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

When will cartilage reabsorb after a rhinoplasty?

Cartilage reabsorption in a graft is not ideal as this cartilage was placed in an effort to support the area in which it was placed. Some reabsorption does take place following a year post-op, but not significantly enough where it would cause issues.

There is a bad smell in my nose post-op. What is wrong?

A nasty smell inside the nose following surgery may just be the result of dried, crusted blood development or extraneous mucous which infiltrated the area, both of which are perfectly normal post-op conditions that can be corrected with saline spray. However, a consultation with a surgeon may be advised in order to evaluate for a possible infection.

Can steroid injections help if I have a hard tip following surgery?

Steroid injections about a year or so post-op can definitely help with any residual swelling and can soften up the tissue in problem areas, but have your surgeon complete these procedures.

When can I wear makeup after a rhinoplasty?

Because of the inherent difficult in keeping the splint dry when there is makeup next to it, it is recommended that patients wait until the splint is removed (1 week post-rhinoplasty) before applying makeup.

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.

Is the bulbous nose which I have post-rhinoplasty a sign that I need to do a revision rhinoplasty?

Even months post-rhinoplasty, the nose can still have a good deal of swelling which skews the appearance of the final results of the surgery. My best advice to patients post-rhinoplasty is not to worry too much about the appearance of the nose until at least 8 months post-rhinoplasty.

Will my insurance pay to correct my crooked nose?

Unless the crooked nose interferes with breathing, it is unlikely that insurance will cover for the costs of the procedure. However, this is best answered by your insurance provider directly.

What is this bump on my nose following rhinoplasty?

Bumps on the nose following rhinoplasty are generally the remnants of swelling and will usually resolve themselves after 3-4 weeks post-rhinoplasty. Harder bumps may also be evidence of calluses forming in the healing bone which will eventually dissipate as the healing process occurs. Either way, patients should not concern themselves when this occurs.

Can I sleep on my side post-rhinoplasty?

Patients can sleep on their sides post-rhinoplasty. However, it is suggested that they maintain extra caution to not bump their nose on the bed frame or a pillow. It might be advisable to sleep with extra pillows under your head to help with this and to counter swelling which will occur in the few days post-rhinoplasty.

Is blood work necessary before a rhinoplasty?

It certainly does not hurt to get it done, especially because it may reveal aspects of a person’s health to a surgeon which may impact the surgery itself and the post-op process. Blood tests can help determine if a person has a clotting issue, for instance, or has other potential complication-causing problems. Personally, in my office, I will often have patients obtain blood work before rhinoplasties.

My nostrils close when I breathe through my nose. What’s wrong?

These symptoms may be attributed to nasal valve collapse which can be corrected via spreader grafts that are harvested from septal cartilage or, in rare cases, ear cartilage.

To narrow the nose, can I have the fat in my nose taken out?

Unfortunately, the amount of fat in the nose is not substantial enough nor is it confined to the right areas (it is mostly in the tip of the nose) to have it drawn out in the effort to correct a wide nose. Narrowing the nose often consists of narrowing the nasal bones themselves via osteotomies.

Are the scars from rhinoplasties too much to handle?

Rhinoplasties come in two main forms: open and closed, with the only difference being that closed rhinoplasties are done via incisions on the inside of the nose (that is, not visible) and open rhinoplasties having more apparent incisions especially on the columella area (the skin between your two nostrils). The incision on the columella in the open rhinoplasty is the only one that has the potential to be apparent, but even these should heal beautifully over time.

Why is there tape on my nose post-rhinoplasty?

This is merely for the purpose of reducing swelling.

I’m having dorsal hump removal via rasping. Should I be ready for public presentation in 8 weeks?

Probably. The majority of the swelling will probably have subsided by then.

I have breathing problems and a cracking noise in my nose. What’s wrong?

This problem is probably best addressed by an examination in a qualified surgeon’s office. However, pure speculation indicates that this may be an issue of the nasal conchae or caused by septal deviation, both of which require surgical solutions.

Is a long nose only shortened by rotating the tip?

It depends on the nose which the surgeon is starting with. This type of technique is ideal for patients who have the combination of a droopy tip and a long nose. However, if the tip is normally rotated, there is no need to mess with it and the issue would be better resolved by shortening the septum and bringing the inferior tissues upward. Consultation with a surgeon is probably the best way to determine a patient’s course of action here.

How can I reduce my droopy tip?

The tip can often be corrected via repositioning of the depressor septi muscles as well as repositioning of the cartilage at the tip already and cartilage grafts.

Can I have breast augmentation and rhinoplasty at the same time?

As long as the patient is healthy enough to have both procedures at the same time and the surgeon of choice is qualified to do both procedures, there does not seem to be a problem with doing them together. However, care must be taken to avoid infection and this is done by choosing a well-qualified surgeon.

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.

Does rhinoplasty improve sinus reactions?

Normal airflow through the nose is essential for sinus function (sinuses are air chambers within the facial skeleton). Therefore, a deviated septum or any other obstruction to normal air flow can be corrected with rhinoplasty and this procedure can improve sinus function. However, patients must evaluate whether a blocked airway is actually the cause of their sinus issues, because any other cause will not be fixed via a rhinoplasty.

Can rhinoplasty be used to widen nostrils?

This procedure is generally less common than using rhinoplasty to narrow the nostrils and typically uses cartilage grafts from the tip of the nose or the ear. Consultation with a surgeon is best, however, to determine a patient’s particular course of action.

Can I use Fraxel treatment on rhinoplasty scars?

It depends on the depth of the scars. Fraxel and other laser treatments can provide relief for patients with more shallow scars, but deeper scars may require re-excision of the scar and dermabrasion of the skin.

Does the product “Nose Up” actually work?

This product may temporarily press up your nasal tissue, but it won’t lead to any permanent changes.

Why is my nose larger on the bridge than before my septoplasty?

During septoplasties, surgeons will perform purposeful re-breaking of the nose (osteotomies) in an effort to correctly align the nasal bones, so a larger bridge on the nose may be the result of residual swelling from this.

Will insurance cover fixing my broken nose?

Generally, surgeries which work to improve the quality of life (in this case, the goal is improving breathing) tend to be accepted readily by insurance. However, if the septum is not deviated and breathing is not an issue, the surgery will only be counted as an aesthetic/cosmetic one and will NOT be covered by insurance.

How is rhinoplasty different for Hispanic patients than other patients?

In general, Hispanic patients tend to have thicker (oilier) skin than Caucasian patients, broader faces and wider nostrils/nasal bridges, weaker cartilage, and a greater proportion of nasal humps. With all these considerations, it is important that surgeons understand the aesthetic goals of their Hispanic patients and tailor their surgical goals to their patient’s needs.

When can I get a nose piercing post-rhinoplasty?

Because of the risks of infection and complications associated with getting a nose piercing early in the post-rhinoplasty healing process, I would wait at least 6-8 weeks post-rhinoplasty to have this done.

How soon can I use nasal irrigation or sprays post-rhinoplasty?

This is probably best addressed by your surgeon. However, I would advise against nasal irrigation because it creates too much pressure in the nasal region that can lead to disrupted healing of nasal incisions.

Is it normal to have post-rhinoplasty snot and boogers?

Yes, especially in the first few weeks post-op. Saline solution applied via Q-tip is probably the best way to combat this.

Can my rhinoplasty be done with local anesthesia?

Technically, it can be. However, particularly if osteotomies are performed, the sound of breaking bones and the general discomfort of injecting local anesthesia may cause anxiety and discomfort for the patient, so general anesthesia is usually the best option.

Can a deviated septum, if it isn’t broken, be bent back into place?

Unfortunately, no. Cartilage, while being highly elastic and bendable, is not necessarily easily movable (at least in a permanent fashion). Deviated septums can only be corrected with a septoplasty.

Why is my nose itchy in the first week post-rhinoplasty?

Chances are this is the result of the splint which is admittedly somewhat irritating and does not allow much oxygen flow to the skin. Itching is good, however, and indicates the absence of infection.

My nasal tip is still swollen. Why?

Patients will often find that residual swelling is pronounced particularly in the tip. This is generally a pretty heavy surgical site during the rhinoplasty procedure and will be subject to the greatest proportion of the swelling. Regardless, patients need not worry as residual swelling gradually dissipates over the course of a year.

How much is dorsal hump removal?

Dorsal hump removal is generally a component of rhinoplasty and thus the costs of it will be very much in line with that of a typical rhinoplasty. As stated before, geographic area, equipment used, and other factors deeply impact the cost of these procedures, but an average rhinoplasty will run somewhere in the area of $5,000 to $10,000.

Are there cheaper ways to disguise/remove a bump on the nose?

Some cheaper options to dealing with a dorsal hump could be to wear larger-frame glasses which take attention away from the bridge, use non-surgical fillers like Restylane to heighten areas around the bump and make it less noticeable, etc.

Can a nose bump be fixed under local anesthesia?

It truly depends on the size of the bump. While small bumps can be removed by rasping under local anesthesia, larger bumps, which carry the risk of open-roof deformity if removed by rasping, require osteotomies which are difficult to really perform under local anesthesia. General anesthesia might be more suitable for this reason, and because of the protection offered by the endotracheal tube (can block blood and other fluids from getting into the lungs during surgery).

Can an alarplasty be done alone?

Certainly, as long as the rest of the nose looks proportional. However, this is usually not the case as patients usually need other procedures to make everything look harmonious on the face. The cost for one alone will generally range from $2,000-$4,000.

What causes dorsal hump formation?

Dorsal humps are usually an accumulation of bone and cartilage which is generally inherited, although trauma to the nose may also cause it (punch to the face, etc.).

What is the structure that separates the nostrils on the underside of the nose?

This flap of skin between the nostrils is called the columella.

Can rhinoplasty correct a wide nose without touching the nostrils?

The ala base (the middle part of the nose) can definitely be corrected in a rhinoplasty without any impact on the nostrils.

Can I improve swelling several months post-rhinoplasty?

Unfortunately, the only real proven method to reducing swelling months post-rhinoplasty is simply being patient and allowing the body to heal itself naturally. Patients especially if they have thicker skin (which is known to make the nose seem more swollen) must remain calm and have faith that the surgeon did his/her job correctly.

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.

Do all surgeons use splints and packing post-rhinoplasty?

Generally, surgeons will use splints in the first week post-op not only to protect the delicate nasal tissues immediately after the surgery, but also as a reminder for patients to be extra careful in the first few days post-op. Packing has generally gone by the wayside due to discomfort/breathing issues felt by the patient and has given way to internal splints.

I had septal cartilage harvested to build my tip, but now it’s too long. What can I do?

Chances are the surgeon who built your tip add a cartilage graft. To return to the preoperative stage, the graft can be easily removed.

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.

Is a closed or open rhinoplasty more prone to causing inverted V-deformity?

Middle vault collapse, the medical condition responsible for the inverted V-deformity, is equally likely in both the open and closed forms of the rhinoplasty procedure. However, this can be avoided prior to surgery with the use of spreader grafts in the middle portion of the nose.

Can I laugh or smile following a septorhinoplasty?

Of course! Patients are told to avoid strenuous activity like exercise for 6 weeks or so post-rhinoplasty, but smiling and laughing does not go under this category.

How soon does skin start thinning after a silicone implant post-rhinoplasty?

Thinning of the skin is one common problem with silicone implants, which is why I am often hesitant to use them. It is best to have the implant removed before it begins to extrude.

Does septoplasty and rhinoplasty get covered by insurance?

As stated in another query, rhinoplasties are strictly cosmetic procedures and are usually not covered by insurance. However, septoplasties (often performed concurrently with rhinoplasties) are functional surgeries which can be used to correct breathing defects and are thus usually covered by insurance providers.

Can I gargle with salt and water post-rhinoplasty?

This symptom probably resulted from the breathing tube used during the application of general anesthesia and salt water can help, as can throat lozenges.

What is a septoplasty?

A septoplasty is a procedure which modifies the nasal septum (the wall in the center of the nose) and usually helps with deviation of the septum in order to correct breathing.

What is your opinion of Gore-Tex and silicone in a rhinoplasty?

Personally, I am more partial to avoiding man-made materials during rhinoplasty which can often pop out post-op and, in the case of Gore-Tex, have a high probability of infection. I prefer to use septal cartilage from the patient’s nose or, if that is not available, from the patient’s ear because the body is accustomed to it.

Can I run 2 weeks post-rhinoplasty?

Any activity which increases blood pressure (even light exercise) can present a problem in terms of swelling. I often recommend to my patients that they refrain from running until at least 3 weeks post-rhinoplasty.

Is touching my nose after cast removal safe?

Gently touching the nose will not affect the results. Just make sure not to bump it hard or push very hard as the nasal tissues are still delicate and malleable.

How can I tell if I have thick skin on my nose or just excess cartilage?

This is probably best evaluated by your surgeon. However, for a rough method of evaluation, you can feel the difference between thick skin and cartilage by feeling your cheek and then feeling your ear. Thick noses can contain a mixture of both, however.

My nose is upturned after surgery, almost unnaturally. Will it come down?

Patients who experience an upturn in the tip of their nose post-op most likely had a surgeon who overcorrected the original condition. However, this is not a concern as the tip should come down within 2-3 weeks after surgery. It is also possible that the upturn may be caused by swelling which is perfectly normal post-op and should come down within the same period of time.

Should I tell my friends and family about my rhinoplasty?

This is generally a matter probably best decided by the patient. However, it is my opinion that true friends and family will support you, regardless of the decisions you make and how they feel about it. I have found that many family members tend to be supportive of the patient’s decision and even those that aren’t will generally not be so outspoken as to openly challenge the decision and try to cancel the surgery.

I have a cartilage-like growth on my lower nose years after rhinoplasty. What is it?

This sounds like a shifted cartilage graft. It might be best for you to evaluate this with your surgeon.

Is thick skin a problem for rhinoplasty?

Rhinoplasties can definitely be performed on patients with thick skin. However, there may be some limitations. Rhinoplasties work by lifting up the skin, adjusting the underlying muscle and cartilage, and then re-draping the skin. However, the skin needs to be tight in the last step which may be difficult to do for patients with more elastic, thick skin, so extra thinning of the underlying tissue might be needed.

What can I do to prevent columella scarring post-rhinoplasty?

Unfortunately, there is very little patients can do to actually prevent scarring. Still, the scars will tend to heal fine if given enough time.

What can I do for a drooping columella post-rhinoplasty?

A drooping columella can be addressed by removing a small section of skin and cartilage from the area and then simply patching up the area.

What can be done to reduce a wide nose?

Depending on what patients define as a wide nose, there are several procedures which can be done to alleviate this problem. Osteotomies can be done to narrow the upper nose, cartilage can be removed from the middle, alar base reductions can be done to reduce nostril width (which is usually the common problem), etc. A more thorough examination is necessary to determine exactly what should be done though.

Will I experience empty nose syndrome after a rhinoplasty and turbinectomy?

Both of these procedures were likely performed to correct a breathing defect. If by empty nose syndrome (which is not a real condition) you mean that the turbinates have been fully removed, this is not likely unless your surgeon went hyper-aggressive on the turbinate removal —- which is not medically advised at all. I would not worry about this.

How long does numbness after rhinoplasty last?

Typically, numbness following rhinoplasty is a common symptom and resolves itself within 8-12 weeks following surgery. However, it may take as long as a year or two before symptoms resolve themselves completely. Patients will know when the nerves regenerate because they are usually accompanied by itching and brief, shock-like sensations

Should cartilage in my nose “pop”?

If this question is for someone who has not had rhinoplasty surgery, this is typical, as cartilage sections in the nose can slide past one another.

Can heavier glasses deform the nasal bones?

It is unlikely that heavier glasses will necessarily deform nasal bones, especially in a nose which has not undergone rhinoplasty. Patients can try going to lighter frames and see what occurs, however, if they are curious as to what could happen.

Why is my tip so stiff 6 months post-rhinoplasty?

Especially if cartilage grafts were introduced, it is normal for stiffness to remain post-rhinoplasty for up to a year due to the trauma which the tip of the nose in particular undergoes during the procedure.

What can I do about an indentation on my nose post-Kenalog injection?

Unfortunately, this is not an issue that will resolve by itself. Steroid injections may have weakened the tissue and caused it to collapse, an issue which can only resolved by injecting fillers like Restylane into the area.

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.

Why do I have a hard tip following rhinoplasty?

A hard tip following rhinoplasty is most likely caused by residual swelling or scar tissue which may have formed, as well as cartilage grafts which may have been used during a patient’s rhinoplasty procedure. As I mentioned in previous queries, the tip of the nose undergoes the greatest proportion of the swelling post-rhinoplasty, so healing takes a while in this area.

What is septurbinoplasty?

This term can be broken down into two parts: sept- and turbino-. It is a procedure which corrects a deviated septum (sept-) and corrects for enlarged turbinates (turbino-), both of which can obstruct nasal airways. Correction of these two issues is often determined as functionally necessary and will usually be covered by insurance.

If my septal cartilage is harvested, how is it replaced?

Generally, in the hands of a good surgeon, cartilage which is harvested from the septum will NOT require replacement as the surgeon will leave a large piece of cartilage there to maintain support of the nasal tip. If more cartilage needs to be harvested for grafting, it will be taken from the ear and the rib.

What I can do post-rhinoplasty to reduce scar tissue formation?

Other than staying protected from sun exposure for at least 4-6 weeks post-rhinoplasty, there is little that a patient can do to prevent scar buildup as it is a product of the body’s natural healing process and varies widely from patient to patient. Fortunately, heavy scarring is rare following a rhinoplasty and, in the extreme cases where they do occur, steroid injections have been shown to reduce or even completely mitigate their appearance.

How can I reduce swelling post-rhinoplasty?

Patients can reduce swelling by asking surgeons to apply surgical tape to the area and also practicing good habits such as reducing alcohol/smoking habits, reducing sodium in the diet, and (if swelling is persistent after several months) engaging in light exercise.

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