placeholder-imgThe decision to undergo rhinoplasty surgery, also known as “nose job” or “nose reshaping” surgery, is an extremely personal one. Rhinoplasty is one of the most technically challenging facial procedures and requires a thorough knowledge of nasal aesthetics and anatomy, significant training and experience, and a meticulous attention to detail. Our patients at Richmond Aesthetic Surgery can rest assured that they are receiving specialized care from our plastic surgeons, Dr. Neil J. Zemmel and Dr. Kasandra R. Dassoulas, who strive to achieve each patient’s individual goals.

What Is Rhinoplasty?

A rhinoplasty is the surgical correction of the nose to address aesthetic and/or functional concerns, helping people to feel more confident in their looks as well as improve their breathing. If you are concerned that your nose is asymmetrical or disproportionate to your other facial features, or if you suffer from breathing impediments, a rhinoplasty can clear obstructed airways in the nose, easing the flow of air through the sinuses, increase facial harmony, and boost self-esteem.

What Are the Benefits of Rhinoplasty?

The specific advantages of each rhinoplasty procedure will vary according to what the patient is concerned with. For those seeking rhinoplasty to address functional issues, the following can be achieved:

  • Correcting a crooked or deviated septum
  • Adjusting the size and shape of the nostrils to improve airflow
  • Widening internal airways of the nose

Patients seeking aesthetic improvements can obtain benefits such as:

  • Adjusting the size and shape of the nose to be in sync with the patient’s other facial features
  • Augmenting the tip of the nose
  • Reducing the prominence of the nose’s ridge
  • Raising the bridge of the nose for a smoother slope
  • Adjusting the size of the nostrils

What Can I Expect During My Rhinoplasty Consultation?

Nose_and_Chin_Combo_-_Animation_-_web_rd256Ideal candidates for rhinoplasty surgery include healthy men and women over the age of 17 who wish to address functional or aesthetic issues with their nose. The first step in achieving a successful rhinoplasty procedure is your initial consultation. During your initial consultation, you will meet your surgeon, and you will discuss your specific concerns and goals for a rhinoplasty. You will undergo a thorough history and physical exam, paying particular attention to your nasal anatomy and function. Based on your initial concerns, they will develop a comprehensive specific surgical plan that will best achieve your anticipated outcome. Using VECTRA® 3D Imaging technology, you will be able to see a visual prediction of your results to help you make a well-informed decision about your health. The VECTRA analysis is also a way to convey to Dr. Zemmel and Dr. Dassoulas the vision that you have for your results.

After the consultation, if you are determined to be a good candidate for rhinoplasty, your surgeon will provide detailed pre-operative instructions in preparation for your surgery. They believe that a successful rhinoplasty depends on clear communication of realistic expectations of surgery with each patient.

What Does the Rhinoplasty Procedure Entail?

All rhinoplasty surgeries are performed by Dr. Zemmel or Dr. Dassoulas at either St. Francis Hospital’s Ambulatory Surgical Center or the Ambulatory Surgery Center at Henrico Doctors’ Hospital – Forest Campus. During this outpatient procedure, patients receive general anesthesia to maximize safety during surgery and minimize discomfort. A rhinoplasty typically takes 2-3 hours to perform, depending on the goals of the individual patient.


Improvements to the function and aesthetics of the nose are attained by making a series of incisions within the nose to expose the underlying nasal anatomy. There are two main categories of rhinoplasty techniques:

During the consultation process, your plastic surgeon will perform a physical exam, review your functional and cosmetic concerns, and determine which rhinoplasty technique can best achieve your goals. For a general look at each technique, take a look at the sections below.

Open Rhinoplasty

Open-Rhinoplasty-300x226The “open rhinoplasty” involves making a small external incision along the columella of the nose (the part between the nostrils). This external incision then connects to incisions within the nose. The soft tissues of the nose are then carefully freed from the underlying cartilage support of the nose, providing direct access to these important structures. At this point, the bony and cartilage support of the nose can be carefully reshaped under direct visualization to improve nasal function and aesthetics. Humps due to the prominence of bone and cartilage can be reduced incrementally. Any deviations of buckling of the septum can also be corrected. This approach provides clear exposure of the cartilages that determine the shape of the nasal tip. As a result, careful refinement of these cartilages can be performed very effectively.

The open approach provides the surgeon with maximal exposure of nasal anatomy and allows for very precise correction of aesthetic and functional deformities. The technique is useful in correction of nasal deformities due to previous fracture, and noses that have significant deviations of the nasal septum.

Closed Rhinoplasty

Closed-Rhinoplasty-300x225The “closed” technique involves using intranasal incisions exclusively to expose the structures of the nose. The technique is useful in correcting more isolated and/or minor deformities of the nose, and in removing isolated septal deviations. While the technique involves fewer incisions and may have less postoperative swelling, it does not offer the same amount of direct exposure and precise control of nasal anatomy.

In either techniques, functional and aesthetic refinements often require the use of cartilage grafts to improve the internal support of the nasal framework. Benefits of cartilage grafts include:

  • Support of the internal nasal airway, thereby improving airflow and relieving obstruction
  • Correction of septal deviation and straightening of the nasal dorsum (the visible surface of the nose)
  • Improving tip shape and projection

If additional cartilage is needed to help reshape the nose, this cartilage is harvested from either inside the middle of the nose (nasal septum) or from the back of the ear. In rare cases in which septal cartilage is unavailable due to previous operation or injury, grafts can be harvested from a segment of rib cartilage.

What Can I Expect During My Rhinoplasty Recovery?

Most of our patients do not experience significant discomfort following their rhinoplasty procedure, and any discomfort is usually resolved with prescription pain medication. Dressings, nasal splints, or external nasal casts are used to protect the nose and expedite healing, depending upon the rhinoplasty technique used for your individual procedure. While some patients may feel a slight numbness in the tip of the nose immediately after surgery, this tends to dissipate after a few months.

During the first days of recovery, you should elevate your head and apply a cold pack to help reduce any swelling. After a few days, you will return to our office allowing your surgeon to remove your dressings and/or splints. Most patients are able to return to work within 1 week of surgery. While at this time you will likely be able to see changes in the appearance of your new nose, the final results will be fully visible 6-12 months after the procedure.

How Much Does Rhinoplasty Cost?

Dr. Zemmel and Dr. Dassoulas customize each rhinoplasty procedure to address the unique concerns of the individual. As a result, the cost of rhinoplasty surgery varies from patient to patient. According to the American Society of Plastic Surgeons’ 2017 statistics, the average cost of rhinoplasty in the U.S. is $5,125 (not including surgical or anesthesia fees).

There are a number of factors that can impact the total price of your rhinoplasty, including the technique used to perform the procedure, surgical facility fees, anesthesiologist fees, and the overall complexity of the procedure. When comparing the cost of rhinoplasty among different plastic surgeons, we recommend you keep in mind that the geographic location of the plastic surgery practice as well as the experience of the plastic surgeon often impact the total cost. Some practices will also quote the estimated cost of the procedure without including the operating facility or anesthesia fees. Make sure to ask what is included and excluded from any price estimates you receive during your research.

When rhinoplasty is performed to restore lost functionality or improve the functionality of the nose, the procedure is typically covered by a patient’s health insurance provider. In these circumstances, cosmetic improvements may also be performed simultaneously while still being covered under your plan. Patients may still be responsible for a co-payment or meeting a deductible requirement. If you would like assistance navigating your health insurance benefits, a member of our staff would be happy to assist you.

Health insurance providers do not typically cover the cost of rhinoplasty when the procedure is performed for exclusively cosmetic reasons, as this type of surgery is considered “elective.” If you are considering rhinoplasty for the aesthetic improvement of the nose, we offer a number of facial surgery financing options that can make the cost of the procedure fit more comfortably within your budget.

What Is Revision Rhinoplasty?

In addition to primary rhinoplasty, Dr. Zemmel and Dr. Dassoulas are experienced in performing nose surgery for patients with issues resulting from a previous procedure. If you are unhappy with the results of a rhinoplasty performed by another plastic surgeon, we can develop a customized plan to achieve the outcome you originally desired. Some patients who still do not breathe easily after rhinoplasty may also seek revision rhinoplasty to improve proper functionality. Revision rhinoplasty is an especially complex procedure since the surgeon must work with scar tissue that has developed from the previous surgery. With a combination of surgical scar and his artistic eye, Dr. Zemmel and Dr. Dassoulas can reconstruct this delicate area of the face with beautiful, natural looking results. To learn more about revision rhinoplasty, please schedule a consultation today.

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