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Introduction

Often referred to as a ‘nose job’, Rhinoplasty is not only popular with Hollywood celebrities, but has become an established procedure for anyone wishing to improve the appearance of their nose. First described in Indian medical texts dating back to 500 B.C., Rhinoplasty is one of the oldest plastic surgery operations yet it is also one of the most difficult to master.

Rhinoplasty surgeon Dr. Lawrence Tong has extensive experience dealing with primary Rhinoplasty (first-time Rhinoplasty), secondary Rhinoplasty
(Rhinoplasty for patients who have had prior Rhinoplasty), and treating complications related to Rhinoplasty. He can guide you through the various options for your concerns.

What Does a Rhinoplasty Accomplish?

Rhinoplasty is a procedure that can improve the appearance of the nose and the function of the nose as well. The procedure primarily involves reshaping the cartilage and bone to achieve these goals.

Who are Candidates for Rhinoplasty?

Almost anyone with a legitimate concern about the appearance of his or her nose could benefit from cosmetic Rhinoplasty. Patients may seek a dramatic difference in the overall look of their nose, or they may just want a small degree of change.

Here are some common reasons why you may want Rhinoplasty and how the procedure can help:

  • Your nose looks too large for your face: overall nasal dimensions can be made to look smaller
  • Hump on the nasal bridge: bridge is made straight
  • Fat, round, or undefined nasal tip: tip is made thinner, sleeker, and more defined
  • Wide nose: nasal bones are thinned, nostrils made less wide
  • Nose sticks out too much: nose is deprojected for better facial proportions
  • Nasal tip points downward: tip is elevated and slightly upturned
  • Crooked nose (naturally or from accident): nose is straightened
  • Crooked septum: septum is straightened, breathing may be improved

Other Candidate Criteria:

  • Patients should be old enough so that facial growth is completed (usually mid-late teens)
  • Smokers should quit smoking at least 2 weeks prior to surgery
  • Patients should be generally fit and relatively healthy; Dr. Tong will always assess your general health and suitability before undergoing any type of surgery
  • A patient should have realistic expectations about what can be accomplished with Rhinoplasty

Issues to be Considered With Rhinoplasty

It is important to know all information regarding previous Rhinoplasty, nasal surgery, or nasal injury. The presence of these factors can make a straightforward Rhinoplasty more challenging.

It is helpful to have a sense of what you would like changed or improved. Try to list at least one or two things that you would like to change about your nose. From there, Dr. Tong can discuss his findings and formulate a personal Rhinoplasty strategy for you. Dr. Tong can provide computer imaging of possible surgical outcomes if requested. It is important to note that computer imaging is an estimation of what might be accomplished surgically, and should not be taken as an implied or explicit guarantee of results.

In analyzing your anatomy, Dr. Tong may recommend a chin implant is if he feels your facial profile would benefit from one.

Open vs. Closed Rhinoplasty

There are two methods of performing Rhinoplasty: open and closed. These terms refer to the way in which the underlying cartilage, bone, and soft tissue are exposed to allow for the procedure to be conducted.

In open Rhinoplasty, the framework of the nose in fully exposed.

  • Advantage: optimal amount of surgical control when compared to closed technique
  • Disadvantage: there may be more swelling that takes longer to resolve after surgery
  • Open Rhinoplasty is preferred with: cases of revision (redo) Rhinoplasty, significant asymmetry, unusual anatomy, or when there is a need for very precise modifications.

The closed technique is the more traditional method of Rhinoplasty that has been popular for decades. It involves making fewer incisions in the nose, and performing the alterations to the framework without seeing the structures directly.

  • Advantage: less swelling and less incisions
  • Disadvantage: it is less precise, and the range of options to manipulate the framework is not as great
  • The closed method is preferred with: straightforward primary (first time) Rhinoplasty that does not need significant tip alteration.

When you come in for a Rhinoplasty consultation, Dr. Tong will give his recommendation about which technique would be best for your goals

Incisions for Rhinoplasty

Any surgical procedure will leave some type of scar. Dr Lawrence Tong specializes in obtaining the least visible scars and putting them in the least visible places. The incisions for open Rhinoplasty are all inside the nose except for a 2-3 mm incision across the columella (the central tissue that separates the right and left nostrils). It hides well because of its location, and this single scar tends to be almost invisible once healing is complete.

The closed technique of Rhinoplasty only utilizes internal incisions.

Dr. Tong will explain the different techniques if you are a candidate for one or both methods.

Details of the Rhinoplasty Procedure

Dr. Tong can perform the Rhinoplasty procedure under two types of anesthesia: general anesthesia or IV sedation (twilight) anesthesia. During the time you are under general anesthetic, you will be asleep and completely unaware of your surroundings. If you are under twilight anesthesia, you may be aware that you are undergoing surgery from time to time during the procedure, but should feel no pain. Your surgery is conducted in the private surgery centre within the medical complex where Dr. Tong’s plastic surgery office is also located, in Yorkville.

Dr. Tong starts your Rhinoplasty by making small nasal incisions and exposing the underlying nasal cartilage and bone. Maneuvers are then performed as needed in order to remove the hump, refine and elevate the tip, decrease (or increase) the projection, and reduce the width of the nose. The surgical maneuvers vary, depending on the individual case.

The hump is removed by shaving cartilage and bone. The appearance of the nasal tip is altered to improve definition by removing, stitching, or adding cartilage in the tip area. The septum is straightened, as needed (again through removal, bending, scoring, or reinforcing the cartilage). The nasal bones are often repositioned slightly to achieve a thinner, more elegant look.

After the last stitches are placed, you will be placed in a special protective Rhinoplasty dressing (nasal splint), and then gently awakened from anesthesia.

Recovery after Rhinoplasty

Our nurses will monitor you in the post-anesthesia recovery area following your Rhinoplasty. You will be allowed to go home once the effects of anesthesia have worn off, accompanied by your friend or family member.

Once at home, you need to relax and protect your nose from being injured. You may perform non-strenuous activities, such as watching television and reading. You should expect your nose to feel very stuffy, as most patients will breathe only through the mouth during the first week. Pain is typically mild to moderate. Pain medication will be prescribed, and may be used during this time. You may have bruising around the eyes in the first 1-2 weeks. The majority of patients return to work (non-strenuous) at 7-10 days.

Dr. Tong will see you at one week to have stitches and the special protective dressing removed. You will likely be allowed to start light exercise (e.g. walking) at 1-2 weeks after surgery. Avoid strenuous activity until 4-6 weeks after surgery, especially sports where you could be hit in the face (e.g. hockey, basketball). After the initial post-surgical visit, you will have follow-up visits with Dr. Tong at 6 weeks, 6 months, and one year after surgery. Post-operative photos will also be taken at these visits.

It is important to stress that the nose may look fairly swollen initially. This is entirely normal and it takes between 6-8 weeks for a majority of the swelling to resolve. Even beyond this, full resolution of the swelling can take 12 months or more. As the swelling subsides, you will notice that the nose gradually becomes thinner and smaller, with the tip taking the longest to fully settle. Patients like the look of their nose right after surgery, but the appearance will still slowly continue to improve as time goes on until it reaches its final form.

As with any surgery, there are risks involved with Rhinoplasty. Although the procedure has a low risk profile, Dr. Tong will make sure to go through the pertinent potential problems associated with Rhinoplasty at the time of your consultation.

Asian and Ethnic Rhinoplasty

When rhinoplasty is performed on a patient who is non-Caucasian, it is termed an ethnic rhinoplasty. (Note that the term ‘Caucasian,’ as it is applies to this discussion, refers to patients of European ancestry.) Ethnic rhinoplasty differs from non-ethnic (i.e. Caucasian) rhinoplasty, as it requires consideration of two important aspects: cultural factors and anatomic factors.

Cultural Factors

Differences in concepts of beauty exist between cultures and must be taken into account when performing ethnic rhinoplasty. For example, in Asian rhinoplasty, creation of a higher bridge is often requested; however, the desired height is typically much less than the height of a Caucasian nose. This example illustrates the essential concept of maintaining the ethnic character of the patient when performing ethnic rhinoplasty. Equally important, however, is determining whether or not a particular patient wishes to follow these cultural perspectives. Communication with each individual considering nose surgery is key to success in ethnic rhinoplasty. It is also imperative that the surgeon is familiar with different cultural perceptions of beauty for patients of every descent.

Anatomic factors

Ethnic rhinoplasty differs from Caucasian rhinoplasty because the anatomy is often quite distinct. For example, in African American rhinoplasty, we often see thicker skin, a wider alar base, and less intrinsic cartilage support. In Asian patients, it is common to see a low bridge, minimal tip projection, a rounded/bulbous appearing tip, and a wide alar width with flaring. The nasal bones in ethnic patients are usually quite different from Caucasian patients as well. These anatomical differences alter the way that a surgeon needs to approach the rhinoplasty. Surgeons performing ethnic rhinoplasty must be aware of these differences and understand how to deal with the distinctions, as the correction is frequently unique and distinct from Caucasian rhinoplasty.

How Much Does Rhinoplasty Cost?

The cost of rhinoplasty in Canada ranges from $8,000 -$10,000, depending on the type of anesthesia utilized and the geographic location where the procedure is performed. In comparing plastic surgery costs, having the surgery performed under sedation (when appropriate) usually costs less than general anesthesia. Similarly, undergoing the surgery in a larger city usually costs more when compared to smaller cities. While the above figure can serve as a general cost estimate, the price of rhinoplasty will ultimately depend on factors unique to your procedure, such as:

  • The nature and extent of surgical work to be done
  • The technique used during surgery (open vs. closed)
  • Whether your rhinoplasty is a revisional procedure

Will I Have Visible Rhinoplasty Scars?

Any surgical procedure will leave some type of scar. Dr. Lawrence Tong specializes in forming the least visible scars possible and putting them in the most inconspicuous places. The incisions for open Rhinoplasty are all inside the nose, except for a 2-3 mm incision across the base of the columella (the central tissue that separates the right and left nostrils). It hides well because of this location, and the single scar tends to be almost invisible once healing is complete.

The closed technique of Rhinoplasty only utilizes internal incisions, leaving no visible scarring after the procedure.

Dr. Tong will discuss the best ways to care for your incisions, and thereby minimize the resulting scars after your procedure. In general, scars tend to heal better when incisions are kept clean and sun exposure is limited. Keeping the area clean in the first week plays a key role in reducing the chances of infection, which can lead to poor scarring. Applying sunscreen on the scar starting one week after surgery  can provide the necessary protection against UV rays that have the potential to darken immature scars.

In addition to sunscreen, patients should avoid active or direct tanning of the area. If you plan on being outdoors for an extended period of time, you should wear a hat that will sufficiently cover the nose. Most men and women find their Rhinoplasty scars are virtually undetectable once they heal. Patients should be aware that all scars will evolve and mature as they heal, initially starting with a light pink colour and gradually fading to closely match the surrounding skin. Every person has a different timeline for scar maturation, but most patients have a fairly minimal scar even at 6 weeks after surgery. If the scar is visible to some extent while the scar is healing, patients can use makeup to hide it until it ultimately fades.

Is a Non-Surgical Nose Job Possible?

A non-surgical rhinoplasty can be performed using volumizing dermal fillers to change the appearance of the nose. In contrast to a surgical rhinoplasty, non-surgical rhinoplasty is more limited in scope. The best and most common use of minimally invasive nose alteration is on the nasal dorsum to augment the bridge, or hide small nasal bumps. In Asian patients, fillers are often used to elevate the height of the bridge. This can dramatically change the appearance of the nose and create a much more balanced profile. Patients with a small hump on the bridge can also have it minimized or hidden by placing some filler around the bump to smooth the appearance out.

Fillers can also be placed in areas to correct asymmetries or contour irregularities from prior trauma, surgery, or normal growth. Occasionally, fillers are used in the tip to augment size or slightly increase projection. This application is more limited, as fillers cannot make the tip look thinner. The tightness of the tip skin and the viscosity of the filler usually create a fuller tip appearance when compared to a thinner one. One unique advantage regarding fillers in the nose is that they tend to last much longer than application elsewhere on the face. In the bridge, it is not unusual to see results lasting for one year or more. A surgeon with experience performing ‘liquid rhinoplasty’ can provide the best advice.

Revision Rhinoplasty

Sometimes individuals who have undergone a previous rhinoplasty from another surgeon do not achieve the results they had originally envisioned and are disappointed with the outcome of their initial procedure. If a primary rhinoplasty failed to correct the cosmetic or functional concerns you sought to improve, Dr. Tong can perform revision rhinoplasty to enhance the outcome of your nose surgery. This intricate procedure involves working with the bones, cartilage, and structures of the nose that have already been operated on, necessitating the advanced training of a qualified revision rhinoplasty surgeon to achieve the ideal outcome.

During a consultation, Dr. Tong will closely examine the appearance and anatomy of your nasal framework to assess how your results can be improved within the context of your goals. He will listen closely to your concerns and surgical objectives to ensure a mutual understanding of the desired outcome is achieved. Dr. Tong generally recommends waiting 10 to 12 months after the initial procedure before undergoing revision surgery. After Rhinoplasty, the appearance of the nose may still change during the first year and even afterward. These changes are related to the very slow and gradual resolution of edema (swelling), as well as the softening of internal scar tissue. Due to the changes that occur after Rhinoplasty procedures over time, there are multiple reasons to delay performing revision surgery:

  1. A revision procedure may be avoided altogether if the nose is afforded time to heal and settle. As the nasal edema continues to resolve and scar tissue progressively softens, the appearance of the nose will change and the problem area(s) in question may correct on their own. This is especially true in the nasal tip region, as the edema in the tip takes the longest to subside.
  2. Evaluation of the nose in the first 10 months after the initial surgery may not be accurate, therefore it can be difficult to judge the ‘true result’ of your Rhinoplasty. Even if the problem area(s) are not expected to resolve on their own, it’s still important for Dr. Tong to have an accurate picture of the anatomy that is not muddied by unresolved edema and scar tissue. An incorrect picture of the anatomy may lead to a sub-optimal surgical plan.
  3. Performing a revision surgery too early is more difficult for the surgeon. The scar tissue will be too firm, and the nature of the scar will make it difficult to differentiate between planes of tissue. These factors lead to a higher risk of failure in correcting the problems in question, and may even create new concerns.
  4. In general, the longer a patient waits to pursue revision rhinoplasty, the greater the likelihood that the surgery will be successful.

Please don’t hesitate to contact our practice for a revision rhinoplasty consultation with Dr. Tong to discover how we can help you fulfill your original reasons for surgery.  

How to Choose the Best Rhinoplasty Surgeon For You

There are a few important factors to consider when pursuing plastic surgery in Toronto and choosing a surgeon to perform your rhinoplasty:

  1. Choose a plastic surgeon that is certified by the American Board of Plastic Surgery. The equivalent Canadian designation is certification by the Royal College of Surgeons and Physicians of Canada in plastic surgery. This accreditation indicates the physician has undergone the required training and passed the appropriate examinations to be called a plastic surgeon.
  2. Choose a plastic surgeon that has significant experience. As with any profession, a surgeon’s work tends to improve year after year as they hone their skills and craftwork. It is an accurate statement to say that a surgeon’s work after a decade of practice is much better than it was in their first year of practice. This is particularly relevant for rhinoplasty, as it is considered by many as the most challenging facial cosmetic procedure to perform.
  3. Choose a plastic surgeon that performs rhinoplasty on a regular basis, as opposed to one that does it occasionally. Although any plastic surgeon may perform rhinoplasty, a surgeon that performs rhinoplasty frequently will have more familiarity in dealing with i) different types of noses, ii) ethnic rhinoplasty, iii) diverse anatomy, and iv) complications that could arise.
  4. Choose a surgeon that communicates well, listens to your concerns, and makes you feel comfortable. During your consultation, you should feel confident that your surgeon understands your concerns, wants what is best for you, and will provide exemplary care during and after surgery. Although it is only common sense that you should feel comfortable with the person who will be operating on your nose when considering plastic surgery, it is surprising to hear from some patients who assume a rushed, or even discourteous surgeon is just ‘part of the process.’

Additional Rhinoplasty FAQs

Can I blow my nose after rhinoplasty?

You should avoid blowing your nose for at least one to two weeks after Rhinoplasty since the nasal framework will be very fragile during the healing process. Patients who had a deviated septum repaired may need to wait longer before blowing their nose. Internal pressure caused by premature nose blowing can cause bleeding, damage to the soft tissues, and may alter the final outcome. Feeling congested after nose surgery is normal, but you can use a saline nasal spray to clear the nostrils. Congestion is usually the result of internal swelling of the mucosal lining. As the swelling resolves, the nasal passages start to open and breathing should improve. Patients are encouraged to sleep with their back propped up with extra pillows during the first week (or more) after surgery, as this is the best method to accelerate resolution of the internal and external edema (swelling).

How long after rhinoplasty can I wear glasses?

As the nasal bridge is healing, wearing glasses—including sunglasses—should be avoided for four weeks to prevent excessive pressure on the nasal bones and tissues. If you use prescription lenses, Dr. Tong recommends switching to contacts until he gives you clearance to resume wearing glasses.  Alternatively, wearing glasses is permitted by using a piece of tape at the central portion of the glasses to suspend the glasses from the forehead, thereby taking pressure off the nasal bridge.

How can I reduce swelling after rhinoplasty?

It is common for swelling to linger for months after Rhinoplasty, but you can accelerate the rate of healing by limiting consumption of salty foods and alcohol. Sleeping with the head elevated (above heart level), as well as using nose tape, can also help reduce swelling. The most important factor, however, is time. You must be patient with the healing process, as swelling and its resolution are part and parcel of the Rhinoplasty procedure. Dr. Tong will provide you with more detailed instructions after your operation.  

How do I clean my nose after rhinoplasty?

For the first few days after surgery, you can use a cotton-tipped swab to gently clean the nasal passages, limiting cleaning to the rim and just inside the rim. Be careful to avoid inserting the swab too deeply into the nasal passages during the first one week. Irrigating the nose with a saline rinse can also help clear the airways of any deeper blood or mucous.

Dr. Tong encourages patients to apply a thin layer of petroleum ointment on the incision line and sutures using a cotton-tipped swab to help soften any dried blood. Dried blood should be gently cleaned as it becomes soft. The nose should not get wet when the nasal splint is in place. During the initial week, you may wash your face carefully with a face towel, being careful to keep the splint dry. You may wash your hair in the shower provided your back is facing the stream of water and you only let the water run down the back of your head, keeping the splint dry. The splint is removed at the first post-operative visit, one week after surgery. After the splint is removed, you may wash your face normally but should avoid placing excess pressure on the nose.

How long will it take for the nose to fully heal after rhinoplasty?

While most swelling subsides within three months after surgery, it can take one year or more for the nose to heal completely. This means that you can expect your nose to continue to change and improve during this time period. In cases of revision rhinoplasty, it may take even longer for inflammation and scar tissue firmness to fully dissipate. Most patients see the majority of their final results after a few months, with the outcome continuing to refine over the first year after surgery and beyond.

Become Educated about Rhinoplasty in Toronto

Our goal is to make you an educated patient. We know that an educated patient will make intelligent choices about their surgery and their surgeon. The initial consultation usually takes over 45 minutes to complete. You will never be rushed or pressured into making a decision. There is a good deal of information to digest during your initial consultation, and Dr. Tong will make sure that you understand every important detail.

To learn more about how Dr. Tong can help you with improving the appearance of your nose, set up a Toronto Rhinoplasty consultation with Dr. Tong by giving us a call at (416) 972-0999. Alternatively, let us give you a call; just fill out our contact form and we will call you on the same or the next business day. No physician’s referral is needed.

See Dr. Tong’s work in our Rhinoplasty before and after photos.

Rhinoplasty (Nose Job) at a Glance

What the procedure does
Makes the nose more attractive looking, can make breathing easier if due to deviated septum
Duration of the result
Permanent
Length of time to perform the procedure
1.5-4.0 hrs
Type of anesthetic most commonly used
IV sedation or general anesthesia
Length of time off of work
7-10 days
Time to get back to exercise
2 weeks light exercise, 4-6 weeks heavy exercise
Pitfalls your Plastic Surgeon should avoid
  • Not removing enough nasal hump
  • Shortening the nose too much (pig nose)
  • Unnatural appearance
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