What To Know Before Getting A Nose Job

Illustrated by Anna Sudit.
Based on what you might have read in the tabloids (“Celebrity Nose Jobs: Before & After!”) or learned through heart-to-hearts with your coworkers, classmates, or squad, rhinoplasty is happening all around us. Though we don’t think anyone really needs a nose job for non-medical reasons, every woman has the right to do whatever she wants with her body and whatever makes her happy — and it’s NBD. But even though this procedure seems super-common, if you’re thinking of taking the plunge — as with making a financial investment, buying a work of fine art, or getting a boob job, for that matter — you need to do your research and make the best, most informed choice for you.

To aid in your decision-making process, we consulted with three of New York’s top plastic surgeons on everything from finding the right doc to the recovery process.

What Happens During Rhinoplasty
Rhinoplasty involves modifying both the bones (upper part) and the cartilage (lower part) of the nose for a variety of desired aesthetic results: a narrower nose, a higher bridge, a more refined tip, removal of a bump, and so on. There are two types of incisions a surgeon could make. One is commonly called the “closed” or endonasal approach, and involves an incision on the inside of the nose. The other is called the “open” or external approach, and also involves another incision across the columella, or that bridge of tissue between the nostrils. The skin is then raised up to allow for rhinoplasty work to be done.

Depending on the desired new nose, the restructuring of the cartilage and bones will differ, explains Sam Rizk, MD. “The degree of cartilage versus bone varies between different people,” he explains. “Not all noses need to be broken. If most of your nose is cartilage, and you have very little bone, I may not necessarily have to break the nose at all. Breaking the nose is generally done more in the process of straightening a nose or narrowing a very wide bony bridge.”

With the closed procedure, the incision is made inside the nose, so there is no visible scar. With an open procedure, a skilled surgeon should be able to close the incision on the columella carefully so that you won’t be able to detect any scarring.

About That Grafting Thing
The surgeon can use septum cartilage that’s already been removed as part of the procedure, or remove the tissue from the back to help augment the nose. “You make a little cut in the back of the ear, where your glasses go, where it’s never seen,” says Norman Rowe, MD, who calls this advancement, which has happened during the past decade or so, a “game-changer.” According to Dr. Rizk, though, there is about a 10% "absorption rate," or chance the grafted tissue will be absorbed back into the face rather than going into the nose. So in place of cartilage, he sometimes uses implants such as the FDA-approved Medpor.

If there is no cartilage that can be used in the ear or nose or when a larger piece of cartilage is needed, Dr. Rowe says some surgeons might take cartilage from the rib — though this procedure is somewhat controversial. The technique requires a surgical incision near a vital organ — the lungs — so there’s risk of scarring, chronic pain, infection, or a collapsed lung. But Dr. Rowe assures us that in the proper hands, using the rib cartilage is very safe. “There is a small chance that during the harvesting of the rib, the lungs could be deflated; however, this situation is easily treated,” he says.

Dr. Rizk prefers utilizing the irradiated rib bank (tissue from cadavers), even though there's an approximately 15% absorption rate. “My first choice of cartilage is septum, the second choice is ear, and my third is irradiated rib cartilage or implants,” he says. “I will not risk a patient’s vital organ, such as the lung — even if it’s a small chance — for a cosmetic improvement of the face or nose. That is my personal feeling.”
Illustrated by Anna Sudit.
Age — Physical & Mental — Is Key
A prospective patient’s face needs to reach skeletal maturity — i.e., be fully formed — before they can get a nose job. For girls, this is generally ages 14 or 15 at the earliest. Since boys’ faces grow a little slower, age 15 is the minimum for males. But obviously, skeletal maturity varies from patient to patient. One way to tell if you're ready: Dr. Rizk assesses whether the foot is fully grown and hasn’t changed in size for a year. No matter what age you are, though, if you’re not emotionally ready for facial surgery, then you should consider waiting.

Do It For The Right Reasons
We get that a nose job might give your self-confidence a boost — or “aesthetic confidence,” as Philip Miller, MD, calls it. But know that rhinoplasty isn’t going to miraculously change your life. “If you’re doing it because you think you’re going to get a better job, or a new boyfriend or girlfriend, or because your marriage is falling apart, that’s not a reason to get a rhinoplasty,” Dr. Miller says. Dr. Rowe cautions against going under the knife because of pressure from parents, significant others, or friends. You need to be doing this for yourself.

If you have body dysmorphia — a chronic mental illness that causes people to obsess over their appearance and physical flaws that no one else sees — plastic surgery is not the solution. “If I see any evidence of body dysmorphic disorder, I will not operate on them,” says Dr. Rizk. “Or if I see evidence of psychological issues, I will not operate on them.” It’s also important to make sure you’re physically healthy, and if you smoke, now is a good time to stop. As we learned in Breast Augmentation 101, smoking impairs circulation, meaning it could affect how well your post-surgery wounds heal.

Know What You Want
Going in for surgery on your face is not like going to Chipotle for a burrito and deciding on fillings when you get there. “The person who should not have a rhinoplasty is the person who cannot find a suitable nose that they want on the face,” says Dr. Miller. Dr. Rizk notes that people with “minor asymmetries should not be getting rhinoplasty.” Asymmetry is natural — even many celebs, like Beyoncé and Harry Styles, have asymmetrical faces.

Find The Right Doctor
As with any type of plastic surgery, you need to confirm that your doctor is “board-certified” with a specialty in “facial plastic surgery” with The American Board of Plastic Surgery. “What that means is that your doctor doesn't do everything,” cautions Dr. Rizk. “He or she doesn’t do boobs one day and liposuction the next day, and is an occasional rhinoplasty surgeon, but he or she is a rhinoplasty specialist.”

One indication is that the doctor has a website fully dedicated to rhinoplasty. “Rhinoplasty is one of the most challenging operations out there,” says Dr. Miller, who suggests finding someone who performs at least 10 or 20 surgeries a month. Even better, look for a double-board-certified surgeon — meaning, board-certified in both facial plastic surgery and otolaryngology (i.e., ear, nose, and throat), like both Dr. Miller and Dr. Rizk.

Connect With Your Doc
“I’d interview the doctor to make sure I’m comfortable with him or her,” says Dr. Rowe. “And they’re comfortable with me.” Plus, talk to the surgeon to make sure you agree — aesthetically and on a personal level. “Make sure your surgeon hears you,” emphasizes Dr. Miller. He always makes sure that he and the patient decide on a “unified vision.”
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Illustrated by Anna Sudit.

Photos Are Your Friends
When it comes to rhinoplasty, the proof is in the photos. “You want to see tens or hundreds of before-and-after photographs of that [surgeon's work] showing you consistent results that you like,” Dr. Miller says. “Not just one or two.” Focus especially on rhinoplasty procedures on noses similar both to your current nose and the look you want post-surgery. Conveniently, these days, doctors tend to display their work on their websites — or should, at least. “A doctor who refuses to show pictures — which some of them will do — I would walk out the door. Because you don’t know what you’re getting,” says Dr. Rizk. You should also bring in photo examples — celebrities in magazines, etc. — to help communicate the aesthetic you want to your doctor.

Manage Your Expectations
“I always tell patients, ‘A nose is like a fingerprint,’” says Dr. Rizk. “I’ll give you the best nose that your nose allows me to give you, but I can’t give you somebody else’s nose.” Each individual has his or her own bone structure, skin thickness, cartilage, and muscles. So even if your nose has been altered, it will still sit on your face differently than it would on, say, Tay Swizzle’s visage. Even with the face-morphing technology some surgeons use, the end result might not be the same as what you saw on the doctor’s computer screen. Different faces, different noses.

Take Time To Recover
You will be wearing a nose splint for three to eight days (looking every bit like an extra from Clueless), depending on your healing process and your doctor. (You’ll also have to clean out your nostrils during that time with peroxide and antibiotic ointment, per Dr. Miller.) You’ll be swollen, and it’s possible — depending on your surgery — that you’ll have a black eye or two. You should avoid doing anything physical (like the gym or “the club,” per Dr. Rowe) for about a month, but you can head back to the office when your splint comes off.

See your doctor immediately if you’re experiencing any difficulty breathing or excessive bleeding a day or two after surgery. Remember to go over any potential risks with your doctor before the procedure.

Be Patient
Your anticipated new nose won’t magically appear in pristine condition the second that splint comes off. In fact, it will not look like your new nose for up to a year after surgery — maybe even two years if it’s a revision rhinoplasty. “Patients should always know that there’s a 10 to 15% risk of a revision or a touch-up procedure after a rhinoplasty,” says Dr. Rizk. According to the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS), in 2014, surgeons reported that 25% or fewer of their patients were not happy with their rhinoplasty and went in for revision surgery.

It takes that long for the swelling to go down not just because the bones and cartilage take a while to heal, but also because of “skin contracture.” Dr. Miller likens your skin to “shrink-wrapping,” saying it takes a while to settle in during the healing process. “Swelling post-op takes from three weeks to three months to go away,” explains Dr. Miller. “Skin contracture can take three to nine months after the swelling goes away. You won’t see the end result for almost a year.”

Pay Up
Like boob jobs, nose jobs vary from state to state, doctor to doctor, and procedure to procedure. The American Society of Plastic Surgeons reports that a procedure costs an average of $4,694, not including anesthesia, operating facility costs, and other related fees.

And there you go: Nose Jobs 101. Class dismissed.
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