Many people who choose to have a rhinoplasty procedure have endured years – or even a lifetime – of self-criticism and, too often, teasing. Even if the joking is good-natured and even if you feel super-confident in other aspects of your life, insecurity regarding a feature as prominent as the nose can take a toll on your mental health and even distract you from the things you love.
Regularly recognized as a top surgeon in the field, Dr. Mendelsohn has performed more than 1,200 rhinoplasty procedures. He and his team understand that a rhinoplasty does more than change the shape of your nose – it changes your outlook on life.
We will take the time to thoroughly understand your concerns, such as the overall size, length or width of your nose, a hook or bump on the central nose or a bulb on the end of the nose. Using detailed illustrations and photos of your face taken from multiple angles, Dr. Mendelsohn will demonstrate how a rhinoplasty procedure will bring your facial features into complementary proportions.
Just as every face and definition of beauty is different, every rhinoplasty treatment is personalized to create natural results that look, and feel, like you.

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Rhinoplasty - Procedure
What to Expect the Day of Rhinoplasty:
- This outpatient procedure takes one to two hours and is performed in a private operating room in our surgery center, which is accredited by the Accreditation Association for Ambulatory Health Care.
- You will receive monitored anesthesia care for this procedure.
- Well-hidden incisions are made inside the nostrils and occasionally across the lower mid-section of the nose.
- Excess bone and cartilage are removed, reshaped or redistributed, and the skin is arranged over this new structure.
- The septal cartilage in the middle of nose also might be molded to allow for better breathing.
- No packing is required.
- A splint is applied over the nose, which will remain in place for a week to hold the tissues in place and decrease swelling.
Surgery Consents Pre Operative Instructions Post Operative Instructions
Rhinoplasty Postoperative Instructions
- The pain will be minimal to moderate and is easily controlled with medication.
- You should sleep and rest with your head elevated for a week after the procedure.
- You may shower the day after the procedure.
- The day after surgery, you will come in for a checkup.
- You may experience some congestion and nasal drip for two to three days.
- Your sutures will be removed six days after the procedure.
- Mild to moderate swelling will peak two days after the surgery and then quickly fade over the next three weeks. You may also have minor swelling that slowly resolves over the next six to twelve months.
- You may have minimal bruising around the eyes and cheeks, which will peak two days after surgery before fading quickly over the next three to five days.
- You may return to many normal acivities within the first week, and most by the end of three weeks.
How do I Prepare for rhinoplasty surgery?
Who is a good candidate for rhinoplasty surgery?
How young is too young to have rhinoplasty?
How long before I see results of rhinoplasty surgery?
How long does it take to recover from rhinoplasty?
Will there be pain following the rhinoplasty procedure?
Will there be significant bruising following rhinoplasty procedure?
When will I notice the final results of a rhinoplasty procedure?
How long before I can apply makeup after a rhinoplasty?
How is a rhinoplasty procedure performed?
How long does the actual rhinoplasty surgery take?
When can I return to normal actives following rhinoplasty surgery?
Can other procedures be performed the same time?
How much does rhinoplasty surgery cost?
What is the difference between “open” and “closed” rhinoplasty?
Is rhinoplasty covered by insurance?
What is the difference between cosmetic and reconstructive rhinoplasty?
What is Dr. Mendelsohn’s philosophy towards rhinoplasty?
Will rhinoplasty improve breathing?
Will insurance cover rhinoplasty?
Are other procedures able to be performed at the same time as Rhinoplasty surgery?
TrueSelfies - True Rhinoplasty Patient Stories
Real patients share their full journey of transformation, from considering a treatment to taking action and enjoying the life-changing impacts.
Advanced Answers in Under 5 Minutes
Advanced Answers
You’ve got specific questions about our procedures, and we’ve got Advanced Answers – provided by our experts in less than five minutes.
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How is Rhinoplasty Procedure Performed (Best Rhinoplasty Procedure 2020)
How is rhinoplasty procedure performed. With regards to exactly how a rhinoplasty operation is performed, there are several main approaches. If you have researched rhinoplasty you will commonly see the two different techniques are used a close approach and an open approach. I typically use an open approach in 90 percent of the rhinoplasty operations that I perform. The biggest difference is basically making an additional little incision along what we call the columnella at the base of the nose here and it that's what we call that area the Collumnella.
It heals beautifully. More importantly, gives us the benefit of fully exposing the nasal anatomy so that the structure is vital to a successful outcome can be addressed. While there are circumstances where a closed approach for rhinoplasty is used, in general, I feel that an open approach is the preferred approach. Rhinoplasty is performed under I.V. sedation not general anesthesia You're not paralyzed and there's no breathing tube that's needed, that is, you're not intubated. You're breathing on your own. This is a wonderfully safe approach to rhinoplasty without the risk and recovery associated with older anaesthesia techniques.
The operative
The. Operative of course the operation of course can vary
desperation of course can vary but for primary rhinoplasty, that is if you haven't undergone rhinoplasty before, the operation generally takes about two to two and a half hours.
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How to Prepare for Rhinoplasty Procedure (Best Rhinoplasty Procedure 2020)
"How do I prepare for rhinoplasty surgery?"or how to prepare for nose surgery. Preparing for rhinoplasty involves a variety of things most of which will be reviewed thoroughly during your preoperative appointment with Gretchen. Questions about the use of medications such as antibiotics and steroids as well as information about your diet, your activity, how to sleep and bathe, as well as other important aspects about your care will also be reviewed. But if I were talking about rhinoplasty and how to prepare for rhinoplasty I'd be more focused on making sure that you and your surgeon,
and if I'm your rhinoplasty surgeon then we will make sure that this occurs, have excellent communication with each other. It is our job to confirm your goals and set proper and realistic expectations. Rhinoplasty is a wonderful procedure for so many seeking its positive impact. It helps to boost self confidence and self esteem and really can be transformative. It's wonderful. This is achieved when good rapport with your rhinoplasty surgeon exists, goals are clear and achievable, and realistic expectations are established.
So preparing for rhinoplasty is really less about what exact things you need to do and more about developing the proper communication. We do review specific things required to prepare for your rhinoplasty or nose job during our preoperative meeting as well.
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Who is the best candidate for Rhinoplasty Surgery - Nose Reshaping (Top Doctor)
"Who is a good candidate for rhinoplasty surgery?" Best rhinoplasty candidates, the best candidates for rhinoplasty are those people who have a desire to make changes for themselves. Poor candidates for rhinoplasty, or any other procedure for that matter, are those doing it for reasons such as, to save a relationship or because someone else wants you to do it.
Having a rhinoplasty may in fact boost your self-esteem and help you develop other relationships with more confidence, but this should be done first for yourself not for someone else. Studies have actually shown a higher incidence, up to 30 percent of reported patients undergoing rhinoplasty, show signs of body dysmorphic disorder. Very simply this is defined as a mental health disorder in which you can't stop thinking about one or more perceived defects or flaws in your appearance. A flaw that appears minor or can't be seen by others but you may feel so embarrassed, ashamed, and anxious that you may avoid many social situations.
So making sure that the choice to undergo rhinoplasty surgery for the right reasons is paramount to a positive experience and outcome. Communicating your goals clearly and understanding expectations and limitations of rhinoplasty are a big part of the preoperative rhinoplasty experience.
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Will There Be Significant Bruising Following Rhinoplasty? (Best Rhinoplasty Procedure 2020)
Will there be significant bruising following rhinoplasty procedure with today's rhinoplasty. Techniques we typically see very little bruising at least with compared to what we historically would see with mild bruising can occur. The black and blue bruising that we almost always saw years ago is really a thing of the past. Of course this varies from person to person and also based on the nature of the rhinoplasty operation. However since we have not packed a nose since 1997 we rarely see significant bruising.
In fact by the time the nasal tape or the splint comes off which is about five to seven days following rhinoplasty most patients look pretty good. Really what we see more than anything is this strange. There's some swelling around the nose and sometimes your eyes look a little bit wider. They look a little bit different because of the swelling. This is of course temporary but several days following this blunt removal most people look really darn good
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Will There Be Pain Following Rhinoplasty Procedure? (Best Rhinoplasty Procedure 2020)
Will there be pain following rhinoplasty procedure. As mentioned previously we do not use packing in the nose. Not since 1997 in my hands. Well that is significant because there is a direct correlation because nasal packing in pain without packing patients do remarkably well. While we provide a few pain pills generally only a half a pill or even Tylenol alone is needed with today's rhinoplasty. This varies from patient to patient but today's rhinoplasty post-operative course from a physical or pain standpoint is really quite amazing.
I attribute much of this to the fact that we no longer to use nasal packing
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Will Rhinoplasty Improve My Breathing? (Best Rhinoplasty Procedure 2020)
Will rhinoplasty improved breathing as a part of rhinoplasty procedure were commonly addressing a deviated nasal septum is an airway problems associated with these bones on the sides of our nose. Three of an inferior turban that's inferior middle and superior. These are structures that can cause problems of breathing commonly associated with allergies. So the simple answer to will rhinoplasty improve breathing is yes we always address the functional components of the nose such as breathing and I must say this is one big advantage to rhinoplasty to be performed by facial plastic surgeons who specialize in nasal anatomy and rhinoplasty.
General plastic surgeons sometimes don't manage the Functional Component
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When Will I Notice Final Results From Rhinoplasty? (Best Rhinoplasty Procedure 2020)
When will I notice the final results of rhinoplasty. Noticing the results from rhinoplasty can vary depending on the nature of your goals and the type of rhinoplasty performed. If your goal is to reduce the nasal dorsal bump then you'll probably notice the results immediately upon removal of the nasal splint. About five to seven days following your procedure. This is a really great thing as there's minimal waiting to see the results. On the other hand if your main concern was a wide nasal tip and if you also happen to have thicker skin then at the same time period that is upon tape removal you may actually think that the tip appears wider.
Yes this really does occur and of course is not wider. We know it. We've narrowed it but with a swelling it may appear that way. This can be very challenging as immediate results are not seen and worry sets in and in fact maybe things do look wider. This is a situation we never want to be in and why we spend so much time being realistic about proper expectations and timeframes. This is also one of the reasons that we spend so much time in the consultative process to fully inform you of proper expectations.
Most patients are realistic and understand that healing can take time but the final results in some of the final details from rhinoplasty surgery really do take about a year
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What Can I Return to Work and Normal Activities Following Rhinoplasty? (Best Rhinoplasty Procedu...
When can I return to normal activities following rhinoplasty surgery following rhinoplasty you may return to many activities almost immediately. We encourage you to get up and go for a walk and do normal non strenuous activities activities such as polarities and yoga where your head isn't a dependent or a lower position than your heart or activities that might require three to four weeks before we give you the go ahead for contact sports such as volleyball and soccer. We generally advise waiting longer periods of time depending on the exact nature of the sport. Six weeks or longer is not unusual for contact sports
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Podcast - Rhinoplasty Guests
Podcast
Follow Your Beauty Podcast – Follow Your Nose! Josh Episode 2
Let's Have Lunch - Rhinoplasty Education during COVID
Let’s Have Lunch the Social Way
A Virtual Consultation with Dr. Mendelsohn
Facial Analysis. Getting started with Facial Plastic Surgery
Live Rhinoplasty Surgery Techniques - Graphic
Video of Live Procedure – Graphic in Nature
Dr. Mendelsohn reviews live Rhinoplasty surgical techniques. While these videos are graphic, they are very informative and useful to review for a better understanding of the steps in achieving a natural and more aesthetic outcome.
Making the Marginal Incision
Making the Transcolumella
Positioning the Columella Strut
Closing
Taping and Splinting
3D Rhinoplasty Animation
Video of Live Procedure – Graphic in Nature
Rhinoplasty Terminology
- In the old days of purely “reductive” closed rhinoplasty, plastic surgeons would perform a rhinoplasty by simply removing cartilage, removing bone and thereby narrowing and shrinking the nose.
- With time, the unpredictable nature of scar tissue contracture would end up distorting many of these noses. The results were unnatural appearing noses.
- With today’s techniques, the rhinoplasty surgeon utilizes more grafts and struts and below is a list of useful terminology for today’s open approach.
GRAFTS IN RHINOPLASTY:
Columellar Strut Grafts
These are cartilage grafts that are placed between the medial crura of the Lower Lateral Cartilages (LLC) and provide support to the tip. Sizes can vary. Positioning and shape can affect rotation of the tip and projection. Very strong columellar struts can be fashioned from rib cartilage to allow building of the tip in revision rhinoplasty or in significantly short & under-projected noses.
Plumping Grafts
Pieces of cartilage placed at the naso-labial junction, usually beneath a columellar strut to “open up” the naso-labial angle in patients with ptotic (droopy nasal tips)
Pre-maxillary Grafts
Larger sheet of cartilage or fascia or implants placed at the naso-labial junction as the foundation for the base of the nose, in patients with severely under developed pre-maxillas.
Shield Type Tip Grafts
Cartilage grafts in various shapes, widths, and lengths (typically resembling a medieval armored shield) placed over the medial crura of the Lower Lateral Cartilages (LLC) extending to the domes or even above. Used to modify the tip and create new and better tip defining points. Can be used to increase projection if the graft extends above the domes of the LLC. Can be used to create a more refined and narrow tip. Can be used in a layered or stacked manner to de-rotate the tip in short, upturned noses. Very commonly used in thick skin Rhinoplasty patients to create better tip definition.
Cap Grafts
Cartilage grafts in various shapes, widths, and lengths (typically resembling a medieval armored shield) placed over the medial crura of the Lower Lateral Cartilages (LLC) extending to the domes or even above. Used to modify the tip and create new and better tip defining points. Can be used to increase projection if the graft extends above the domes of the LLC. Can be used to create a more refined and narrow tip. Can be used in a layered or stacked manner to de-rotate the tip in short, upturned noses. Very commonly used in thick skin Rhinoplasty patients to create better tip definition.
Blocking Grafts
Small oval shaped cartilage grafts placed on the upper back portion of an extended shield type tip graft to add support and prevent the upper end of the shield graft from bending backward. Used in cases where extended shield grafts are used and placed above the lower lateral cartilage domes for added projection and length.
Alar Batten Grafts
Larger oval shaped cartilage grafts placed over or under the lateral portion of the lower lateral cartilages and extending to above the pyriform aperture bone. Used to support the lateral ala (nostrils) and prevent pinching or collapse. Can be used for cosmetic purposes but often used for functional purposes to prevent dynamic alar collapse during inspiration.
Rim Grafts
Cartilage grafts placed at the alar rims to provide support and prevent pinching or collapse in rhinoplasty patients with thin nostril skin. May be used to correct minimally retracted alar margins.
Composite Grafts
Usually cartilage grafts harvested from the ears with the skin also attached to the cartilage. These are used to correct vestibular stenosis as well as correct moderate to severely retracted or notched alar margins.
Spreader Grafts
Cartilage grafts placed between the upper lateral cartilages and the dorsal septum. Very useful grafts in prevention of some post-operative Rhinoplasty deformities as well as correction during revision Rhinoplasty. Sutured into placed.
Cosmetically spreader grafts can be used to:
-Help straighten a crooked nose
-Open a pinched middle vault and fix an “hour glass shaped” nose
-Help de-rotate an over rotated nose when used as a D.A.R.T.
-Lengthen a short nose when extended beyond the caudal septum
-Prevent “inverted V deformities” post rhinoplasty
-Create nice “brow-tip aesthetic lines”
Functionally used to:
Spreader grafts can improve breathing by opening the internal valve area between the dorsal septum and the upper lateral cartilages.
Onlay Grafts
Cartilage or fascia grafts placed over the middle vault, or dorsum to add bulk, width, or height. Can be crushed or morsalized cartilage. Not “functional” grafts usually but mostly cosmetic.
Radix Grafts
Cartilage, diced cartilage, or fascia grafts placed at the radix to increase the height of the radix and the “nasal starting point.” These grafts may show their edges in thin skinned rhinoplasty patients.
Caudal Septal Extension Grafts
Very useful and powerful grafts placed to increase the length of the septum and nose. Used in ethnic patients with short noses or in revision rhinoplasty cases. Usually this graft is taken from rib cartilage but thick septum or double layer ear cartilages can also be used.
Lateral Wall Grafts
Cartilage grafts to replace over aggressively reduced Upper Lateral Cartilages in Revision Rhinoplasty
Temporalis Fascia Graft
Soft tissue graft used in patient with very thin skin to help camouflage and create a smoother nose. Can be used at the tip, dorsum or radix. Alloderm, which is a cadaveric a-cellular dermal graft, can also be used as an easier, but more expensive alternative.
SUTURE MATERIAL IN RHINOPLASTY:
Vicryl
An absorbable braided suture that can be used in Rhinoplasty but not the best choice. It can cause inflammation, infection, or extrusion (spitting of the suture).
Monocryl
A fantastic mono-filament (non-braided) absorbable suture that can be used in Rhinoplasty. Often used in a 5.0 size for dome defining sutures.
PDS
A fantastic mono-filament (non-braided) absorbable suture that can be used in Rhinoplasty. Often used in a 5.0 size as dome defining sutures, or 6.0 for securing tip grafts. Takes a few weeks to months longer than Monocryl to absorb.
Plain Gut & Fast Absorbing Gut
Quickly absorbing sutures used in Rhinoplasty to close internal incisions. Fast Absorbing Gut dissolves quicker than Plain Gut but the two are very similar. Used in 3.0, 4.0, 5.0 and 6.0 sizes.
Chromic and Mild Chromic
Quickly absorbing sutures used in Rhinoplasty to close internal incisions.
Prolene
Permanent mono-filament suture that can be used in certain areas of the nose during Rhinoplasty. It is often unnecessary and can be substituted with PDS. The suture is not removed if used internally.
Nylon
Permanent mono-filament suture that is often used in a 6.0 or 7.0 size to close external Rhinoplasty columella incisions. The suture is removed in 3-7 days if used externally.
Ethibond
Permanent braided Polyester suture used by some Plastic Surgeons in Rhinoplasty. High risk of infection and post Rhinoplasty problems.
GRAFT MATERIAL IN RHINOPLASTY:
Septal Cartilage
A large portion of the Septal Quadrangular Cartilage can be harvested and used during rhinoplasty. In revision rhinoplasty, this cartilage is often missing and unavailable, as it may have been used during the previous Rhinoplasty surgeries. Septal cartilage is the first choice of cartilage for most Facial Plastic Surgeons.
Septal Bone
A portion of the perpendicular plate of the ethmoid bone, at the back-top end of the septum, can be used for graft material although not ideal.
Ear (Auricular) Cartilage
A greatly versatile source of cartilage for grafts. Incisions can be placed in front or behind the ear(s). Cartilage can be harvested from various parts of the ear and used in rhinoplasty and revision rhinoplasty. Under skillful hands, no major cosmetic deficits should be noticed with the ears after surgery.
Ear Composite Graft
Powerful grafts taken from the ear including cartilage and attached skin. Used to correct “soft tissue triangle defects” as well as retracted nostrils and vestibular stenosis. Very technically challenging grafts to place and do not always survive.
Post Auricular Fascia
Soft tissue taken from behind the ear to help camouflage areas, in thin skinned rhinoplasty patients.
Temporalis Fascia
Strong soft tissue layer covering the temporalis muscle, used to camouflage areas in rhinoplasty patients with thin skin. It can also be used to augment the radix.
Rib Cartilage
Large, strong cartilages harvested from the ribs 5,6,8,9,or 10. Used when abundant cartilage and building material is needed in rhinoplasty or revision rhinoplasty. Often used to build up the bridge or lengthen the tip. Frozen or Irradiated cadaver rib may also be used. When carved properly, these cartilages have a minimal risk of warping.
Bone
Bone from the ribs, skull, scapula or hips can be used in major reconstructive cases.
IMPLANT & ALLOPLASTIC GRAFTS USED IN RHINOPLASTY:
Mersilene Mesh
Permanent implant that resembles “cheese cloth.” Often used in general surgery to fix hernias. Can be layered and used nicely as a chin implant.
-Not a good option in the nose due to risk of acute or delayed infection.
Gore-Tex (PTFE)
Permanent soft plastic implants. Comes in sheets or in pre-formed strut type implants.
-Not a first option in the nose due to risk of acute or delayed infection.
Silastic (Silicone)
Pre-made implants in different shapes and sizes. Very commonly used for Asian rhinoplasty.
– Not a good option in the nose due to risk of acute or delayed infection as well as shifting.
Medpore
Pre-made implants in different shapes and sizes. Very commonly used for Asian Rhinoplasty.
– Not a good option in the nose due to risk of acute or delayed infection as well as shifting. Very difficult to remove once in place for a few weeks.
Surgicel
Cellulose sheets used for hemostasis. Used abroad for radix grafts as a “Turkish Delight” which is diced cartilage wrapped in Surgicel. Temporalis Fascia is a much better alternative.
SUTURE TECHNIQUES IN RHINOPLASTY:
Single Dome Stitch
Mattress type stitch placed at the dome of the Lower Lateral Cartilage to bend the dome into the desired, more defined shape. The suture material most commonly used are 5.0 PDS, 5.0 Monocryl, 5.0 Clear Prolene, or 5.0 Clear Nylon
Double Dome Stitch
Mattress or simple type stitch placed between the two domes of the two Lower Lateral Cartilages to bring them together and create more symmetry. Plastic Surgeons must be careful to avoid cinching the suture down too tight to prevent a “uni-tip” appearance
Alar Spanning Stitch
Simple type stitch placed between the cephalic, lateral aspects of the Lower Lateral Cartilages to reduce tip convexity. Must be used carefully as it can create alar rim retraction.
Wright Stitch
Suture placed to correct a deviated caudal septum. It essentially pulls the deviated septum to the other side of the anterior nasal spine
Septal-Columellar Stitch
Suture placed to position the tip in relationship to the rest of the nose by placing a suture from the septum to the columella. It is also used in “Tongue-In-Groove” maneuvers to suspend a “hanging columella.” There are many other stitches used in Rhinoplasty to attach grafts or bend and manipulate cartilages. There are also other less commonly used grafts and suture materials in Rhinoplasty and Revision Rhinoplasty that can be used in certain situations.
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