasty, some patients opt for liquid rhinoplasty, also known as nonsurgical rhinoplasty, which involves injecting dermal fillers (such as Restylane) into specific areas of the nose to achieve cosmetic changes. These nonsurgical nose job outcomes are temporary and limited in what can be achieved.

Some plastic surgeons, including Dr. Linkov, use computer renderings of what the nose might look like after surgery to help guide patient decision-making. The most crucial thing is that both the doctor and the patient agree on the aesthetic goals. Please remember that the computer image is not a guarantee of what will follow after surgery, but rather a framework for the surgeon to work with during the procedure.

You should be able to return to work a little more than a week after surgery. However, there may still be some swelling and reddish incisions.

Dr. Linkov will use an external splint to keep your cartilage and bone in place while they heal. The splint will help minimize swelling and protect your nose’s new shape. Internal splints may be used by your doctor to offer support within the nose and to stabilize the reshaped septum after septoplasty. Internal and external splints are usually left in place for one week following surgery.

Dissolvable stitches are often used internally to keep the lining in place during healing and may take many weeks to completely break down. Non-dissolvable sutures are commonly used on the outside of the nose and should be removed within 5 to 7 days after treatment.

Bruising is common following surgery and can last anywhere from two to three weeks. Most swelling in the nasal tissues will usually subside within two months. However, depending on your procedure’s complexity, it can persist for a year or even longer, typically in the tip of the nose. We use delicate surgical techniques and Arnica Montana to decrease the extent and the intensity of swelling and accelerate postoperative healing.

Rhinoplasty makes your nose’s blood vessels extremely sensitive, and exercising too soon after surgery can result in bruising, nose bleeds, and other postoperative complications. Hence, you should avoid any exercise other than light to brisk walking for at least one week following your surgery. Within three to four weeks of the treatment, you can gradually resume gentle, non-contact exercises.