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Rhinoplasty FAQs

What is a rhinoplasty?
Rhinoplasty or "nose job" is a surgical procedure to refine and/or reshape the nose. It can change the size, length, width, projection, bridge or tip. It can also straighten a crooked nose. Rhinoplasty is a cosmetic procedure and sometimes it is done at the same time as a functional procedure such as septoplasty (a procedure done on the nasal septum, which is a structure separating the right and left nasal cavities) to straighten it.

What are the benefits of rhinoplasty?
Benefits may range from improved breathing to an enhanced appearance and self confidence. According to Dr. Sam Rizk, the nose is a central facial structure and impacts beauty and facial harmony to a large degree. The shape of the nose can give a more or less sophisticated appearance, a long or drooping nose can make a person look older, a bulbous tip can make a person look more ethnic. Visual improvement from a rhinoplasty can be subtle in a person with a minimal deformity or more dramatic in a person with a significant deformity.

What is satisfaction rate with rhinoplasty?
In Dr. Rizk's practice 90percent of patients are happy with their results and 10 percent feel they could have had a better nose and some of these 10 percent may choose to do a touchup or revision rhinoplasty. Some patients are unrealistic about their expectations and their thicker skin may not shrink after surgery as much as these patients would like. Dr. Rizk is very honest with patients and explains this before the surgery. Also some patients may form more scar tissue inside the nose making it less defined than the patient would like-these are factors beyond the surgeon's control. Sometimes kenalog (steroid injections)-done every few months -may reduce this scar tissue. If a patient is not satisfied with their rhinoplasty and if Dr. Rizk feels something can be done to improve the results, he will do it. However, if Dr. Rizk feels patient is unrealistic, he will choose not to re-operate. Also some patients have body dysmorphic disease and Dr. Rizk chooses not to operate on them. Dr. Rizk makes most patients happy but the few unhappy ones are also a reality of rhinoplasty. It is important to be realistic in your expectations and understand possible complications as well which are rare but may include stuffiness, scar tissue, bleeding, asymmetric results from scar tissue, and possible need for revision.

Am I a good candidate for rhinoplasty?
Dr. Sam Rizk, a nose specialist and double board certified facial plastic surgeon in New York city, will operate on selected patients whom he deems to be healthy and emotionally as well as psychologically stable ,and whom he feels have realistic expectations. Dr. Rizk will sometimes not recommend surgery if he feels he cannot meet the patient's expectations or if the patient's requests do not coincide or agree with Dr. Rizk's artistic sense. Rhinoplasty surgery is a very precise and artistic operation and results cannot be 100% guaranteed and some patients, although rare, may require a revision rhinoplasty. If a patient cannot accept the risk of a possible revision, even if it is very rare, they should not undergo rhinoplasty in the first place.

What is revision rhinoplasty?
Revision rhinoplasty or secondary or tertiary rhinoplasty is a rhinoplasty procedure used to revise or fix a past procedure. It may be necessary because of an overly aggressive previous procedure or because of poor healing. Dr. Sam Rizk does a large number of revision rhinoplasty procedures every week on a regular basis. It is a more complex procedure and requires more surgical time.

What is septoplasty?
Septolasty is a procedure done from inside the nose to repair a crooked or deviated nasal septum. The septum is the structure which separates the right and left nostril and goes back far into the nasal cavity. The septum consists of cartilage and bone. Symptoms of a deviated and crooked nasal septum could include difficulty breathing through the nose or sinus problems. Repairing the nasal septum can be done at the same time as a rhinoplasty if medically indicated.

How do I know if I have a deviated nasal septum?
If you have symptoms of difficulty breathing through your nose, you should seek a consultation. If you have difficulty breathing through your nose and you do not like the way your nose looks, seek a consultation from a board certified facial plastic surgeon. Upon examining your nose, a facial plastic surgeon will determine if you have a deviated septum and if it is significant enough to cause nasal blockage. A CT scan (special x-ray of nose and sinuses) may be ordered to determine the extent of septum deviation and to look at the sinuses.

How do I choose a surgeon?
Do your homework, research the surgeon online, look at reviews, but be careful - a bad review does not mean you have a bad doctor. Online reviews are unregulated and can arise from a number of situations unrelated to a surgeon's patients or practice. So research if your surgeon teaches at conferences, look at the surgeon's awards given such as best doctors, etc. Castle Connelly is a prestigious Best Doctor’s award given based on a vote from other doctors. Look at the photo gallery and most importantly choose a surgeon who does a lot of noses and who is a specialist in rhinoplasty. A facial plastic surgeon specializes in facial surgery and does not do body work versus a general plastic surgeon who does face and body work. Make sure your surgeon does rhinoplasty on a regular basis many times per week and make sure your surgeon is board certified by the American Board of Facial Plastic and Reconstructive Surgery (www.abfprs.org). Dr. Sam Rizk is a double board certified facial plastic surgeon whose practice specializes in noses. Dr. Rizk was voted Best Rhinoplasty Surgeon by Castle Connelly by his peers in 2008. Dr. Rizk does not do body plastic surgery.

At what age can rhinoplasty be performed?
Typically, a female can undergo rhinoplasty at age 14 and a male at age 15. These are the ages where the nose is fully formed and where the teenagers are developing self image and confidence. Some teenagers also have functional issues with breathing from sports-related injuries which need to be addressed as well. Dr. Sam Rizk, a New York City facial plastic surgeon, performs rhinoplasty on teenagers only if the teenager really wants it, in addition to the parent. Dr. Rizk will not perform rhinoplasty on a teenager for the parent's wishes alone. The teenager has to be mature enough to be able to understand the procedure and recovery process.

Is rhinoplasty painful?
Dr. Sam Rizk's patients rarely complain of pain following rhinoplasty. According to Dr. Rizk, maybe 1 or 2 patients of a 100 will have to take the prescribed pain medicine. Some discomfort is expected and usually relieved with extra strength Tylenol. The tip of the nose is usually numb for a few months following the surgery. Dr. Rizk uses minimally invasive endoscopic 3D techniques (see videos from Doctor's show on homepage) where smaller incisions are made inside nose and the nasal structure is altered from under the muscle layers without damaging this overlying muscle. By precisely altering the nasal structure while visualizing it with a high definition 3D telescope system, the blood vessels and muscle covering the nasal skeleton are not damaged which results in less pain, bruising and swelling. Additionally, the high definition 3D telescopes allow precise visualization of the nasal structures through smaller internal incisions, thus, enabling Dr. Rizk to change the nose accurately with less risk of over-reduction or under-reduction of the nose and a more rapid painless recovery.

How long does rhinoplasty take?
The time it takes to do a rhinoplasty depends on many factors such as whether it is a primary or secondary rhinoplasty and whether grafts are needed or not, whether it is an Open versus closed (endonasal) rhinoplasty and on the thickness of the skin as well. On average it takes between 1.5-3 hours to do a rhinoplasty by Dr. Rizk. That being said, Dr. Rizk does not look at the clock when operating-he feels this is an artistic operation and he does not rush in any of his surgeries, leaving more time than is needed to do every procedure. Revision rhinoplasty may take up to 3-4 hours depending on scar tissue and graft usage and harvesting tissue from other areas. Dr. Rizk does a very meticulous operation and does not rush. Dr. Rizk also feels that surgical times longer than 4 hours result in diminishing returns due to irreversible stretching of skin and sometimes very prolonged swelling. Furthermore, the nose swells up so much with longer surgical times that it becomes impossible to assess nuances in the shape of the nose. This is why Dr. Rizk spends time creating his surgical plan prior to the surgery with detailed diagrams to decrease operative time.

What kind of anesthesia is required?
Rhinoplasty is safest with general anesthesia where airway is protected with a tube. Sedation anesthesia may be used in selected cases as indicated. General anesthesia can be performed where patient is breathing on his/her own as well.

Where does Dr. Rizk perform his rhinoplasty surgery?
Dr. Rizk performs the rhinoplasty in his Park Avenue Certified Operating Room Facility. This facility is the ultimate in safety and privacy, and has the latest most sophisticated modern equipment for rhinoplasty. The office based facility has only Board Certified anesthesiologists and does not use nurse anesthetists for anesthesia. Additionally, the post surgery recovery rooms have a nurse to patient ratio of 1:1 versus hospitals which may have 1 nurse for 6 or more patients. Dr. Rizk has all the emergency equipment required as a hospital for any emergency that may arise. Dr. Rizk also has admitting privileges in many local hospitals on the upper east side of New York City in close proximity to his facility. After the patient recovers in a private suite, he/she is then discharged and follows up with Dr. Rizk in a week. Sometimes, patients from out of town stay in a hotel and this is arranged by Dr. Rizk's office staff. Sometimes the patient may request a private duty nurse and this can be arranged as well with Dr. Rizk's staff. Occasionally, Dr. Rizk does rhinoplasty surgery at hospitals as well.

During a consultation, does Dr. Rizk formulate and discuss a plan for rhinoplasty?
If Dr. Rizk determines that you are a good candidate for rhinoplasty, he will formulate a plan and discuss what you would need in the procedure. He will gather information and discuss if open or closed approaches should be used and if he will use cartilage for grafts or implants. If he decides to use cartilage, he will also discuss possible sources, such as septum ear or banked rib cartilage.

What does a rhinoplasty entail and what kind of rhinoplasty procedures are available?
Surgical techniques for reshaping the nose may vary but in general, incisions are made either inside the nose (closed) or on the piece of skin separating the nostrils (open) and the skin and soft tissue envelope is separated from the cartilage and bone framework of the nose. The framework is reshaped and sculpted and the overlying soft tissue envelope is then replaced and a splint is applied to the nose for a week to help keep this new shape in place.

Open rhinoplasty (external) is done from a small incision on the columella (center piece of skin in the middle separating right and left nostrils). Endonasal (closed) rhinoplasty is performed from small incisions inside the nose. The 3D endoscopic high definition rhinoplasty techniques can be used with endonasal and open approaches. Dr. Rizk performs most primary rhinoplasty surgeries with the endonasal 3D high definition approach. Dr. Rizk also performs open rhinoplasty in selected cases with thick skin where multiple grafts are needed and in some revision rhinoplasty procedures. Dr. Rizk does not like to limit his approach to ONLY open or ONLY closed procedures as some surgeons do. He feels there are indications for both the open and the closed approaches. An alar base reduction or nostril reduction is sometimes needed with rhinoplasty and Dr. Rizk performs this procedure from a small incision on the inside of the nostril, not on the outside of the nostril (see section on nostril reduction of this website for more information)

I have thick skin on my nose, could I still obtain a good result?
As the Ethnic population in the United States is increasing, Dr. Rizk does a lot of rhinoplasty on patients who are ethnic (Asian, Middle Eastern, African American, Latino/Hispanic) with thick skin as well as some Caucasian patients with thick skin. Patients with thick skin on their nose and large pores can obtain an excellent reduction in most cases with the use of grafts, implants, as well as 3D defatting of the nasal tip. Dr. Sam Rizk states that ear cartilage is too soft and weak to be able to define the nasal tip (but it can be used for other types of grafts in the nose). Far superior and stronger grafts include the septum or rib. Medpor is also an excellent implant for defining the nasal tip and bridge and it does not resorb with time and integrates well with the nose. Dr. Rizk custom sculpts the medpor implant to fit your nose during your procedure, It is not a one size fit all implant. Rib cartilage is also adequate in strength but may warp and absorb slightly with time. Dr. Rizk does not like silicone implants in the nose because they do not integrate well and move with time. Dr. Rizk has come across a few patients with thick skin whom he could not help with a standard rhinoplasty and who had a condition known as rhinophyma and these patients required further treatment with laser to shrink the skin and pores.

How about the recovery?
In addition to the use of the 3D high definition telescopes and the smaller incisions, Dr. Rizk recommends a special type of vitamin K called mephyton (5mg) to be taken before and after surgery which also reduces swelling and bruising. Dr. Rizk also gives the herbal supplement arnica to be used before and after surgery in his Rapid Recovery Surgical Packet. Dr. Rizk also uses a tissue sealant inside the nose which seals blood vessels and decreases bruising. He also does not close the incisions inside the nose completely; instead, he approximates the incisions, which allows blood and fluid to drain instead of collecting under the skin after surgery. The incisions when approximated close on their own after a few days. This tissue approximation instead of a tight closure functions as a natural drain which aids in the rapid recovery. Dr. Rizk also asks his patients to avoid aspirin products for 2 weeks before and 2 weeks after nasal surgery. He also believes that other herbal supplements such as St John's wart, fish oil, vitamin E and ginko biloba promote bleeding and bruising and should be avoided as well. Vitamin C is an excellent medication to start 2 weeks before and continued for 2 weeks after rhinoplasty (1000mg per day) because it decreased swelling and promotes healing. Lastly, Dr. Sam Rizk recommends a diet free of regular salt. Kosher Sea salt is much better to use than regular salt. Some patients also benefit from light therapy, lymphatic drainage, or acupuncture to further decrease any persistent bruising or swelling. Dr. Rizk may recommend these treatments after the surgery and will refer you to a specialist. Light therapy is used by NASA to promote healing of wounds in space where light is scarce.

When can I look presentable after rhinoplasty?
With Dr. Rizk's rapid recovery techniques, you would look presentable where it would be unrecognizable that you had a rhinoplasty a week on average following the surgery. The nasal splint is removed a week following the surgery. You may be asked to use tape at night for a few weeks to decrease swelling if your skin is thick. Final result takes 1 year or longer in a revision rhinoplasty.

When can I go back to exercising after rhinoplasty?
Moderate exercise can be resumed in 2 weeks after rhinoplasty. Yoga and heavy exercise as well as contact sports should be avoided for 6 weeks after rhinoplasty.

When can I fly after rhinoplasty?
You can fly 1 week after rhinoplasty surgery. Most out-of-town patients who undergo rhinoplasty with Dr. Sam Rizk stay in New York City for 1 week minimum. Dr. Rizk's staff can make arrangements for hotels in NYC, if necessary.

When can glasses be worn after rhinoplasty?
Glasses should be avoided for the first 6 weeks after rhinoplasty, unless they are light and can be taped to the forehead. Sometimes Dr. Rizk will allow them to be used before if a piece of surgical tape is placed under the glasses and if they are light.

What food can I eat before and after rhinoplasty?
Soft foods are recommended for the first few days after rhinoplasty. As discussed above, a diet with less salt is also recommended to decrease swelling. Regular food may be resumed a few days after the surgery. Hard foods should be avoided for the first week after rhinoplasty.

Do you break the bones in every rhinoplasty surgery?
Dr. Rizk does not break the bones in every rhinoplasty surgery. The nasal bones are broken in about 50% of rhinoplasty surgery and it is done to narrow the nasal bridge if a large hump is removed. Sometimes Dr. Rizk alters only the nasal tip which is made of cartilage and does not touch the bridge and in these cases there is no breaking of bones either. Dr. Rizk points out that most of the nose is made of cartilage and significant alteration can be achieved without breaking the bones. If the bones are broken, it is a precise break done with a minimal internal incision under visualization with the 3D telescope. Dr. Rizk does not break the nasal bones blindly as is done by most rhinoplasty surgeons-He does it with Direct visualization with his high definition telescope technology.

Can a runny nose occur after rhinoplasty/septoplasty surgery?
It can happen but is very rare. If it happens it usually clears by 6 months.

Can you lose the sense of smell from rhinoplasty/septoplasty surgery?
Although loss of sense of smell is very rare, it may happen. Dr. Rizk has not had this happen to his patients with thousands of rhinoplasties. The sense of smell may be lost also from a cold or viral infection. Sometimes the sense of smell if it is diminished before the septoplasty/rhinoplasty procedure can improve if a significant deviated septum, contributing to a loss of sense of smell, is repaired. A nasal polyp can also cause a diminished or absent sense of smell and removing a nasal polyp may improve the sense of smell.

How do I take care of my new nose after rhinoplasty?
Avoid contact sports for 6 weeks. Keep the inside of your nose moist with the ointment provided in Dr. Rizk's rapid recovery kit as well as using the saline spray provided in the kit as well. Avoid aspirin use and use of medications which promote bleeding and bruising such as vitamin E and herbal supplements such as ginko biloba, fish oil, and St. John's wart. Do not manipulate your nose or touch it excessively.

When can I return to work after rhinoplasty?
Generally, most patients return to work 1 week after rhinoplasty.

Are black eyes common after rhinoplasty?
Bruising or discoloration of the eyes is uncommon with Dr. Rizk's rapid recovery techniques. If they occur, they usually resolve in 7 days and if they do not resolve, Dr. Rizk has a special cream which helps them to fade away.

Is Nasal Packing Necessary After Rhinoplasty Or Septoplasty Surgery?
Dr. Samieh (Sam) Rizk, a nasal specialist from New York City, does not use packing. He feels packing increases swelling in the nose and prevents appropriate necessary drainage after surgery. Instead, he uses a tissue glue inside the nose which decreases bleeding and absorbs in a few days instead of packing. Additionally, Dr. Rizk does not close the incisions inside the nose completely, he approximates the incisions and lets the fluid drain in between the stitches inside the nose. This results in a much more rapid recovery than tightly closing the incisions and using packing. This is one of his tricks for a rapid recovery.

How Do I Find Out About Newer Rhinoplasty Techniques?
The 3D high definition endoscopic rhinoplasty, pioneered by Dr. Sam Rizk, is a cutting-edge type of rhinoplasty done with minimally invasive incisions inside nose and uses a high definition 3D telescope to better visualize the nose structures being changed and enter under and deep to the covering muscle layer, thus preserving it. This technique is a more precise method of getting accurate results with a more rapid recovery. All nasal structures which we change (ie: cartilage and bone) have a protective soft tissue layer made of muscle, fat and skin. The nerves and blood vessels are in this covering layer so if the nasal structures (cartilage and bone) can be changed without altering this protective layer, then there is less swelling, pain and bruising. Preserving this protective muscular layer using this technique allows for a smoother result with no sharp edges or pointy noses. Using this technology is akin to how the microscope changed our understanding of microorganisms. Older less precise techniques may enter above the muscle layer and under the skin, thus creating irregularities in the muscle and damaging blood vessels which create more bruising and swelling. So much more detail is seen inside the nose with Dr. Rizk's technique, and thus a precision operation is possible with less of a need for revision surgery. Precision is important in changing structures of the nose since millimeters make a difference. If the skin is thick and this overlying soft tissue layer needs to be thinned, it can be also done with pinpoint accuracy using this 3D technology.

What Is A Graft?
A graft is a piece of cartilage (rarely bone) obtained from the patient's own septum (parting wall between right and left nasal chambers) or from patient's ear. The best place to obtain a graft is from the patient's own septum and very often a septoplasty (repair of a deviated nasal septum) is done to improve breathing at same time as a rhinoplasty. This would provide cartilage for grafting. If the rhinoplasty is a revision and there is no septum left, then the ear is the next possible choice, where the cartilage is obtained from a small incision behind the ear and does not affect ear shape or hearing. Rib cartilage is sometimes needed in revision rhinoplasty cases.

When Is A Graft Used In Rhinoplasty?
In primary rhinoplasty (a nose that has never been done before), grafts are used to help define the nose, especially noses with thick skin, and create a stronger nose as well. In other words, if patient's tip cartilages are weak and bulbous, cartilage grafts can change their shape to make them structurally stronger and give a more defined look. Some weak cartilages are bulbous because they are very round and a cartilage graft can help make them less round and more straight, while at the same time strengthening them. In older rhinoplasty procedures, more cartilage was removed and over time, this resulted in areas of collapse. With cartilage grafting, less cartilage is removed so the nose is stronger. Instead, the shape of the patient's cartilages is changed and made stronger, rather than excised. Also some nasal tips have no projection and are too round and a cartilage graft (tip grafts and columellar struts) may be necessary to provide more projection and definition. Sometimes the tip cartilages (so called lower lateral cartilages) are too convex and round, and a lateral crural strut graft is added to change this round bulbous shape and make the tip cartilages more defined. Dr. Sam Rizk favors these grafting techniques mentioned above to define the nose and achieve dramatic results with less cartilage removal.

In revision rhinoplasty, where too much cartilage has been removed and the nose may have areas of collapse such as a saddle nose deformity or external nasal valve collapse with sharp, pointy, edges to the nasal tip, cartilage grafts are used to fill holes or collapsed areas. These grafts strengthen the nose and improve the function and the shape of the nose. We all recognize the stigma of a "done" nose, we see it everywhere and it becomes a source of ridicule for the media. These over-done noses require cartilage grafting to achieve a balanced naturally defined nose.

In Case The Surgeon Needs To Use Grafts To Build A Collapsed Nose In Revision Rhinoplasty, What Is Best To Use?
Dr. Samieh Sam Rizk, New York based facial plastic surgeon: My first preference is a cartilage from inside the nose (nasal septum). If the septum cartilage is absent or not enough, the next best grafts will be taken from the ear. This will cause no side-effects as to the hearing ability or shape of the ear. The ear provides a soft curved graft and may be good for a small area of collapse but does not provide major support. About 20 percent of patients may require rib cartilage. Rib cartilage can be provided from banked irradiated rib and has equivalent longevity as the person's own rib but avoids a second surgical site. It has been used for many years with no disease transmission. When rib cartilage is used it is very important to sculpt them to soften their shape. Dr. Rizk innovated a micro-diamond sculpting powered instrument to shape and sculpt the rib cartilage as well as other types of cartilages to soften their edges.

Synthetic implants such as medpor and gortex also can be used if cartilage is not available and have an excellent history with infection rates less than 2 percent as well as permanence in the nose in appropriately selected patients. Dr. Rizk does not use synthetic implants in diabetic or patients whose immune system is compromised. Dr. Rizk does not recommend the use of nasal silicone implants because they tend to move with time and never integrate in the nose properly. He tends to remove many silicone implants placed in Asian patients that have moved and extruded with time.

Can Grafts Be Visible? Is There Any New Technology To Smoothe Graft Edges?
If the graft edges are not smoothed correctly, a graft may be visible especially in a thinned skin person, less so if the skin is thick. Also grafts tend to be used more in thick-skinned patients. Dr. Sam Rizk, has innovated a method of smoothing graft edges to eliminate visibility by using a patented- powered micro-diamond sander which basically smoothes out grafts with a spinning micro-burr. This technology is a great way of sculpting a cartilage graft and Dr. Rizk developed this technology from his artistic background as a sculptor. If the skin is really thin and the patient has visible grafts from an older rhinoplasty, the grafts can be taken out and smoothed and put back in. Also, Dr. Rizk occasionally uses Alloderm in some patients to thicken their skin.

What Is Alloderm And How Is It Used?
Alloderm is a non-cellular human dermis taken from an organ donor and treated with FDA-approved treatments. Alloderm has been used for over 30 years in many regions of the body for cosmetic and non-cosmetic surgeries and has stood the test of time with safety and lack of disease transmission. Some of it will absorb with time but some of it does remain. It has been used to line the mouth in cancer reconstruction and has been used as a skin replacement in burn victims. It has been used in millions of cases. Dr. Rizk has not encountered infection with Alloderm in over two thousand cases of its use. It helps to thicken the skin and camouflage graft edges.

What Is The Revision Rate After A Rhinoplasty?
The national revision rate over the patient's lifetime is in the range of 15%. However, this varies depending on the skill of the individual surgeon and the complexity of cases in a surgeon's practice and what percent of those are revision surgeries. Other factors that may lead to a revision may include scar tissue and weaknesses in certain areas of the nose as it heals. The healing process is different in every patient and may not be 100% predictable. Additionally, as the patient ages and the years pass after a primary rhinoplasty, the nose ages as well and the skin on the nose thickens with age and this may lead to the need for a revision. The chance of requiring revision surgery diminishes by strengthening the nose with cartilage grafting and minimal excision of the nasal tip cartilages.

What Are Complications That Can Occur With Rhinoplasty?
If a surgeon is not conservative and if too much cartilage or bone has been removed, breathing problems or cosmetic deformities may occur as below.

What To Do If I Have Large Pores On My Nose And Rosacea Skin? Is There Any Treatment For This?
Rosacea is a chronic condition where the sebaceous glands and pores of the nose continue to enlarge and grow. When the condition progresses to a very large nose, it is called "rhinophyma" which can be quite disfiguring. Medical treatment consists of oral antibiotics of the tetracycline family and topical antibiotics and steroids. Success has been achieved with the fractionated CO2 laser on the nose to shrink the pores and reduce the excess skin. Several treatments may be necessary. More information on this laser can be seen on the section of this website on "rhinoplasty with laser".

What if I am not satisfied with my rhinoplasty after Dr. Rizk performs the procedure?
There is a small number of patients, especially those who are ethnic with thick skin, who may not be happy with their result. This is rare and may be due to scar tissue, unpredictable healing, inability of the thick skin to contract adequately despite steroid injections after the surgery or poor scarring. If Dr. Rizk feels like he can achieve a further improvement with a revision rhinoplasty, he will recommend it. It is important to have realistic expectations and to understand that each nose is unique, like a fingerprint, and healing is also unique. It is very important to not request that a nose or result look like a celebrity or another person, as this may not be possible with your particular skin.

NOTE: ALL THE FOLLOWING PICTURES ARE ACTUAL PATIENTS THAT DR. RIZK PERFORMED REVISION RHINOPLASTY TO CORRECT UPTURNED NOSES, POINTY NOSES, SADDLE NOSES AND ASYMMETRIC NOSES.

1. A Saddle nose is an over scooped profile

Before
After
Saddle Nose Front View Before Photo
Saddle Nose Front View After Photo
Before
After
Saddle Nose Before Photo Side View
Saddle Nose After Photo Side View
Before
After
Woman With Saddle Nose Before Photo
Woman With Saddle Nose After Photo

2. A pinched tip occurs when too much cartilage of the tip has been removed.

Before
After
Woman With Pinched Tip Before Photo
Woman With Pinched Tip After Photo
Before
After
Pinched Tip Before Photo Side View
Pinched Tip After Photo Side View

3. An upturned nose can result if too much cartilage is removed from the tip of the nose as well.

Before
After
Saddle Nose Front View Before Photo
Saddle Nose Front View After Photo
Before
After
Saddle Nose Before Photo Side View
Saddle Nose After Photo Side View
Before
After
Woman With Saddle Nose Before Photo
Woman With Saddle Nose After Photo

4. Asymmetric result can occur.

Before
After
Woman With Asymmetric Nose Before Photo
Woman With Asymmetric Nose After Photo

5. Under-Resection (not enough) of cartilage may result in bumps that are irregular. If there is too much removal, cartilage grafts are necessary in order to re-build the structure. If too little was removed, further reduction may be necessary. Under-resection is usually less complex to correct than an over-resection of the tissue. A pollybeak deformity usually results from under-resection of cartilage.

Before
After
Woman With Under-Resection Nose Before Photo
Woman With Under- Resection Nose After Photo
Before
After
Under-Resection Nose Before Photo Side View
Under-Resection Nose After Photo Side View

6. Bossae (the unsightly points of the tip may occur) Bossae are sharp edges or knuckles bulging into the skin and may result from cartilage over-resection, warping or being cut and that may require cartilage grafts to fix.

Before
After
Woman With Bossae Nose Before Photo
Woman With Bossae Nose After Photo
Before
After
Bossae Nose Before Photo Side View
Bossae Nose After Photo Side View

7. Drooping or ptotic tip may result if the tip was not supported properly in primary rhinoplasty. Normal nose-lip angle is in the range of 90-105 degrees and varies between men and women. A larger angle will look better for women and a smaller angle is better in men. Many times the tip needs to be supported with cartilage grafts to avoid this complication of droopy tip. Treatment includes adding a cartilage graft.

Before
After
Drooping Nose or Ptotic Tip Before Photo
Drooping Nose or Ptotic Tip After Photo

8. Infection - although rare, can still occur and must be treated with appropriate antibiotic therapy or drainage of any abscess.

9. Bleeding - also not common but can occur, usually in first few days and must be treated expeditiously as needed.

What Can A Surgeon Do To Help Minimizing The Complications' Risks?
Dr. Sam Rizk recommends that a clear communication between the surgeon and the patient is a key in order to help diminish any dissatisfaction or complications. The surgeon should be able to understand what the patient's goals are and also understand the support structures of the nose. The surgeon must also understand how the nose changes as it heals and the effect of over-resection of cartilage on breathing and cosmesis in the long term. A detail-oriented and conservative surgeon who does a careful analysis of the internal and external structures of the nose will make the correct surgical plan to minimize complications.

How Can I Know If The Surgeon Is Detail-Oriented, Careful, And Performs Surgery In A Conservative Approach?
Don't judge the book by its cover-it is simply hard to know whether he is a good doctor or not. However, there is a way for patients to get the hint. Candidate patients should do some research or ask the surgeon about his idea of beauty and healthy looking noses. Patient should ask about the surgeon's preference of performing the rhinoplasty surgery-the one that choose to perform in a conservative approach should be an ideal one. The surgeon should be able to maintain a natural appearance and appropriate in both a functional (ie breathing) and cosmetic perspective for patients.

Will Complications Still Occur If The Surgeon Does Everything As Explained On This Website?
The answer for this question is yes. Even if the surgeon does everything well, complications can still happen. There is always a chance for everything including "un-inviting" things that can happen during the surgery, and as a result, can lead to complications. In this case, no matter how careful the surgeon was during pre-surgery analysis and during and after the surgery, there is always a chance of complications. The best thing that the surgeon can do is to try to minimize the chance of complications as answered above.

If I Had A Bad Nose Job, What Do I Do?
The potential for a dissatisfactory result or unhappy patient can be from a few factors. Either there was a gap in communication in the preoperative visit between what the patient wanted and what the surgeon did. It is very important to establish a good line of communication prior to the surgery. It is also important to understand the surgeon's aesthetic taste, best done by looking at his photos of other patients he did. Other factors that may lead to a poor outcome is an over-aggressive reduction without supporting cartilage grafting which may lead to a pinched tip or a scooped upturned nose. Lastly, patient factors such as thick skin may limit the ability of the surgeon to get a more refined nose and if the thick skin is not addressed preoperatively with the patient, that may lead to disappointment. The perspective patient should ask the surgeon if he/she does ethnic rhinoplasties with thick skin and should ask to see pictures. If the patient is not satisfied with the outcome, they should not judge result too soon because swelling persists for a year and a revision cannot be done before a year. A patient needs to be patient and wait in the first year and not jump into a second surgery. They should communicate their feelings with their surgeon first and also seek a second opinion.

What are the options if I have a retracted nostril?
Retracted nostrils (alar retraction) may occur from previous rhinoplasty where too much cartilage was removed and may require either an alar rim graft (composed of cartilage only) or a composite graft (composed of cartilage and skin). A rim graft can be harvested from the ear or septum. Dr Rizk does not recommend rib grafts for the rim grafts as they are too stiff. Composite grafts are typically harvested from the ears and will result in a scar in the front portion of the ear but is usually concealed very well.

What is temporalis fascia and what is it used for?
If patients have thin skin, little imperfections can show on the thin skin of the bridge and tip. Temporalis fascia is a flat piece of soft tissue which can thicken the skin and camouflage imperfections. Temporalis fascia is obtained from an area over the patient's ear and is a soft piece of flat tissue which is sculpted as needed and inserted under the skin of the nose and over the cartilaginous and bony framework. As an alternative to temporalis fascia, if patient does not want a second surgical site, Alloderm sheets may be used to thicken the skin. Alloderm is obtained from a tissue bank and is FDA approved and its use is safe. Sometimes Dr Rizk used either temporalis fascia or Alloderm over cartilage grafts to soften their edges and decrease visibility.