Rhinoplasty (Nose Surgery)

The size and shape of your nose are some of the key elements for facial harmony and balance. If you’re self-conscious about the appearance of your nose—or if a structural problem makes breathing difficult—Dr. Persons performs nose surgery (rhinoplasty) to correct these concerns. With her art background and surgical training, Dr. Persons sculpts aesthetically pleasing noses during rhinoplasty surgery at her San Francisco Bay Area practice.

Is Rhinoplasty for You?

Cosmetic nose surgery can benefit patients who believe the size or shape of their nose detracts from their overall appearance. Some people have noses that are too long for a short face. Others’ noses are too broad for a narrow face. Some have unattractive humps, and some droop with the passage of years and the effect of gravity pulling the nasal tip down.

These things can, in most cases, be corrected. The surgery is also an artistic endeavor. Sculpting the nose requires a careful analysis of many features present in a particular face. The size of the forehead, the strength of the chin, and the length of the lips all influence the appearance of the nose. The nose, in turn, influences the appearance of the whole face. It is sometimes advisable to create a stronger chin (mentoplasty) to correct what appears to be an excessively large nose or to shorten the upper lip. Essentially, the nose sits in the center of the face and is a focal spot for the beauty of the face. It cannot be viewed alone.

Dr. Persons strives to create a nose that is in harmony with the rest of the face and, when viewed separately, has a pleasing appearance. She carefully analyzes the nose and tempers her recommendations with the wishes and desires of the patient. Some patients know exactly what it is that they do not like about their nose, and some know only that they don’t like their nose. In almost all instances, it is our experience that surgical changes, where appropriate, can enhance the beauty of the face and make the patient happy to have sought the change.

Barbara L. Persons, MD, FACS

Barbara L. Persons, MD, FACS

Board-Certified Plastic Surgeon

As a fellowship-trained plastic surgeon whose personal connection to plastic surgery inspired her to pursue this career as a lifelong calling, Dr. Persons engages with each of her patients on a very personal level. She's known for creating results that look natural and brings a woman's perspective that patients appreciate.

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Combined Procedures

Rhinoplasty can be combined with the repair of the nasal septum, also known as septoplasty. The septum is the structure that should sit in the middle of the nose, separating one side from the other. Often, twists and deflections may be present which obstruct breathing through the nose. Septoplasty improves this problem.

What Is the Right Age for Rhinoplasty?

There are only 2 limitations to the timing of nasal surgery. Dr. Persons generally avoids doing extensive surgery on children. There are major growth centers in the nose that affect the growth of the face. In cases of severe disfigurement due to accidents, we perform surgery in an attempt to restore the alignment of those centers.

For lesser deformities, we defer surgery until after the child has stopped growing. If parents are concerned about a nasal imperfection, we prefer to consult with them early on so that we may reassure the parents and inform them of the possibilities and limitations. We also like to monitor pictorially the changes brought about due to the deformity during the growth process.

The second limitation upon surgery is for adults sustaining a nasal fracture. We attempt to realign the nose within 10 days of the accident. If reconstructive surgery is necessary, we prefer to wait at least 6 weeks. Rhinoplasties performed on teenagers and young adults are often very beneficial to the social development and self-confidence of the individual. Similarly, many rhinoplasties that we perform are on individuals in their forties and fifties, occasionally older. The aging process is reflected in many ways in the nose, and its correction can add youthfulness and freshness to the appearance.

The Consultation

During the consultation, Dr. Persons makes every effort to understand what changes you want. She makes a detailed analysis of the face and nose, allowing her to inform you of the possibilities and limitations. Following this consultation, you should have a good idea of the surgical goals. Dr. Persons attempts to create the desired changes surgically, using her skill and experience. Sculpting a nose is far different than working in clay. It is also significant to note that the changes performed on the table are not the final result. It’s important to consider the healing process and its effect upon the final result. This is always taken into account in the surgical planning; however, the actual healing is not within the surgeon’s control. It typically takes about a year to see the final results of rhinoplasty.

The Procedure

Dr. Persons performs rhinoplasty using Light Sleep Anesthesia at the Surgery Center. Patients usually come to the Surgery Center the morning of surgery, and we administer sleeping medications through an IV. Once your asleep, local anesthesia is then injected into the nose to numb the area. Surgery generally lasts about an hour-and-a-half. Patients experience no pain during the surgery, and most patients remember nothing about the surgery. After spending some time in the recovery room, patients are driven home by a friend or family member.

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Recovery

Most rhinoplasty procedures require no external incisions and, therefore, no external scars. All the work is done from the inside of the nose—a technique called closed rhinoplasty. It seems amazing to be able to work inside such a small space, but it can be done. Dr. Persons may perform open rhinoplasty in some cases, making an incision on the thin strip of skin between the nostrils. This is barely visible once it heals.

When Dr. Person performs septoplasty to improve breathing, she uses nasal packing that remains in the nose for 24 hours. Tape and a splint are applied to the outside of the nose to maintain the new positioning. She places a bulky pressure dressing over the eyes and forehead for 4 hours after surgery. This reduces swelling and discoloration from the surgery. The tape and splint are left on for approximately 7 days, and a gauze drip pad is taped below the nose to catch any blood or mucus. This needs to be changed 4 to 8 times in the first 24 hours. A drip pad may be used for 3 or 4 days after the surgery, as needed.

The final result takes a period of time to achieve. One can generally get a good idea of what the nose will look like by 1 month after the surgery. But be patient, because it keeps getting better and better.

First Week After Surgery

Most patients experience very little discomfort after rhinoplasty, although pain medication is provided if needed. You must keep your head elevated to approximately 30 degrees for the first week by sleeping with 2 pillows under the mattress and 1 or 2 pillows under your head. Avoid bending over during this time, and limit your activities to walking. Exercise, straining, and lifting should be avoided. It’s important to not be in situations where you may inadvertently bump your nose. We schedule follow-up appointments for the day after the surgery if you need nasal packing removed. We remove the tape and splint approximately 7 to 10 days after the surgery. Be careful not to get the tape and splint wet. If they should become loose, let us know.

First Month After Surgery

The level of activity maintained the first week should be the same level maintained until 3 weeks (21 days) after surgery. At that time, you can gradually increase the intensity of your activities until the end of the fourth week. The exception is contact sports, which you shouldn’t resume until 6 weeks after the operation.

The nose and eyes may be swollen and discolored after surgery. Approximately 80 percent of the swelling and 100 percent of the discoloration are usually gone by 2 weeks after surgery. Up to 90% of the swelling is gone after 2 months, and the rest slowly disappears over the first year. Although the nose is still swollen after the first month, most people would not recognize this fact. You won’t notice swelling. Instead, you’ll see that the nose becomes more refined with better definition during the first year.

The inside of the nose may be swollen for approximately 3 weeks after surgery. It may be difficult to breathe through the nose, but you’ll appreciate improved breathing after that thanks to the straightening of the septum.

Get Started

Choosing a rhinoplasty specialist is the first step in your journey. Request an appointment with Dr. Persons using the online form or call our office at (925) 283-4012 to schedule an appointment.

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