Rhinoplasty Commonly Asked Questions

A rhinoplasty is a reshaping of the nose for cosmetic reasons. It does not specifically do anything to improve breathing. In colloquial terms, a rhinoplasty is a "nose job."

A septoplasty is a reshaping of the septum, the wall that separates the two sides of the nose. Its purpose is to improve breathing. While this can be responsible for breathing problems, in the past some plastic surgeons would do a small and insignificant septoplasty because in the past insurance companies would pay for septoplasties, but they never did for rhinoplasties.

So the septoplasty was effectively an excuse to get the rhinoplasty covered by insurance. Certainly there are a great many patients who in fact need septoplasties today, but because of the changes in the attitudes of insurers they are less frequently done than in the past.

A patient is a good candidate for a rhinoplasty if there is a feature in their nose that they wish to have changed. They need to be healthy both in body and mind, meaning that they have to be physically healthy as well as emotionally being appropriately motivated for surgery.

The starting point is to be sure whether you actually want to change the appearance of your nose, and if so, in what way do you wish it would look different. Do you want a bump removed? A narrower tip? You need to decide. And then when you meet with Dr. Teitelbuam, he will examine you with a mind for determining two things. First, whether he agrees that you have the problem you think that you do. The second thing is for him to offer his opinion about whether you will indeed look better with such a change. Most patients see Dr. Teitelbaum with something very specific in mind, and the vast majority of the time they have appropriately analyzed their nose and indeed such a change would make them look better. But sometimes a patient sees a problem that really isn’t there, and/or to treat such a thing would actually make a patient look less attractive.

The most critical step is that a patient must be emotionally mature enough to know for sure that they want to change their nose and the way in which they want it to change. For instance, a teenager with a stereotypical Persian or Jewish nose may be torn between simply removing a bump on their nose or taking it a step further and making their nose very small and characteristic of another race. A teenager may not yet have the self-awareness to know what they want to do. From a physical point of view, it is common for teenagers’ noses to often look big for their faces, only to come into better proportion later. There are no specific rules about this but it needs to be considered. Finally it is important to note that when a surgeon operates on a structure, future growth of that area is often inhibited. So in a perfect world plastic surgeons prefer to wait to do rhinoplasties on teenagers until their nose has stopped growing. Girls will typically stop growing earlier than boys. Dr. Teitelbaum will ask patients whether they are still growing taller or whether their weight has stabilized. Another important consideration can be when a girl started her periods. This all must be weighed against a young person’s self-esteem at a very delicate stage in their life, and the extent to which surgery will make them feel better at that point.

A closed rhinoplasty is done through incisions hidden within the nose. An open rhinoplasty has a visible scar that goes across the columella, the piece of skin that separates the nose into two nostrils.

If the rhinoplasty is done "open," then there will be a faint scar across the columella.

Dr. Teitelbaum prefers closed rhinoplasties because he prefers to have a hidden scar and he believes the nose takes on a better appearance.

A nose should look natural after a rhinoplasty, meaning it should look as if you could have been born with it. There should be no telltale signs of surgery. There are two reasons noses do not look natural, and Dr. Teitelbaum avoids them both. The first is that the nose does not belong on the face, such as a Northern European nose on a Chinese person or an Irish nose on a Middle Eastern person. Dr. Teitelbaum did so-called "ethnic rhinoplasties" years ago on non-whites trying to look white, but he does not do those any longer. Such results do not look attractive. It is however sometimes attractive for a black patient to have surgery to make their nose look like a more attractive black nose, but any attempt to go down the "Michael Jackson path" is always ill-advised. The second reason that noses may not look natural is that the nose itself looks like it has been operated upon, such as having the tip turned excessively up, having the tip overly narrowed and pinched, or having "grafts" in the nose that become displaced or irregular.

Grafts of cartilage or even silicones are sometimes placed into the nose to augment a nose that lacks tissue or is weak and needs support to increase projection of the tip, or to help with airflow. As a matter of personal style, Dr. Teitelbaum is very conservative about his indications for using nasal grafts. While they are excellent and important in many occasions, they can also make the nose look too large and sometimes even bulky. The grafts can become visible under the thin skin of the nose, creating unnatural angles and shapes. But when appropriately indicated and well-executed, they can help nasal function and appearance.

Dr. Teitelbaum uses grafts from the body’s own cartilage, either from the so-called septal cartilage that divides the two nasal passages or from cartilage in the ear. The septal cartilage is the first choice, but if it has been used in an earlier rhinoplasty Dr. Teitelbaum will use ear cartilage. Another choice is to use cartilage that is on the rib cage or even the rib itself. Finally, there are some surgeons who use artificial silicone grafts.

A rhinoplasty is most often done as a single procedure. But it is often done in conjunction with a chin implant or liposuction under the chin. There is a very important aesthetic balance between the two that must be done. But it is safe to do a rhinoplasty with a variety of other procedures, the most common of which would be otoplasty (ear pinning), facelift, liposuction, and breast augmentation.

There is typically black and blue under the eyes if the bones need to be broken, which is usually necessary if the nose is wide or if there is a big bump that needs to be removed. Some patients have much more of a pronounced tendency to bruise, and some do not. It seems that thicker and more olive or even black skin bruises the least, and the fairest and thinnest skin bruises the most. Keep lots of cold compresses over the eyes and cheeks for the first couple of days after surgery as well as keeping your head up can help reduce bruising. In either case it is safe to cover over the bruising with makeup, and the bruising is typically gone in about six days.

If Dr. Teitelbaum needs to break the bone on the nose to narrow it here will be a splint on the nose for five to seven days after surgery.

There is little if any discomfort when a splint is removed from your nose after surgery.

You will only have packing in your nose if Dr. Teitelbaum needs to take a cartilage graft from your septum. Patients don’t like packing because it makes their nose seem stuffy and it can be difficult to breathe out of. But when Dr. Teitelbaum uses it, he uses special packing that has breathing tubes within it.

It can be safe to have another rhinoplasty. But the goal is always to get it right the first time. If there is a revision, hopefully it would be to do just a little tweak, such as removing a bit more of a hump or smoothing out the nose. These things can obviously be done.

Dr. Teitelbaum and his patients prefer general anesthesia because there is no anxiety about or possibility of the patient experiencing any pain with surgery. It allows Dr. Teitelbaum to focus all of his attention on what he needs to do to create the best possible nose for you. And most important of all, it leaves an anesthesiologist who is singularly focused on keeping the patient safe and comfortable.

Insurance will never cover a rhinoplasty, because a rhinoplasty is a cosmetic procedure. A septoplasty is done to improve breathing, and if the problem is documented to be severe enough, most insurers will pay. But what they pay today is often very little and does not cover the cost of the procedure unless a patient chooses to go to an in-network provider. Dr. Teitelbaum is not a provider on any insurance plans. But if you need a septoplasty and it is covered, he will ask you to cover the cost of surgery yourself and you will be reimbursed the full amount your insurance company pays in surgeon fees.

Rhinoplasty patients are medically able to go home the night of surgery provided there is someone who will be responsible for helping to take care of you. There is an excellent aftercare facility across from Dr. Teitelbaum’s office, and some rhinoplasty patients will go there to recover in peace and quiet or because there is no reliable person at home to look after them.

Dr. Teitelbaum calls all patients the night of surgery, including after rhinoplasties. And he will encourage you to call him if you have any questions.

A rhinoplasty is not a very painful procedure. You will be sore and feel stuffy. Dr. Teitelbaum will give you enough strong pain medications so that if you are in pain you will be able to take them and alleviate your pain. So pain itself should not be a barrier to getting a rhinoplasty if it is otherwise something you would want to do.

Most patients will go to work after the splint comes off at five to seven days after surgery, though there may still be bruising as long as seven days. Some patients will go back to work after just a few days if they don’t mind being seen with a splint on their nose, which in some circles in Los Angeles is not a big deal. But you will be well enough to work on the computer from home the day after work.

You can drive when you are off of all narcotic pain medication and feel totally unrestricted by your discomfort such that you could make any movement you might need to safely drive your car.

You should wait about a week before traveling by airplane after a rhinoplasty to be sure that there is no swelling that can cause difficulty clearing your ears during a flight.

It is safe to start exercising again about three weeks after a rhinoplasty. You can walk before then, but wait a full three weeks to elevate your heart and really exercise.

You can lift a cooperative child that is up to 35 pounds right away. But don’t try to pick up your child if he or she is upset.

You can shower the morning after the rhinoplasty but you should try to keep your splint dry.

Swelling increases after surgery, usually peaking about 5-6 days after surgery. After that, the swelling will subside, rapidly at first, and then gradually. After one month, you’ll think the swelling is gone, but it will still go down more at three months, and even more at six months and even a year, though at that point changes are subtle.

Use a Q-tip to clean inside your nose with peroxide twice a day, and then rub some Bacitracin antibiotic ointment following the peroxide.

The sutures will come out in 4-6 days after surgery if you have an open rhinoplasty. But in most all cases Dr. Teitelbaum does a closed rhinoplasty, in which case the stitches are inside the nose and dissolve on their own.

The main problem to look out for after a rhinoplasty is bleeding. This tends to be more of a risk when a septoplasty is also done. If this happens you will either get a significant bloody nose or realize you are swallowing a lot of blood from the back of your nose. If this happens call Dr. Teitelbaum immediately so that he can meet you in the office or emergency room and stop the bleeding.