Rhinoplasty (Nose Job)

Rhinoplasty, commonly referred to as a nose job, is a surgical procedure aimed at changing the shape of your nose. Even though rhinoplasty is one of the most popular surgeries worldwide, it is not exclusively a cosmetic procedure. It also aims to improve and maintain the nasal function if the patient has a reduced airflow.

When you visit City Facial Plastics in Manhattan, NY, for a consultation, Dr. Gary Linkov spends the necessary time on an extensive evaluation of your nasal airways. He puts his vast experience into this pre-operative systematic analysis. His expertise and attention to detail have made him the number one choice for nose job patients not only within the U.S. but from all over the world.

A nose job is a procedure that is not difficult to perform but extremely challenging for exceptional, long-lasting outcomes. Hence, choosing a surgeon who possesses outstanding surgical skills and has an eye for perfection is of the utmost importance.

Rhinoplasty specifically describes nose plastic surgery that alters the bone, upper lateral cartilage, and/or lower nose cartilage. Your Manhattan nose job specialist recommends that he performs both functional and aesthetic nose job simultaneously.

When combined, a rhinoplasty procedure can address several medical conditions at once, including:

• A breathing or sinus issue
• 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 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. If your nose has matured or stopped growing, you can benefit from Dr. Linkov’s cosmetic nose reshaping. There is no maximum age, but you must be medically and emotionally able to proceed with a surgical procedure. You can get a rhinoplasty as early as your adolescent years, although anyone under 18yo requires full parental consent.

Minimum age requirements to undergo a rhinoplasty procedure include:

• Girls can be as young as 15 or 16 years old
• Boys can be as young as 17 or 18 years old

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

You should not 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 surgery, Dr. Linkov schedules two initial consultations, which can take up to 12 hours total. During your first rhinoplasty consultation, you and your surgeon cover a wide range of topics that may potentially disqualify you.

Some of the factors that might potentially affect your candidacy entail:

• 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 outline your goals for surgery explicitly. 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 assessing the six parameters of your nose to determine whether your goals are realistic.

Additionally, your rhinoplasty surgeon takes pictures of your nose from eight different angles with digital imaging computer software. In a 3D simulation, you can see what your nose might look like after surgery. To avoid a robust mental fixation on a projected outcome, you aren’t given any pre-operative simulated images before surgery. The computer image isn’t a guarantee of your result after surgery, but rather a guide for Dr. Linkov during surgery.

The best surgical approach depends on the preferences of you and Dr. Linkov. Your NYC-based rhinoplasty surgeon is comfortable with both methods. He guides you through selecting the best one based on your particular case unless you require a more complex nose reconstruction. The differences between the two procedures include:

Closed rhinoplasty

It is called an endonasal approach and this technique:

• 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

It 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. This technique:

• Allows for 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.

Once you’ve decided to undergo nose surgery, Dr. Linkov gives you the following preparation instructions:

• 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, and airways are protected. In general, the surgery takes two to four hours. You spend another hour in recovery.

The major steps of the surgery include:

1. 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.
2. 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.

3. Grafting. Dr. Linkov expertly carves and places the necessary grafts into your nose’s inner structure to suit your needs.
4. 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.
5. 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 nose job 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.

Depending on the peculiarities of your case, you might experience the following side effects:

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

During the short-term healing phase, you should take several precautions to ensure the best result:

• 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 uses methods to more permanently secure the tip during surgery to limit its ability to droop.

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 nose job. 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 New York City rhinoplasty 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.

The cost of a nose job 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. The surgeon’s fee can range from $5000 to $25000, plus the additional fees for the operating room and anesthesia.The cost of a nose job will vary by:

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

As an alternative to surgical rhinoplasty, some patients choose to undergo a liquid rhinoplasty, which refers to using a filler (such as Restylane) to add volume to parts of the nose to create certain cosmetic changes. These results are temporary and limited in what can be achieved.

Not exactly. It is possible to do a rhinoplasty alone, a septoplasty, or a septorhinoplasty together. The most common scenario is that they are done together since the septum is the most common source of cartilage for a nose job and often the septum needs to be addressed for cosmetic and functional concerns.

The literature reported satisfaction rates after rhinoplasty in NYC are in the 80-90% range. The rates are lower in men compared to women. These results underscore the difficulty of nose job surgery and the need to find the best rhinoplasty surgeon who performs many of these surgeries every year.