Hi, I’m Dr. Sanjay Parashar; an aesthetic and plastic surgeon with over 25 years’ experience. I have performed more than 10,000 surgeries overall, which include 400+ rhinoplasty surgeries.
Here I will provide you all the information you need to make an informed decision regarding rhinoplasty, and to prepare yourself for it. If after this, you still have more questions, I’d be delighted to answer them in an in-person consultation. Read on…
Rhinoplasty – The most sought after facial contouring procedure
An ideal nose is one which is in harmony to all other facial features and proportions of a person’s face.
Unfortunately, for many people, the shape, size, and contours of the nose (including nostrils), are disproportionate to their face or disfigured due to birth defects or injury. For such people, rhinoplasty is the perfect solution allowing them to enhance their facial contours.
Like so many other surgeries, rhinoplasty is also both a science and an art. Learning, experience, and wisdom perfect the science; while the artistic nature comes into play when assessing what will look aesthetic and natural, and then being able to deliver results accordingly.
Here are the 3 stages that will take you towards the naturally aesthetic nose shape you desire:
Stage 1: About Rhinoplasty - What you need to know before your initial consultation
There’s a certain degree of information you should have regarding rhinoplasty even before your initial consultation with me. This information will help you be better prepared and have a more meaningful consultation session.
Rhinoplasty, also known as, Nose Job, is a surgical procedure to change the shape and appearance of your nose, or improve its function (correct breathing difficulties), or both. The objective of the surgery is to reshape your nasal contours to make them more aesthetically appealing and/or more effective functionally.
I do believe the nose is one of the most integral and artistic parts of a person’s face and overall appearance. Under the expertise of a skilled surgeon, the rhinoplasty procedure also has an artistic angle to it, so that the nose is not just reshaped, but done in such a way that the new look is more appealing, yet natural, and aligns beautifully with your overall features and looks.
Rhinoplasty is done under general or local anesthesia depending on the type of surgery. It takes 1-3 hours, and is usually done as an outpatient procedure, with the patient going back home the same day. Revision rhinoplasty (corrective rhinoplasty) can take up to 4 hours.
The major cosmetic or aesthetic reasons why rhinoplasty is undertaken are:
- Resizing the length of the nose in relation to the face
- Resizing the nose width – widening/ narrowing to make it more proportionate
- Resizing the nostrils in relation to the nose/ face
- Correcting crooked, hooked, pointy, upturned noses
- Straightening out humps, or unevenness on the bridge of the nose
- Correcting nasal tips that are drooping, large, or bulbous
The aim of cosmetic rhinoplasty is to enhance facial appearance and improve self-esteem.
Although rhinoplasty is widely done as a cosmetic procedure, in many cases it is done for medical reasons too – to fix birth defects, breathing issues (septoplasty), or damage from injuries (reconstructive rhinoplasty).
It is a safe and highly popular procedure, has a short recovery time, and can provide you the best results to get a more desirable facial appearance, or to improve the functionality of your nose.
It is very essential for me that you are clear on why you are considering rhinoplasty. So, even before your initial consultation, you should reflect on some questions:
- Are you clear about what is wrong with your nose?
- Are you thinking of rhinoplasty as a life-changing procedure?
- What are your goals and expectations from the surgery?
- Do you understand that there isn’t one ideal nose?
- Do you accept that minor flaws are likely to remain?
I will be asking you these questions in my initial consultation, and your answers will help me to assess whether you are a right candidate for rhinoplasty.
If you are an adult – male or female, are in generally good health, not pregnant, ideally a non-smoker, have a positive attitude, and have realistic expectations from the surgery, you are potentially a good candidate for rhinoplasty.
If you think having a nose job is going to change your life, or solve relationship issues, etc., then you aren’t a good candidate.
I will be keenly assessing your suitability for rhinoplasty through your answers in our initial consultation, and will proceed only if satisfied that you are a good candidate.
Rhinoplasty can be classified in various ways based on:
A. Surgical Technique
- Endonasal/ Closed Rhinoplasty
- Open Tip Rhinoplasty
B. Nose Size Change
- Augmentation Rhinoplasty
- Reduction Rhinoplasty
- Aesthetic Rhinoplasty
- Medical Rhinoplasty (septoplasty)
- Reconstructive Rhinoplasty (due to injury, birth defects)
- Primary Rhinoplasty (first time)
- Secondary or Revision Rhinoplasty
I have already touched upon the rhinoplasty reasons in a prior section, so, for this section, I will concentrate on the rhinoplasty types based on surgical technique – open/ closed, the type of size change to be made, and revision rhinoplasty.
Closed vs Open Rhinoplasty
In endonasal or closed rhinoplasty, all incisions are hidden inside the nose. In open rhinoplasty, all incisions are inside the nose, except one, which is on the skin between the nostrils, but it is very small and fine, and difficult to see.
As a rhinoplasty surgeon, I perform both open and closed rhinoplasties. There are advantages to both approaches, and I will choose the best approach after our initial consultation based on your specific circumstances.
Augmentation Rhinoplasty and Reduction Rhinoplasty
Since adjustments to the size of the nose is one of the major reasons people opt for rhinoplasty, rhinoplasties are also classified as augmentation rhinoplasty (increasing the nose size), and reduction rhinoplasty (reducing the nose size).
In a reduction rhinoplasty, I remove and rearrange cartilage and bone from your nose to reduce its contours. The nasal skin will shrink later to match the new contours.
In an augmentation rhinoplasty, I may add implants/ grafts to increase to increase the nose size. Implant/ graft options include silicone implants (restricted use due to risk of infection), porex implants (MEDPOR® – my personal preference), cartilage grafts taken from other parts of your own body (septum, ears, ribs – used when small amounts of grafts are needed), and bone grafts (limited to reconstructive surgeries).
The type of rhinoplasty that will be done for you is a decision I will make during our initial consultation.
Primary Rhinoplasty and Revision Rhinoplasty
It is always best to get something right the first time. The same applies specifically for rhinoplasty too. It is a fact that 10% of all rhinoplasties worldwide go in for revision or corrections. This is known as secondary rhinoplasty, corrective rhinoplasty, or revision rhinoplasty.
Revision rhinoplasty is undertaken when the results from the initial rhinoplasty are unsatisfactory, or they have resulted in functional problems such as congestion, or breathing issues.
The changes made to your nose structure during a rhinoplasty surgery are permanent. However, subsequent injury, or other factors can alter the appearance of your nose. If you have undergone aesthetic rhinoplasty before your complete physical development (i.e. before adulthood), the ongoing development of your body can also affect your nose and the rhinoplasty results.
As mentioned earlier, you should also keep in mind that about 10% of rhinoplasty surgeries worldwide go in for a secondary, corrective or revision rhinoplasty.
I see and handle a lot of cases for revision rhinoplasty too, so I would suggest that you choose a surgeon wisely the first time itself, and you can minimize your chances of needing a revision rhinoplasty.
The recovery period for rhinoplasty is usually about 10 days. By the end of this period, the splints and gauze put after the surgery would have been removed, and most of the obvious bruising and swelling would have subsided. Complete internal healing could take 4-6 months.
If your surgery is done as an outpatient procedure, you will be able to go home the same day. Have someone to drive you back.
If you are working, I suggest you apply for at least one week’s leave, and plan to have your surgery just before the start of the weekend.
Strictly following the recommended post-recovery plan will help you recover faster.
Importantly, the skill of your rhinoplasty surgeon also affects your recovery period.
When we meet, I will share actual cases of my patients and what enabled their quick recovery.
Every surgery carries some risks, but at this stage of my experience and expertise, the risks that my patients have are minimal. Standard risks include:
- Anesthesia risks
- Infections of any kind
- Need for corrective rhinoplasty
- Altered smell sensation
- Implant displacements
Risks are minimized in the hands of an expert surgeon, by doing the surgery in a good, licensed clinic or facility, following proper protocols; and by the patient carrying out all given instructions – both before and after surgery.
Rhinoplasty cost varies based on the following factors:
- Extent of changes needed to the nose
- Whether the procedure is being done under general or local anesthesia
- Whether it involves overnight stay
- Hospital/ Clinic used for the surgery
- Skill & expertise of the rhinoplasty surgeon
When rhinoplasty is done as a cosmetic procedure, insurance does not cover the cost. If, however, it is done for medical reasons, all or part of the cost may be covered by insurance. Please check with your insurance provider about your policy entitlement.
Another significant aspect to take into consideration, besides just the costs, is your comfort factor with the rhinoplasty surgeon, and your faith in the surgeon’s expertise. Pay a bit more – but be sure, and be comfortable with your surgeon.
This is especially important, because if not done right the first time, you might need a revision rhinoplasty; so, consider that in your decision-making.
To know the cost applicable for your specific case, please book a consultation.
The choice of your rhinoplasty surgeon is a decision to be made with due care. While cost is a relevant consideration, there are other more important factors that should determine your decision:
- Qualifications and certification, specifically plastic surgery related certifications and memberships, such as membership of American Society of Plastic Surgeons (ASPS)
- Years of experience as a plastic surgeon, number of surgeries done
- Number of rhinoplasty surgeries done
- Proof of work – before/ after images
- Patient testimonials
- Surgeon reputation
- Your comfort factor with the surgeon, his manners, his patience in answering your questions
- Surgeon’s philosophy regarding patient safety
You are planning a significant surgery, and one that requires very specialized training and even artistic flair, so it’s extremely important that you decide wisely. Pay more if needed, but choose a surgeon who has an extensive portfolio of successful rhinoplasty surgeries. Make sure that you are fully comfortable with your surgeon.
If you are looking to do a revision rhinoplasty, choose a revision rhinoplasty specialist, as a revision rhinoplasty is a more specialized procedure.
I have done many hundreds of rhinoplasty surgeries, including revision rhinoplasty surgeries for patients unsatisfied with results of prior surgeries done elsewhere. You can read my full profile here.
The clinic or hospital for your rhinoplasty surgery done should be carefully chosen. Ensure that the facility is licensed. A hospital is not necessary for a rhinoplasty surgery, an accredited/ licensed clinic is just fine.
The clinic should have a licensed anesthetist on board, competent nursing and operations staff, and the surgical room should be clean and hygienic.
Ministry of Health (MOH), Dubai regularly conducts inspection of all medical and surgical facilities in Dubai and license is granted or renewed only if the prescribed conditions regarding hygiene, safety, etc. are met.
My medical center – Cocoona Center for Aesthetic Transformation, Dubai is an MOH-licensed clinic, and we are permitted to perform surgeries under local anesthesia. We also have competent anesthesiolgists on board, and a full team of caring and professional nurses, patient counselors, and other support staff.
If your surgery needs to be performed under general anesthesia, we can do it another licensed facility of your choice, or where we have a tie-up.
Now that you have all the base information regarding rhinoplasty, you should take the next step of booking the initial consultation.
Stage 2: Initial Consultation – My questions to you, Facial and nasal examination, Explaining the rhinoplasty procedure, Your residual questions
During our initial consultation, I will first ask you certain questions, conduct a facial and nasal examination, then explain the rhinoplasty procedure to you, and finally answer all your remaining doubts and concerns.
At the end of the consultation session, my goal is to have clarified to you fully and clearly what you can realistically expect from your rhinoplasty surgery, assessed your eligibility for rhinoplasty, satisfied all your concerns and doubts, and assured you of my capability to provide you the best results. Having done that, I will connect you with my patient counselor, who will handle the routine aspects of preparing you for your prospective surgery.
- What aspects of your nose are bothering you the most?
This is a very specific question that helps me identify what is bothering you and I can compare your concerns with actual physical findings on your nose. If it matches, I am confident of giving you a good result. If I feel it does not match, then we will see if we can come to a consensus on the issues, else I will sadly have to decline to proceed with the rhinoplasty. I suggest, before coming for a consultation to stand in front of a mirror, observe your nose from all angles, and identify your concerns. You can also do that by taking a portrait size photo in different angles such as frontal, 3 quarter view, profile view, and basal view.
- What are your expectations?
It is very important for me to understand your expectations. I will than analyze if they are realistic or unrealistic. I will explain to you what to expect, and whether I will be able to meet your expectations.
Some people prefer minimal changes that will not be obvious, others prefer radical changes. Some patients ask for natural results, which I am happy and skilled to provide. I am not comfortable with unnatural looks and visible scars that leave tell-tale signs of surgery, or with excessive structural modifications.
At the end of the day, your nose needs to not only look aesthetic, it also needs to function well.
- What is your medical history?
I will inquire about any breathing issues, deviated septum, past surgeries, pregnancies, medical illnesses, allergies, ongoing medications, etc., to gauge your suitability for surgery, and which technique of surgery will be best for you.
After I’m through with my initial questions to you, and upon getting an idea of your expectations from the surgery, I will do a thorough facial examination, focusing on your nose, and your overall facial features. I will evaluate the following:
- Facial proportions
- Bone structure of the nose
- Cartilage framework
- Nasal tip structures
- All aesthetic lines and angles (there are some standard guidelines)
- Balance of the nose vis-à-vis the face and chin
- Intranasal examination
For small changes, like hump removal, nasal tip width reduction or augmentation, and tip elevation, I use computer morphing to display and discuss the final post-procedure possibilities. That gives me a clear idea of what my patients are thinking. Extensive computer morphing can be unrealistic and causes misunderstanding between patient and doctor.
Based on my findings from the examination and our earlier discussion, I will determine which method of rhinoplasty would be most suited for your specific case.
The basic rhinoplasty process involves making all incisions inside the nose (closed rhinoplasty), or one additional incision under the tip of the nose (open rhinoplasty), adjusting the underlying elements, and then closing the incisions.
Your surgery will be done either at an accredited day care surgical facility such as Cocoona, or a hospital, depending upon your choice, and anesthesia considerations.
Understanding the process involves knowing about anesthesia, basic surgery steps, post-procedure recovery, return to normalcy, risks involved, and expected results.
- What anesthesia is used?
The procedure involves some form of anesthesia. Mostly it can be done under local anesthesia with IV sedation. In some cases, it may require general anesthesia.
- How is the nose reshaped?
After making the incisions, I separate the nasal skin from the underlying bone and cartilage, which are then sculpted to give the desired look. The nasal skin is thereafter draped back over the new contours (in time, it shrinks or expands in accordance the new structure). In the end, the incisions are closed.
- What type of rhinoplasty will be done for you?
The type of rhinoplasty – open tip or closed – will be a decision that I will arrive at based on the extent of structural changes that are needed to achieve your desired shape and your cosmetic expectations from the surgery.
The closed approach works better for patients who need minor corrections, but a surgery that requires major reconstruction, would be better performed as an open rhinoplasty.
Likewise, the choice of local or general anesthesia during surgery could be based on your personal preference. But in some cases, such as for a septoplasty (medical rhinoplasty), I would need to do the surgery under general anesthesia.
- How is a natural looking shape attained?
The key to performing a natural rhinoplasty is to understand the proportions of the nose and face – both a science and an art, correct the deformity that is causing problem, and keep the scars within the nose and nostrils. The most common issues resulting in unnatural appearances are overdone nose, or excessive thinning of the nose. Additionally, visible scars, and breathing problems from damage during surgery are also common with less experienced or less skilled surgeons.
As a surgeon who takes immense pride in his work, I always strive for results that look perfectly natural relative to my patients face. That objective is best achieved when someone who knows you, but doesn’t know that you have undergone a rhinoplasty, looks at you and notices you look different and more beautiful, but can’t place their finger on what exactly the change is. That’s when I know, and you’ll know, that your new nose looks “naturally” beautiful.
It is for this reason that I restrict computer simulations, and refuse to do excessive structural modifications.
It’s also important to understand that a nose shape that looks beautiful and natural in another person, might look out-of-place in your face. So, each person’s “natural” shape is different, is related to their ethnicity, and determined on a full study of their facial proportions.
At this stage, you are likely to have some more questions for me to clarify. Some such questions are covered herein. I will be glad to answer these and any other concerns you have.
- What is the recovery phase immediately after the procedure?
After the surgery, a nasal splint is applied on the nose to protect the new nose structure. Sometimes, a pack may also be placed inside the nose. There may or may not be a need for hospitalization depending upon the extent of the surgery. The nasal pack is removed in 24- 48 hours, sutures of open rhinoplasty approach are removed on the 5th day, and the splint is removed after 6-7 days.
Some bruising and swelling may be visible for 5-10 days. Most of my patients return to work in 1 week to 10 days. Some use makeup to cover the bruise. You should also be able to socialize in 7-10 days after surgery. However, you may experience swelling, hardness, numbness, and discomfort for few weeks. The nose can take about 4-6 months to completely heal from inside.
- What should be done post-surgery to improve the results?
Strictly follow the recommended post-surgery plan for faster recovery – including taking your medications, and keeping your follow-up appointments schedule.
Using cold compresses will also help to keep the initial bruising and swelling under control.
Avoid excessive exposure to the sun, and keep a generally healthy lifestyle to retain your results.
- When will the results be visible?
Once your initial swelling subsides within 1 to 2 weeks, your altered nasal contours will be immediately visible. However, it will take about 12 months for your new nasal contours to fully take shape, and for the final nose shape to emerge.
Stage 3: The Next Steps …
After our detailed initial discussion, almost all matters would have been clarified. You will then get a handbook that explains the details of before and after care, medications to avoid, risks and complications, financial agreement, consent and permission forms, medical history form, etc. Please spend some time reading the booklet completely.
My patient coordinator will get back to you with cost details applicable to your surgery, and the booking protocol, and will also answer any questions you may have in the run-up to the surgery.
Then a pre-operative appointment will be arranged wherein we will do a complete medical checkup, measurements, surgical planning, photographic documentation, and other necessary paperwork.
Finally, on the appointed day, I will perform the rhinoplasty, transforming your nose shape to the desired one.
It is advisable to have a family member or friend to drive you back home after the surgery.
Have a look at some of the testimonials from my patients, and here are some ‘Before & After’ pictures too. You might also want to spend a few minutes watching the video below to better understand the rhinoplasty process.
For many people, the shape, size, and contours of the nose (including nostrils), are disproportionate to their face or disfigured due to birth defects or injury. For such people, rhinoplasty is the perfect solution allowing them to enhance their facial contours.