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Houston Cranio Facial


A good sense of facial balance often relies on the shape and size of the nose. If you’re considering a nose job — which is also known as “rhinoplasty,” — to resolve a longtime insecurity or to simply enhance your appearance, the procedure can be one of the most complex and rewarding options available to achieve greater facial harmony. Commonly referred to as a “surgery of millimeters,” even minor adjustments to the nasal contours can yield a stunning improvement. However, such intricacy often requires the skill and experience of a rhinoplasty surgeon who has specialized knowledge in procedures of the face, head, and neck.

As a double board-certified craniofacial plastic surgeon, Dr. Eric Payne is uniquely qualified to make your desires a reality using state-of-the-art rhinoplasty techniques. Dr. Payne has trained in facial plastic and reconstructive surgery and can evaluate your concerns and create the most effective surgical plan to improve the form and function of your nose.

What Issues Can Be Corrected with Rhinoplasty?

Rhinoplasty is designed to alter the nasal bones, cartilage, asymmetries, and soft tissue of the underlying nasal framework. This can balance the proportions of the nose and/or make it easier to breathe by fixing the blocked airway, which is also known as nasal obstruction, depending on your motivations for nose surgery. In general, the procedure is performed under cosmetic surgery which can also address the following concerns:

  • Dorsal hump in the nasal bridge
  • Over- or underprojected nasal tip
  • Round or bulbous nasal tip
  • Crooked, misaligned, or long nose
  • Nostrils that appear too wide/thin
  • Difficulty breathing due to a deviated septum

By correcting the issues listed above, rhinoplasty allows patients to achieve a greater sense of facial harmony, which — in turn — improves their entire appearance. With form comes function, and a septoplasty or rhinoplasty can significantly improve nasal breathing problems. Dr. Payne’s knowledge and training in facial plastic surgery can provide you with superior results while ensuring you maintain the natural beauty and character of your face with your cosmetic procedure.

Often, some patients may have a birth defect, such as cleft lip, which can cause a nasal deformity requiring plastic surgery intervention. These situations may require additional surgery to correct the septal deviation with a septoplasty. A team approach is necessary with facial plastic surgeons or an ENT surgeon who specializes in otolaryngology to help treat any additional sinus disease.

Is Rhinoplasty Right for Me?

Rhinoplasty can be a potential solution if you would like to improve the appearance of your nose, or if you have difficulty breathing as a result of a deviated septum. Cosmetic rhinoplasty can be performed on both men and women to correct the structures of the nose. With any surgical procedure, it’s important for patients to be in good health and maintain realistic expectations about what surgery can achieve. The types of enhancements possible with rhinoplasty typically depend on your age, ethnicity, anatomy, and skin quality. In some cases, jaw surgery with a genioplasty advancement (or chin implant) can assist in balancing your facial features by giving you a more natural appearance of the nose. Dr. Payne will thoroughly review your medical history and concerns to confirm that rhinoplasty is safely and successfully able to attain your desired results.

If you have already received rhinoplasty from another plastic surgeon but you’re unhappy with the final results, Dr. Payne also performs revision rhinoplasty to improve upon the results of a previous nose surgery. These secondary procedures are evaluated on a case-by-case basis and Dr. Payne would be happy to speak with you about your unique situation and determine the best options available to you. Revision rhinoplasty is often more challenging and requires a longer plastic surgery procedure to correct or enhance features.

Ethnic Rhinoplasty

There are a variety of distinct facial characteristics when it comes to different ethnic backgrounds. Patients from different backgrounds often have similar features that they would like to correct via rhinoplasty. These features can range from a flat, wide nasal bridge to a nasal tip that creates a low projected appearance. Dr. Payne will create a unique treatment plan to compliment the natural character of your face.

What are Commonly Shared Features That Can Indicate Ethnic Rhinoplasty?

  • Asian Rhinoplasty – Often, the tip and the bridge of the nose tends to be smaller and shorter which patients may wish to enhance. Grafts can also be used to help with thick skin, a depressed bridge, or a wide and depressed nasal tip. Goals of Asian rhinoplasty may include increasing the dorsum of the nose and nasal tip projection, with narrowing of the nasal alar base.
  • Persian/Middle Eastern Rhinoplasty – A Middle Eastern nose can have a large nasal tip and nasal profile, which can be reduced to meet the desired appearance you are looking for. There may also be a significant amount of bump. The goals of Middle Eastern rhinoplasty, while maintaining the characteristics of a patient’s ethnic background for a more natural appearance, are to decrease any dorsal projection or a dorsal nasal hump, as well as to increase the nasal tip projection rotating the tip upwards.
  • African American Rhinoplasty – African American noses tend to have less projection and, typically, an increase in width. Rhinoplasty in this ethnic group can build the nasal bridge height and provide a more defined nasal tip with narrowing of the nostrils to provide a natural appearance. A common aspect of African American rhinoplasty is to reduce the nasal alar width.

Rhinoplasty Pre-Operative Information

We recommend you stop smoking and avoid secondhand smoke as well as any nicotine products for approximately two months before rhinoplasty. Nicotine can increase the risks of infection and poor wound healing, even leading to a loss of skin due to the vascular restriction effects of using nicotine. We recommend stopping supplements, herbal medications, and medications that cause bleeding such as aspirin, Motrin, and NSAIDs at least one week prior to your surgery. Avoid sun damage and tanning beds for at least two weeks prior to surgery.

In preparation for your surgery, do not put on any make-up or lotion on the day of your rhinoplasty. Please remove all jewelry or piercings prior to surgery. It is recommended to wear comfortable loose-fitting clothes. A button-up shirt or a zip-up jacket and sweatpants are recommended.

Closed vs. Open Rhinoplasty

Closed rhinoplasty and open rhinoplasty are the two primary techniques utilized to reshape the nose. The best approach for each person differs based on a patient’s nasal framework and the nature of the improvement(s) desired. In general, a closed procedure is performed using internal incisions — this does not result in any visible scarring, but the technique may only be appropriate for certain patients. In contrast, open rhinoplasty places an incision at the base of the columella. This refers to the natural crease where the nose meets the upper lip, resulting in little to no noticeable scarring after surgery. Open rhinoplasty typically allows a greater degree of visibility and surgical control during the procedure, allowing Dr. Payne to complete a range of enhancements to the bridge, tip, or framework of the nose. The improvements possible with closed rhinoplasty are usually limited, but rest assured our board-certified craniofacial plastic surgeon will determine the most ideal technique for your individual needs.

How is the Rhinoplasty Procedure Performed?

Rhinoplasty surgery is usually performed using the open or closed technique. Closed rhinoplasty uses internal incisions to improve the nasal framework, allowing no visible scarring after the procedure. Incisions for a closed rhinoplasty are typically made inside the nose and the skin is not lifted to expose the cartilage framework. While this approach can be suitable for certain types of corrections, closed rhinoplasty is often not the most ideal choice for all patients.

Open rhinoplasty accesses the nose using a small incision made at the natural crease of the columella, which refers to the strip of tissue that separates the nostrils. In addition, incisions are connected inside the nose to allow the skin to be elevated. This allows complete visibility of the nasal framework so Dr. Payne can make the desired improvements while helping ensure incisions remain discreet and undetectable. Other times, the use of cartilage grafts may be taken from the other body parts which can help with reshaping of the nose. The best technique for your needs will be determined during your pre-operative appointments. In general, rhinoplasty is an outpatient procedure performed under general anesthesia with local anesthesia.

What Can I Expect During the Recovery Period After Rhinoplasty?

Right after your nasal surgery, your nose will be secured with a splint that helps compress the tissue to minimize swelling. The splint will be removed at your post-op visit. It is recommended to keep your head elevated for at least 10-14 days after surgery — even while sleeping. Swelling may occur after the first 48 hours and this is considered a normal reaction. Most patients describe the recovery period after rhinoplasty as very tolerable, and oral pain medications are usually enough to manage discomfort.

Swelling and minor bruising are to be expected and should gradually subside in the weeks following rhinoplasty. After a septorhinoplasty, you may use Afrin spray intermittently to stop bleeding as needed, which can help with nasal breathing. If you experience increased nasal bleeding with bright red blood (with a need to change your nasal pad every 30 to 40 minutes), please call our office immediately.

Bloody nasal discharge for 3 to 4 days after surgery is normal. A nasal drip pad can be used. Keep the inside edges of your nostrils and any stitches clean by using a Q-tip saturated with hydrogen peroxide, followed by a thin coating of Bactroban/mupirocin or gentamicin ointment. Although the majority of inflammation should resolve within a few weeks, residual swelling can last for six months to one year. Depending on the nature of your work, most patients are able to return to their jobs within 7 to 14 days. It’s very important to avoid any strenuous activity for about six weeks after surgery, or until Dr. Payne clears you for more demanding activities. Dr.Payne will go over postoperative instructions with you and provide detailed information about your recovery to help facilitate a smooth healing process.

How Long Do Rhinoplasty Results Last?

Rhinoplasty is designed to enhance your nasal framework for a lifetime, allowing you to enjoy your more balanced and proportionate nose shape for the long-term future. That said, it may take patients six months to one year to realize the final outcome of rhinoplasty while swelling gradually subsides. Breathing problems can significantly improve with septorhinoplasty surgery. In safeguarding the quality and longevity of your results, Dr. Payne recommends exercising caution when playing sports and other recreational activities where a sudden blow to the face is possible. Smoking is also strictly prohibited during your recovery, as nicotine can slow down the healing process and negatively affect the quality of your results. By exercising proper care during the recovery period, following Dr. Payne’s post-operative instructions, and living a healthy lifestyle, the results of nose surgery can be very enduring.

How Much Does Rhinoplasty Surgery Cost?

When it comes to the cost of rhinoplasty, the surgeon’s experience and certification is the key factor. Dr. Payne is a board-certified plastic surgeon who has had specialized training in craniofacial surgery. He is also a current member of the American Society of Plastic Surgeons and a diplomat of the American Board of Plastic Surgery. The price for rhinoplasty can vary based on each person’s concerns and the area of the nose that needs alteration. Additional anesthesia or hospital fees will be factored in as well. Most rhinoplasty surgeries have a physician’s fee that can range anywhere from $5,000 to $8,000 for minor to moderate nose surgery. For a case that requires more reconstruction of the nose job, the price can be as much as $10,000 or more.

Are There Alternatives to Rhinoplasty?

While rhinoplasty is the premier procedure when it comes to cosmetic nose surgery, it’s possible that other facial plastic surgery options may better align with your overall goals. In certain cases, patients who believe they need rhinoplasty may actually benefit more from chin surgery. Chin augmentation is designed to balance the facial features by using an implant to achieve greater facial harmony. A facial implant can not only improve a weak or recessed chin, but also works to help offset a dominating nose in some patients. Dr. Payne would be happy to evaluate your concerns and determine whether a chin implant may be a more ideal solution to address your concerns.

For other patients, revision rhinoplasty may be a more appropriate procedure to reconstruct the nose. This secondary procedure is performed on a case-by-case basis and can help improve the outcome of a previous nose surgery for individuals who were treated by another plastic surgeon and who are dissatisfied with the results. Revision rhinoplasty is among the most complex reconstructive procedures available and requires the expertise of a highly skilled provider. For this reason, it’s in the best interest of patients considering revision rhinoplasty to select a qualified craniofacial plastic surgeon who specializes in procedures of the head and neck to perform their surgery.

Additional Rhinoplasty FAQs

Are there any dietary restrictions after rhinoplasty?

Right after your cosmetic surgery, we recommend that you start with a liquid diet only. The next day, you may begin a soft food diet consisting of mashed potatoes, applesauce, steam-cooked vegetables, etc. You must avoid foods that require excessive upper lip movement, such as sandwiches, corn on the cob, and apples.

Will I have a scar after rhinoplasty?

To ensure your scar is healing properly after surgery, we recommend that you follow our scar management plan which will be provided at your post-operative visit. Dr. Payne will help to hide your scars and discuss how to properly take care of your scar after your cosmetic procedure.

What about non-surgical rhinoplasty?

In some cases, a non-surgical solution to address the nose can be performed with what is called a “liquid rhinoplasty” procedure. This technique involves injectables, such as fillers and BOTOX®, to change the shape of the nose without surgery. For instance, a dorsal hump on the nose can be addressed using fillers injected into the tip to smooth out the transition. This can only work if the deformity is not severe. Sometimes, BOTOX® can be added to help with nasal flaring or to increase nasal tip projection. Combining fillers with BOTOX® can simulate a rhinoplasty for patients who want to see what the possible changes would look like, but understand that there are limits to injectables. The cost of non-surgical rhinoplasty ranges from $600 to $2,000 depending on what is needed.

What is preservation rhinoplasty?

Preservation rhinoplasty is a new movement to maintain the structural support of the nose during rhinoplasty. In the past, techniques used during rhinoplasty were to reduce the nose at the expense of its function. Most people suffered from a nose that may look a certain way, but that they couldn’t breathe through. This means that not only the cartilage, bone, and muscles are maintained, but also the ligament structures that hold it all together. The concepts for the newer techniques in rhinoplasty require a unique understanding of the nose’s structural anatomy. The long-term outcomes for preservation rhinoplasty are likely more reliable.

Rhinoplasty is considered one of the most powerful procedures to not only improve the shape and appearance of the nose, but also to repair a deviated septum. Don’t hesitate to contact Dr. Eric Payne today to find out if nose surgery can help you achieve your aesthetic goals.