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Nose Job / Rhinoplasty


Nose Job / Rhinoplasty

Because the nose is a central feature of the face, it can have a significant influence on your appearance and on your self-image. Some people want changes made to their nose because:

  • They are unable to breathe through their nose.
  • They believe their nose appears too large or wide for their face. 
  • They believe their nose is crooked or off center.
  • An injury has changed its appearance.
  • Their nose has a hump or depression when seen in profile.
  • The tip of their nose droops or plunges, or is thickened or enlarged.
  • They believe their nostrils appear too flared.

Surgical nose alterations (rhinoplasty) can shorten or lengthen the nose, change its shape or contour, narrow nostrils, or lift and define the tip. Dr. Friedman considers your features, the skin on your nose and what you would like changed. The upper half of the nose is bone, and the lower half is cartilage. Surgery can modify bone, cartilage, or both. Talk with your surgeon about what surgery can achieve.

Dr. Friedman looks at photographs of your face to determine the best approach for your surgery. Like everyone, your nose is asymmetrical; one side of it is probably longer or different in some way than the other. Some people choose to have chin enhancement surgery in addition to nose surgery because the two are an important reference point for each other. Because nose surgery involves changing the bone and cartilage, it is considered to be one of the more complex facial plastic surgeries. Many people are pleased with the results of nose surgery. However, it is still possible the results do not meet your expectations. The elasticity and age of your skin also affects the final results. Approximately 5 to 10 percent of people who have nose surgery done are not satisfied.

Revision Rhinoplasty

If you are not satisfied with your nose surgery, you might choose to have a second procedure to correct what you don’t like (revision rhinoplasty). Dr. Friedman may recommend waiting 1 year after rhinoplasty to allow your nose to settle into its final shape. Your surgeon will meet with you and do a very thorough evaluation to determine exactly what you don’t like about your nose. Once you decide to have nose surgery, follow these guidelines carefully:

3 months before surgery, stop using nasal medications, such as nasal sprays, steroids or any other type of drugs. This is to reduce the risk of bleeding and healing problems.

If you are or have previously used cocaine, tell your surgeon. Cocaine use must be stopped 1 year before nose surgery as it may cause total nasal destruction.

Follow the instructions you have been given about not taking certain medications and abstaining from nicotine products and avoiding secondhand smoke. Dr. Friedman may make incisions only on the inside of the nose (endonasal/ closed rhinoplasty). Or, he may make a small incision at the underside of the nasal tip across the vertical strip of tissue separating the nostrils (columella) as well as within the nose (external/open rhinoplasty). The approach Dr. Friedman uses depends on your desired results and what he thinks is best for you.


The septum is the cartilage and bone structure that supports the nose and separates it into 2 sides. Ideally, the septum runs exactly down the center of your face (midline). However, many people have a deviated septum, in which their septum is off center. A deviated septum can cause breathing difficulty and repeated sinus infections. Talk to Dr. Friedman about whether you have a deviated septum.  If you do, it can be corrected during your nose alteration surgery. This procedure is called septoplasty. Neither rhinoplasty nor septoplasty corrects allergies or nasal swelling.

What to Expect:

Dr. Friedman makes incisions to sculpt bone and cartilage to achieve a new shape. He repositions the bones in your nose and builds up certain areas using bones or cartilage. If the nose is being narrowed or the nostrils are being reduced, wedges of skin at the base of the nostrils may be removed through incisions that are hidden in natural creases of the nose. After surgery, a splint is applied to the bridge of the nose to protect it and stabilize internal tissues. You may have a bandage placed at the base of your nose and packing inside your nostrils to prevent bleeding. To reduce swelling and bruising, apply ice packs to your eyes and keep your head elevated for 3 days after surgery.

Risks may include:

  • Infection.
  • Bleeding.
  • A sinus infection caused by a blockage in the nasal passages.
  • Breathing difficulties caused by irregularities of the cartilage or bone.
  • Temporary reduced sense of smell; rarely, it is permanent.

Additional surgery may be required to treat some of these complications or if the outcome of the surgery does not match your expectations. A period of 9 to 12 months is needed for healing before another surgery can be done.


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Rhinoplasty is the surgical alteration of the shape of your nose. With rhinoplasty, you can modify the upper portion of your nose (which is bone), the lower part (which is cartilage), or both.

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