Rhinoplasty

Dr.Kassir is the best rhinoplasty surgeon in New York and New Jersey. Having performed over 8,000 rhinoplasties on patients from 121 countries; he is an expert inProcedure designer rhinoplasty procedures and an international rhinoplasty educator. 

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About Rhinoplasty

by Ramtin Kassir, M.D., F.A.C.S.

Do you have any problems breathing through your nose or do you have chronic nose or sinus complaints? Has a prior injury made your nose out of proportion to your other facial features?

Rhinoplasty or nose job surgery, is the surgical procedure that involves changing the shape and size of the nose. Dr. Ramtin Kassir MD performs this procedure for his New Jersey patients that involves reshaping the nasal bones and cartilages to produce a balanced and harmonious nose that blends with the person's facial features.


What is Rhinoplasty?

Rhinoplasty, or cosmetic nasal surgery, improves the shape and size of the nose. The procedure can remove a hump, change the shape of the nasal tip, and straighten the nose. The size and shape of the nostrils can be changed. The goal of rhinoplasty is often to achieve better harmony between the nose and the other facial features. Dr. Kassir is a triple board certified surgeon who has performed thousands of rhinoplasty surgeries for his patients and is considered to be one of the best Rhinoplasty surgeons in New Jersey and NYC.

Rhinoplasty has become one of the most popular facial plastic surgical procedures in recent years as more and more people seek to change the appearance of their noses. Many are unhappy with the nose they were born with while others have had the shape of the nose distorted from an injury. Disorders of nasal breathing and sinusitis often complicate the situation. A range of techniques are used to fully address the desired change in appearance as well as to improve nasal breathing and correct chronic sinus infections. Sinus surgery, if indicated, is done with endoscopes to avoid any visible incisions.

Rhinoplasty may be performed under general or sedation anesthesia on an outpatient basis. Most health insurance plans still provide some coverage for functional nasal surgery and sinus surgery.

Good Candidates For Rhinoplasty

Are you thinking about having a rhinoplasty surgery? Healthy teenagers and adults who wish to have an improvement in their nasal appearance are good candidates for the rhinoplasty procedure. The decision about having the rhinoplasty operation is a very important and personal one. You should first consult with Dr. Kassir at his surgical clinic in the Wayne, NJ, 799 Park Avenue, NYC, or Ridgewood NJ office before deciding on the operation. For most patients that undergo this nose job procedure, the results are life changing. Patients describe an increase in confidence and boost in self-esteem. The ideal NJ and NYC candidates for rhinoplasty are:

  • You are unhappy with the size and/or shape of your nose.
  • You have breathing problems limited to your nose.
  • You suffered an injury that has altered the look of your nose.
  • You have breathing problems.
  • You are over the age of thirteen.
  • You have good physical and emotional health.

Does Insurance Cover Rhinoplasty?

Insurance may cover some of the functional aspects of rhinoplasty. In other words, those procedures that improve breathing:

  • opening sinus drainage pathways (endoscopic sinus surgery),
  • shrinking large turbinates (turbinate reduction),
  • straightening a crooked septum (septoplasty),
  • valve surgery (placing cartilage grafts to stabilize the breathing passage).

Different Kinds of Rhinoplasty Procedures:

Dr. Kassir performs many different kinds of rhinoplasty procedures in NJ, including:

Revision Rhinoplasty: Revision Rhinoplasty is performed when the initial rhinoplasty procedure is unsatisfactory.

Teen Rhinoplasty: Dr. Kassir is an expert in Teen Rhinoplasty in New Jersey.

Ethnic Rhinoplasty: Dr. Kassir commonly performs African American rhinoplasty, Asian rhinoplasty, Hispanic rhinoplasty, and Middle Eastern rhinoplasty.

Celebrity Rhinoplasty: Dr. Kassir is a leading expert in celebrity rhinoplasty.

See Dr. Kassir's RealSelf reviews

Rhinoplasty: Questions & Answers

Can a 16-year old girl get a rhinoplasty?

The surgeon and the girl’s parents must consider this question and evaluate whether the patient is physically and emotionally ready for the procedure. However, at 16 years old, a female patient would be within the “safe zone” of having a rhinoplasty done.

Is it normal for my nose to twitch post-rhinoplasty?

Patients may experience paresthesias post-rhinoplasty, which is a zapping sensation that occurs when sensory nerves begin to regrow in a trauma-affected area. However, twitching is unusual and should be addressed via consultation with the surgeon.

Are there any recommended vitamins to take pre- and post- surgery?

Often, the question which patients must come to terms with during these times is actually which vitamins to AVOID. Vitamin E is known to cause unnecessary post-rhinoplasty bleeding and should be avoided in the week after surgery. Certain vitamins can help, including Vitamin A and Vitamin C, as well as certain herbs like Bromelin and Arnica which can reduce swelling.

When can I start lifting weights?

Patients can resume light exercise after 3 weeks post-rhinoplasty and then build up to strenuous exercise over the next couple of weeks after. However, I often recommend that they stop if they detect additional pressure in the nasal area. Increased blood flow to the area could increase the amount of potential scar tissue that forms post-rhinoplasty.

How can I combat excessive “nostril show” post-rhinoplasty?

This unintended consequence of a rhinoplasty, which is normally caused by over-removal of tip cartilage and the resulting upward rotation of the lower edge of the nostril, can be addressed with a columellar tuck which reduces the distance from the base of the nose to the columella (thus allowing the nose to seem normally rotated) and an alar rim graft which weights down the nostrils a bit, thus showing the nostrils less.

Can I take Zyrtec-D prior to my rhinoplasty?

I would advise against it because of one of the ingredients in Zyrtec-D known as pseudoephedrine which is a stimulant that can increase blood pressure and heart rate, thus creating a slightly increased risk of bleeding during and post-surgery. Contacting your surgeon and the anesthesia department of the hospital where you will be having this procedure done is the best option here.

A flesh covered ball came out post-rhinoplasty. Is that normal?

Completely. It is normal for residual blood and tissue to remain within the nose, especially if the patient does not blow their nose post-rhinoplasty (which they shouldn’t), and mix with the mucous produced there.

Why does some packing come with nasal tubes?

A major complaint which patients have with nasal packing (gauze which pushes the skin against the septum for better healing) is that they feel congested and are forced to breathe through their mouths. For this reason, nasal packing with tubes are introduced to help the patient breathe through the nose and feel less congested.

Does weight gain impact rhinoplasty results?

No, not at all. Nasal tissue has very little fat, so weight gain or loss will not impact the results of a rhinoplasty.

Can I have a rhinoplasty with a cold?

Generally, it is best for the patient to be as healthy as possible prior to an elective surgery like this. Many surgeons will not risk a bacterial infection during a rhinoplasty as there is a possibility for complications.

What are the risks of shaving down a nasal dorsal hump?

Nasal dorsal humps can be reduced through rhinoplasty. However, one major risk, particularly if the surgeon is not well experienced, is the appearance of nasal bones through the skin (check for well-experienced, qualified surgeons to avoid this). Other than that, the other risks are pretty standard for rhinoplasty and can be mitigated in the hands of a qualified, experienced surgeon.

Is twilight sedation safe for rhinoplasty?

I generally prefer using general anesthesia during the operation simply because it allows for protection of the breathing airway via endotracheal tubing, minimizes the danger of the patient moving around surgery, etc. However, some surgeons will opt for twilight sedation if they trust their anesthesiologist enough.

My nose is growing downwards and affecting my smile. What can I do?

What may be interpreted as nasal growth past the age of 20 or so (when nasal growth actually stops) is rotation of the tip of the nose downwards due to gravity and aging. This can be corrected via a tip-plasty in which the depressor septi muscles which cause nasal drooping are partially released and the tip is lifted, sometimes via a cartilage strut.

When can I start smoking following surgery?

Though I would rather patients quit smoking entirely after surgery, I would wait at least 4 weeks post-rhinoplasty to begin again. Cigarettes contain nicotine and carbon monoxide, the first of which is a vasoconstrictor and causes tissue death in the surgical area by limiting blood flow and the second of which decreases the blood’s oxygen capacity and also causes tissue death.

Why are osteotomies done instead of rasping in some cases?

Both of these techniques are used in cases where there are dorsal humps. Rasping is used when there is a small dorsal hump and is what patients often refer to as a “shaving” of the dorsal hump. However, in cases where there are large dorsal humps, shaving away the dorsal hump will result in a very flat nose with a larger hole (called an open roof deformity). The solution to this are medial and lateral osteotomies which realign the nasal pyramid and close up the hole in order to produce a more aesthetically pleasing appearance.

Should I get a rhinoplasty during high school?

Generally, after ages 15-17 for women and 16-18 for men, rhinoplasty can be done. However, patients in high school should consider whether they are ready for any side-effects and complications from the surgery which could occur including swelling, bruising around the eyes, etc. If not, they could consider having it done before college.

What should I do for a flat nasal bridge?

If the flat bridge is from fractures, then osteotomies can be done to narrow a wide nose. If congenital then osteotomies may not be enough and dorsal onlay grafts may be necessary.

How can I fix my pointy nose?

A rhinoplasty is probably the best option for patients looking to decrease the projection of their nose and adjust their tip cartilages in an appropriate manner.

What does a nasal valve collapse surgery entail?

Generally speaking, this procedure involves the use of cartilage grafts to strengthen the cartilage on the inner nasal wall and to widen the openings. Collapse of the internal nasal valve requires a spreader graft, which is more intensive. Collapse of the external nasal valve may be alleviated with a smaller graft.

Is the “work-ready” benchmark of 1 week post-rhinoplasty apply to more physically active jobs?

Depending on the degree of modification to the nose and the procedures performed, patients will generally be work-ready within 6 days to 2 weeks post-op. However, 2 weeks is usually the max, unless patients will be doing a heavy amount of exercise in which case, they are recommended to wait 4-6 weeks.

I have heard of a quick fix nose job in ethnic communities which focuses primarily on nostril width and doesn’t concern itself with osteotomies. Is this an alternative to a traditional rhinoplasty?

Surgeons can reduce the size of the nostrils via an alar base reduction/Weir reduction in which a thin, crescent-shaped patch of skin is removed from the nostril and the hole is stitched. However, it is advised that, before going ahead with this surgery, patients not only choose an experienced surgeon, but also consider whether they truly want to do JUST this surgery. Often, nostril reduction is accompanied by a thinning of the upper nose as well which needs to be done with osteotomies.

I have overprojection and a hard tip following placement of a cartilage graft and a columellar strut. Is that normal?

If the cartilage graft was taken from the rib, this is a perfectly normal symptom as rib cartilage tends to be sturdier compared to septal or ear cartilage. Also, depending on the timeline post-op, this may be a normal part of the healing process and may resolve itself over time.

I have bumps on my nose almost a decade post-rhinoplasty. Is it scar tissue developing years after my procedure?

It is unlikely that this is scar tissue. More likely, this is caused by the thinning of the skin with aging that makes the results of the rhinoplasty more apparent years after the procedure has been performed.

How does the nose change from ages 10-21 (male)?

Generally, during puberty, there is an explosion of growth in the nasal and jaw areas (disproportionately so compared to the rest of the body). When this happens, slight imperfections may be accentuated —- similar to how enlarging a photo can reveal hidden flaws. As such, it is normal for slight bumps to turn into larger dorsal humps, etc.

Can wearing glasses cause alterations in your nose shape growing up?

This is unlikely as the glasses only exert very slight pressure.

How can I correct my bulbous tip and upturned nose?

Correction of the bulbous tip would be the easier problem and can be solved by thinning the lower lateral cartilages in the tip and stitching them together to create a narrower defined tip. An upturned nose is more difficult and can be corrected in several ways, including the use of grafts or weakening the suspension elements of the nose and repositioning/securing the tip in a more preferable position by suturing the tip cartilages to the skin.

Can rhinoplasty make the nose oily?

Normal oil secretion by the skin can be altered because of the trauma to the nose and the cutoff of blood circulation in the area. Post-op, this could result in acne breakouts as oil and other sebaceous fluid becomes trapped in the pores due to the post-op surgical tape.

Is it bad to bump the nose following rhinoplasty?

It is important that patients keep in mind the fragility of the nose following the rhinoplasty, especially considering the osteotomies (purposeful breaks in the nose) which were likely created during the procedure. Thus, keeping the nose protected is a top priority. By bumping their nose, patients risk septal hematoma (accumulation of blood in the nasal septa) which must be treated in the ER.

What is a supratip dip?

A supratip dip is a slight dip in the nose right above the large tip of the nose. It is usually preferred on females because it adds a degree of femininity to the nose.

Can I simply just have a nasal hump removed rather than having a full-on rhinoplasty done?

Unless the nasal hump is small, it is probably best to having a full-on rhinoplasty simply because of the risk of open roof deformity (shaving off a larger bump leaves a hole that can only be filled with osteotomies that force the nasal bones inward). In addition, removing the nasal bump without having tip work done also makes the nose look unintentionally longer as well.

My swelling has gone down but there is still a bump post-rhinoplasty. What do I do?

For patients without a great deal of swelling, a bump on the nose may unfortunately be permanent and may need to be fixed via fillers.

Can I preview results of my rhinoplasty prior to surgery?

Most surgeons will have some of imaging software that allows patients, during consultations, to see EXACTLY what the doctor plans on doing and also lets them do a before-and-after side-by-side comparison of the results. I have found that this very comforting for patients and highly advise patients to see a surgeon who has this software.

What is this bump on the inside of my nose post-rhinoplasty?

At long periods of time post-rhinoplasty (a year or so), bumps on the inner wall of the nose will most likely be scar tissue which can alleviated with the help of steroid injections or a simple excision under local anesthesia. However, short-term bumps may be sutures that need to be taken out or swelling that will dissipate by themselves.

Will my nose rotate upwards as the swelling heals post-rhinoplasty?

It depends where the swelling is. In some patients, there is swelling in the supratip region which weighs down the nose and causes it to droop. The subsiding of the swelling will thus cause the nose to correct itself and rotate upward.

When can I have a facial after a rhinoplasty?

Due to the trapping of sebaceous fluids in the pores due to the surgical tape, it is common for patients to experience acne breakouts post-op. You should be ready for gentle cleaning at around 1 month post-op, but, if the nose is still sore, wait a couple more weeks beyond that.

Do rhinoplasty results really take a year to show?

In general, full healing (that is, full dissipation of the swelling from the procedure) will take up to a year to heal properly. However, the bruising and swelling which results varies widely depending on if osteotomies were performed, the type of rhinoplasty performed, etc. The majority of the swelling, however, in most cases will resolve itself within 4 months and the nose will generally be presentable to the public without significant issues within 1-2 months.

How long does a nose job last?

Ideally, patients will only require one rhinoplasty within their lifetime. Subtle changes will occur over time: the tip of the nose will begin to descend gradually, because the new nose ages with the rest of the body. However, such changes are subtle and will not require additional surgeries.

My nose tip dropped too much post-rhinoplasty. What can I do?

Depending on the time frame, I would wait until a year post-op to begin considering revision surgery. However, further support in the tip may be necessary via a strut graft.

What are these white bumps inside my nose post-rhinoplasty?

Patients days into the post-op process may see white bumps that are representative of sutures that have not fully dissolved/healed yet.

Can rhinoplasty correct flaring nostrils?

Nostril flares can be corrected with procedures like the alarplasty/alar base reduction in which the nostrils are narrowed and an alar base resection is performed with the help of a crescent-shaped wedge removal in the nostril wall. However, this procedure is rather difficult as it entails extreme precision in order to reduce the likelihood of asymmetrical nostril development.

Why is my columella so swollen after surgery and will it get better?

The tip/columella area is a primary surgical site during a rhinoplasty and will take longer to heal in terms of swelling than other areas of the nose. The swelling will tend to gradually dissipate over the course of a year, but should be generally resolved within 6 months.

How can an ethnic nose be made thinner at the tip?

Quite often, this is done by suturing the nasal cartilages in a more narrow fashion and bringing it cartilage grafts from the septum or the ear for additional support. However, the problem which surgeons often have with ethnic noses is that ethnic noses tend to have thicker skin which does not drape nearly as nicely over skin as thinner skin does. Thus, the results may not look quite as apparent.

Why do some many people regret rhinoplasties?

The main reason why people regret their rhinoplasties is generally because they are dissatisfied with their surgeon’s performance. In order to prevent this from happening, it is suggested that patients thoroughly research their surgeon prior to going ahead with surgery and make sure that their expectations are realistic and align with the plans of their surgeon. Communication is key to this step.

When can I drink after a rhinoplasty?

It is advised that patients refrain from alcohol for at least one week post-rhinoplasty. However, this drinking is to be in moderation, with heavier drinking reserved for at least one month post-rhinoplasty.

How long does congestion last post-rhinoplasty?

Congestion usually clears up within 6-8 weeks of a rhinoplasty and tends to get better gradually.

Who or what determines what kind of nose is possible for me during rhinoplasty? Can I get any nose I want?

The type of nose which you get post-rhinoplasty depends on your surgeon’s skill and what you bring to the table (existing nose, genes, etc.). The goal of surgeons is to modify an existing nose and correct for any defects which bother/inconvenience a patient, not substitute one nose for another. Giving your surgeon pictures of what your ideal nose, although not always possible to recreate exactly on the face of a patient, will give him/her a good idea of what you want.

How can one reduce nose size without excess skin?

In reality, thick skin is more difficult to manage and drape over a newly created cartilage foundation than thin skin because it is more elastic and willing to stretch. Therefore, reduction rhinoplasty is considerably more difficult under these circumstances because, while skin does contract, thick skin does so far less.

What can be done about the callus which developed after my rhinoplasty?

Generally, calluses which develop after a rhinoplasty will heal naturally and resolve themselves gradually within 1 year post-rhinoplasty as the body reabsorbs the bone and cartilage in the callus. If this does not occur, however, the bump can be rasped (filed) away.

How can I minimize skin care complications post-rhinoplasty?

Because the surgical tape and cast applied to the skin in the week after rhinoplasty traps sebaceous fluid within the pores of the skin, it is common for patients to experience acne breakouts in this time period. Having a facial prior to the surgery may be the best way to combat this as it cleans out the pores beforehand.

Can I die from complications of rhinoplasty?

Of course, every surgery carries with an inherent risk. However, as long as the patient in question is healthy and gives us a full run-down of anything (allergies, etc.) which could cause problems, the risk of them driving to my office to do the rhinoplasty has more inherent risks than the rhinoplasty itself.

When can I start sleeping normally, not elevated, post-rhinoplasty?

Simply for the purpose of reducing swelling, one week of sleeping in an elevated position is probably adequate enough.

The columella is hanging post-rhinoplasty. Is this bad?

As stated in other questions, the columella area is a primary incision site during the surgery and undergoes more trauma than other portions of the nose in the procedure. Lymph flow may be disrupted in this area causing fluid buildup (edema), but this will resolve itself over time.

Is it normal to have headaches every day following rhinoplasty?

Because rhinoplasties often entail the narrowing of the bridge of the nose, it is normal for a minority of patients to experience sensitivity and discomfort for a period of weeks. No concern is needed.

When can I play soccer post-rhinoplasty?

Patients can conceivably begin playing contact sports at a period of 6-8 weeks, with most surgeons suggesting waiting until the first 8 weeks simply because of the risk of bumping/breaking the nose in contact sports like football or soccer.

When can I wear sunglasses post-rhinoplasty?

Because of the trauma which your nose undergoes during a rhinoplasty procedure (the coagulation of blood, elevation of cartilage and other internal structures), the nose is much noticeably weaker post-rhinoplasty and is more prone to burns and discoloration from UV rays. It is recommended that patients wait at least 4 weeks, potentially even 6, before wearing sunglasses.

How soon can I get pregnant post-rhinoplasty?

If patients are trying to have a baby, it is advised that they wait at least 6-8 weeks before pursuing any vigorous activity like sex simply because of the risk of bumping the nose and also increasing blood pressure and triggering nose bleeds.

Why do I have cartilage lumps post-rhinoplasty?

In most cases, small lumps and bumps post-rhinoplasty are simply the result of residual swelling from surgeries which tends to dissipate over the course of a year. Sometimes, they could be from residual shavings of cartilage which will also be reabsorbed by the body.

I have a sore red bump inside my nostril. What is that?

This is most likely your inferior turbinate, a shelf of tissue and bone, which is often cauterized during a rhinoplasty and can swell up post-op.

Are African American rhinoplasties more difficult/impossible to perform?

Although it can be difficult to perform a rhinoplasty on African-American patients simply because of the tendency for surgeons to modify the nose to Caucasian standards (make it overly thin, etc). There are surgeons who have plenty of experience in ethnic rhinoplasties such as this, so African-American patients are better off consulting with these surgeons.

Is a growing dorsal hump normal in the 20s?

Probably not, as nasal growth tends to stop soon after puberty (15-17 for girls, 16-18 for boys). This may be the sign of a callus formation, or the buildup of cartilage and bone.

Can a broken nose be fixed under local anesthesia?

This can be done, especially if the broken nose is corrected within a week of the original trauma. However, if the broken nose is on a child, sedation or general anesthesia may be more appropriate given the painfulness of the needles.

How can I clean the outside of my nose post-rhinoplasty?

It is important that, when a patient’s surgeon gives him/her the OK to begin cleaning the outside of the nose, they remain gentle. Generally, patients will use sterile solution like alcohol on gauze/cotton.

Can a Headbutt cause a permanent bump on the bridge of the nose?

Generally, patients will be aware if a nasal fracture has occurred immediately after a trauma. In most cases, bumps on the nose following trauma are a result of soft tissue damage particularly in the periosteum (where the nasal blood supply is housed) and will degrade eventually.

How can I fix a broken nose tip?

Generally, the tip is composed of a great deal of cartilage and thus may be prone to fracture. These types of injuries are generally only treatable with a rhinoplasty procedure.

How long will it do to see the results of alar base reduction?

Unlike traditional rhinoplasties, the results of an alar base reduction should be almost immediate. There may be redness for the first week or so, but swelling and other issues should not be apparent to the extent of a rhinoplasty.

Can rhinoplasty scar tissue be corrected/fixed?

While slight scarring is common for rhinoplasty procedures, unsightly scarring in the sites of external incisions, etc. is relatively rare and may warrant aggressive treatments like kenalog (steroid) injections. However, a consultation may be needed for this.

Can I use a tampon or pad during anesthesia for a rhinoplasty?

The only risk associated with tampon use during a rhinoplasty procedure is toxic shock syndrome, which is only an issue if you foresee not being able to change a tampon on a regular basis. Tampons themselves should not interfere with the anesthesia in any way.

What is the recovery time for a closed rhinoplasty?

This is where patients should learn the distinction between healing time and recovery time. The healing time, that is, the full realization of the results of the procedure and the full reduction of swelling and bruising, of a rhinoplasty is about a year. However, patients are generally work-ready within 7-10 days which I would consider the primary concern regarding “recovery time”.

Will a nose job affect my smile?

The cutting and stretching of nerves around the tip and the upper lip/teeth during a rhinoplasty will definitely cause a general numbing of the area, particularly if the surgery in question was a revision rhinoplasty where extensive cutting of scar tissue occurred. However, these symptoms are very temporary and will probably dissipate within 2-3 weeks post-rhinoplasty.

How long is the time period from consultation to surgery?

This really depends on the surgeon’s schedule, the patient’s schedule, and the need to obtain medical clearances.

What should I ask my doctor during my rhinoplasty consultation?

Excellent question. Some things to ask your surgeon before you allow him to operate in order to determine whether he/she is worth your time could include:
What board certifications do you have?
How many rhinoplasty surgeries have you performed, especially within the last year?
May I see before and after pictures of your work, particularly with my type of surgery?
How much will this surgery cost? And how many revisions have you had to do on your work and what does that cost?
What sort of anesthesia do you use for my type of procedure?
Which hospital are you affiliated with?

How can I correct my broken nose?

Correction of a broken nose involves a procedure known as open reduction which involves the creation of osteotomies (controlled fractures) to realign the septum of the nose. In some patients, spreader grafts might be necessary to ensure that the nose does not collapse during or after surgery.

Can removal of a hanging columella cause the nostrils to appear wider?

Although it may seem like the weight of the cartilage in the columella may help “pull the nostrils back” in terms of flaring, this is not true. In the hands of a good surgeon, a hanging columella can be easily corrected without changing the other aspects of the nose, including width of the nasal bridge/tip.

How harmful is cocaine post-rhinoplasty?

Because cocaine acts as a powerful vasoconstrictor, it decreases blood supply to nasal tissues and thus inhibits the healing process and even causes these tissues to be necrotic and die. I would highly advise AGAINST using it simply because of hearing cases where patients run into an array of issues post-rhinoplasty, including septal perforations.

When is alcohol consumption post-rhinoplasty fine?

Alcohol in moderation should not a problem at around 3 weeks post-op.

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