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Michael C. Fasching, M.D.

Board Certified Plastic Surgeon


Types of Rhinoplasty Explained

Submitted by Dr. Fasching on Mon 03/05/2018 - 22:01

Rhinoplasty, sometimes also referred to as “nose job” surgery, is a fairly straightforward and well-understood procedure. At least, it is for plastic surgeons. Many patients are surprised to discover that they have a wealth of options to consider when they decide to give their nose this classic surgical makeover. There are a number of different objectives rhinoplasty can meet, two surgical methods to choose from, and even slightly different techniques available for specific ethnicities. If you’re considering having a nose job, you’ll find everything you need to know before you book a consultation in the guide below:

Functional Vs. Aesthetic Rhinoplasty

While most people think of rhinoplasty surgery as being purely cosmetic, it’s actually used to treat a number of medical conditions as well. Functional rhinoplasty, which can potentially be combined with cosmetic rhinoplasty in order to meet multiple patient objectives, is a vital medical tool. It can ease or even cure the breathing problems that often arise as a result of the following conditions:

  • Deviated septum. A deviated septum occurs when the cartilage that separates the nostrils is not properly aligned. Instead, it sits at a slant, partially or completely obstructing one of the patient’s nostrils. This can cause the patient to snore chronically or develop dangerous sleep apnea, so doctors often recommend that patients with this condition get a functional rhinoplasty. During functional rhinoplasty, the tissue between the nostrils is surgically released, repositioned, and then sutured into place so that both nostrils are fully opened.


  • Nasal polyps. Nasal polyps are small benign growths that sometimes form within the nasal passages, where they inhibit breathing. Rhinoplasty surgery can be used to remove these polyps without doing damage to the nose.


  • Breathing problems that result from congenital abnormalities. Sometimes the nose develops in an abnormal way within the womb, causing breathing difficulties. In fact, even an unusually flat nasal bridge can inhibit breathing in some people. Rhinoplasty surgery is therefore often used to raise the nasal bridge and open the nasal passages.


  • Damage from accidents. Because the nose protrudes from the face, it’s often the first thing that’s impacted when a person is in a sports-related or motor vehicle accident. Even a bad fall can sometimes result in a broken nose. Fortunately, a type of nose job called “reconstructive rhinoplasty” exists to help injured people regain a functional, attractive nose. During reconstructive rhinoplasty, injured tissues are gently coaxed back into alignment so that they heal properly. If you have been in a bad accident, you don’t need to have your nose restored to exactly its previous shape. It’s usually okay to ask your surgeon to make cosmetic adjustments where possible. Most surgeons are happy to help their patients make the best of a bad situation by giving them a more attractive nose than the one they had previously.

Cosmetic rhinoplasty, on the other hand, can correct all of the following aesthetic issues with the nose:

  • If you have a distracting hump on the bridge of your nose, rhinoplasty surgery can remove it and give you a straighter nose. Rhinoplasty surgery can also make a “hooked” nose more even.


  • Rhinoplasty can be used to correct abnormalities in the shape of the nose. If the tip of your nose is angled rather than straight, this operation can give you a straighter nose.


  • Rhinoplasty can make a nose that “juts out” somewhat smaller, so that it sits closer to the face.


  • While we think of nose jobs as being used exclusively to make the patient’s nose smaller, they can actually build the nose up in size as well. Rhinoplasty surgery can give a flat or “button” nose a slight bridge, for example, so that the patient achieves a more striking profile.


  • Rhinoplasty surgery can make the tip of a person’s nose thinner. It’s therefore often used to correct a bulbous nasal tip.


  • If you have a very wide nose, rhinoplasty can be used to make your nostrils somewhat thinner.


It’s important to understand that, as effective as cosmetic rhinoplasty is, it does have certain limitations. The human nose is an extremely complex breathing apparatus, full of different parts that are held together by connective tissues. As such, plastic surgeons are somewhat bound to what’s already present within the patient’s nose when they perform a nose job. They cannot remove a great deal of bone or cartilage from the nose, for instance, because the nasal passages would no longer be adequately supported (and they would therefore be at risk of collapse).

When performing rhinoplasty, plastic surgeons focus on altering the patient’s existing tissues just enough to produce the desired changes, while also doing the least amount of damage possible to the nose. For this reason, it’s essential that you go into your rhinoplasty consultation with realistic expectations: Your surgeon will not be able to make a large, hooked nose into a tiny, inverted button nose, nor will your surgeon be able to create an aquiline nose out of a wide, flat nose. What he or she will do, however, is create a nose that is straight, even, and in perfect proportion with the rest of the face. This will make you much more photogenic (as camera lenses focus heavily on the nose) and make your other facial features more noticeable.

If, with these expectations in mind, you don’t get the kind of results you hoped for after having rhinoplasty surgery, you will have the option of having your nose job revised. A final type of cosmetic rhinoplasty known as “revision rhinoplasty” exists in order to allow patients to have alterations made to their procedure.

Even if you have a very skilled plastic surgeon, there’s always a slight possibility that revision rhinoplasty will become necessary. This is because every person’s nose heals differently, and it’s impossible for surgeons to predict with 100 percent accuracy how a patient’s scar tissue will form. And this scar tissue can affect the final appearance of the nose once healing is complete. If you’re not happy with the results of your rhinoplasty for any reason, it’s strongly advised that you return to your surgeon for revisions as soon as possible. Your surgeon might be able to make small “tweaks” in your nose job without re-opening the nose, if deeper healing has not yet occurred.

Because each nose job produces scarring within the nose, there’s a limit on how many revision rhinoplasties you can have. If scarring becomes too extensive, it could interfere with the functionality of your nose or negatively affect its appearance.  Most people can only have one or two revision rhinoplasty operations. This is another reason why it’s extremely important to go into your rhinoplasty consultation with reasonable expectations. Many of the “bad” nose jobs seen in the media are a direct result of celebrities opting to have too many revisions in pursuit of the perfect Hollywood nose. Don’t strive to have your nose match a very specific “type” in this manner; pursue the shape of nose that will work with your unique facial structure.

Open Vs. Closed Rhinoplasty

When performing rhinoplasty, there are two predominant surgical techniques to choose from: Open and closed. During an open rhinoplasty, the surgeon makes an incision in the columella (the piece of soft tissue between the nostrils). This allows him or her to lift up the tip of the nose and therefore gain greater access to the nasal passages. This facilitates the creation of more profound surgical alterations, but it comes with a small risk of external scarring. During closed rhinoplasty, on the other hand, no incisions are made to the exterior of the patient’s nose. Instead, the surgeon will make a series of incisions within the nose and use very small, thin surgical instruments to change its shape.

In most cases, open rhinoplasty is necessary, regardless of whether the patient wants to have a functional or aesthetic rhinoplasty. In order to correct a deviated septum, for example, the tissues between the nostrils must be incised, otherwise they could not be repositioned. Some cosmetic alterations, such as a significant reduction in the size of the nasal bridge or tip, are also only possible when the surgeon has a great deal of access to the tissues within the nose. In general, closed rhinoplasty is used either for minor functional corrections (like removing nasal polyps) or slight adjustments to the bridge of the nose.

While some patients wish to opt for closed rhinoplasty because they are worried about developing an external scar, it’s important to adhere to your surgeon’s recommendations. While it’s true that closed rhinoplasty presents no risk of scarring and is associated with less postoperative swelling and soreness, it has a few disadvantages to keep in mind as well. In addition to its more limited ability to change the shape of the nose, it’s been shown to create more scar tissue within the nasal passages (when surgeons use it to create more substantial alterations in the shape of the nose). This can limit the patient’s ability to have revisions and it often leads to less precise and predictable results. Finally, sometimes the supportive tissues around the tip of the nose can become damaged during this type of operation. As a result, the nasal tip may slide out of position slightly many years after the patient’s rhinoplasty has healed. Open rhinoplasty, on the other hand, is associated with excellent long term results.

Ethnic Rhinoplasty

The term “ethnic rhinoplasty” does not refer to a specific type of rhinoplasty, but rather the practice of adapting rhinoplasty surgery to suit different nasal structures. Each ethnicity (Caucasian, Asian and Native American, African, Middle Eastern, and Hispanic) comes with its own particular nasal composition, and in order to produce excellent results, rhinoplasty surgeons need to be well-versed in how to work with these ethnic variations. Caucasians, for example, tend to have noses with thinner skin, but more supportive tissue within the nasal bridge. People of African descent have tough, thick nasal skin but often have less tissue to work with within the nasal bridge. Middle Eastern individuals often have a distinct prominent, hooked nasal shape (in addition to having moderately thick nasal skin) … Etc. If a surgeon tried to use exactly the same surgical techniques on each of these patients, the results would be nothing short of disastrous. As such, when considering rhinoplasty surgery, it’s extremely important to verify that your chosen surgeon if familiar with your ethnicity’s nasal structure. Ideally, you should try to find a surgeon who has worked with patients of your ethnicity before, but depending on where you live, this may be difficult.

Furthermore, be aware that a truly skilled plastic surgeon will not try to erase the unique ethnic characteristics of a patient’s nose. Instead, he or she will focus on making the nose more proportional with the rest of the face while preserving those characteristics.

Rhinoplasty: Ideal for Better Breathing and a Better Self-Image

Having rhinoplasty surgery can be extremely beneficial. Correcting breathing problems, for example, can help the patient sleep much more soundly and exercise more easily. This in turn has been shown to lead to a lower risk of obesity, high blood pressure, cardiovascular disease, and diabetes. Meanwhile, cosmetic rhinoplasty can increase the patient’s self esteem and potentially help him (or her) advance his career. When you consider the fact that rhinoplasty surgery usually only requires a short healing period, it becomes clear that this procedure is a wise investment for the majority of eligible patients.