What is Rhinoplasty (Nose Job)?
Your nose is the central feature of your face and is likely one of the first things people notice about you. Having a flattering, symmetrical nose can significantly improve your overall appearance and confidence. However, a deviated septum, a misshapen, or abnormal nose, can disrupt facial harmony or cause impaired breathing. Fortunately, even minor tweaks to the nose can result in dramatic cosmetic improvements to the entire face.
Rhinoplasty, also known as “nose job”, is a surgical procedure that is performed to permanently change the shape and size of the nose, correct breathing problems, or fix a deviated septum. Aesthetic treatment goals may include reducing or increasing the size of the nose, narrowing the span of the nostrils, or reshaping the nose and tip. Rhinoplasty surgery can also help patients achieve various corrective goals, such as improving breathing function and repairing a congenital disability or injury.
Rhinoplasty Before and After Photos
* Each patient is unique and individual results may vary.
Rhinoplasty Philosophy
Dr. Bustillo’s personal philosophy regarding rhinoplasty is a fusion of the craft he learned from his mentors and his personal experience after performing hundreds of nasal surgeries. His philosophy continues to evolve as he serves patients and works to provide the best possible results using rhinoplasty to correct the nasal structure.
He learns every day after evaluating every one of his surgical results. He continuously strives to deliver a natural result that will last throughout the patient’s life.
Figure 1
A “ski slope” nose from the 1970’s
Figure 2
Before and after rhinoplasty result by Dr. Bustillo
Figure 3
Closed rhinoplasty. Note the cartilages being delivered.
For the last fifteen years, there has been a great debate on whether the rhinoplasty Miami operation should be performed in an open or a closed fashion (Figure 3). However, these are only approaches. They are called approaches because they are simply the method the surgeon uses to assess the areas of the nose that need to be altered. They are not techniques.
Figure 4
Open rhinoplasty columellar incision
Figure 6
Before and After open rhinoplasty incision Dr. Bustillo
Figure 7
Before and After open rhinoplasty incision Dr. Bustillo
Figure 8
Before and After closed rhinoplasty by Dr. Bustillo
Techniques are the methods that the surgeon uses to change or alter the specific anatomic areas of the nose. The “open” or external approach involves an incision in the columella, or the column between the nostrils (Figure 4, 5, 6, 7). The “closed” or endonasal approach involves a series of incisions inside the nose.
One approach is not better than the other. They are different and each one is used for different types of noses. Having the operation performed in one way does not guarantee a better result.
Instead, Dr. Bustillo believes that there are noses that may be better served with the closed approach and some that are better treated with the open approach. He performs both the open and closed approaches, depending on the nose.
For example, a nose with a perfect nasal tip and a small hump may be best treated with a closed approach to reduce the nasal hump (Figure 8). The advantage, in this case, is that the tip is not distorted, the surgery is less traumatic, and the recovery is faster.
A nose with a weak and wide nasal tip and a hump may be better served with an open approach. The tip can be strengthened and narrowed with dome sutures and the hump reduced. The advantage is that all of the elements of concern can be addressed and an excellent result is achieved.
Because all noses are different and the rhinoplasty operation should be individualized for every patient, the doctor believes that rhinoplasty surgeons should be versatile and capable of performing both the “open” and “closed” approaches.
The Rhinoplasty Procedure
Over the past decade, great advances have been made in the art and science of rhinoplasty. In the past, rhinoplasty was performed in a reductive manner. In fact, there are still many surgeons that perform rhinoplasty in this fashion.
In reductive rhinoplasty, the surgeon removes much of the bone and cartilage to achieve a smaller nose. The nasal structure is reduced in size by cutting off and removing portions of the nasal tip cartilages. In essence, the structural framework of the nose is weakened and destroyed.
Figure 9
Bad rhinoplasty result performed by another surgeon
While most of these noses have a satisfactory appearance in the immediate post-operative period, their shape can continuously change for several years (Figure 9). This occurs as the healing and scarring forces take over a nose that has lost all of its structural support.
More often than not, the end result is a nose with a surgical appearance. In addition, removal of nasal tip cartilages can result in severe breathing problem that can be very difficult to correct.
Experience has taught modern rhinoplasty surgeons that simply cutting away the nasal tip cartilages can lead to functional and aesthetic complications. Today’s advanced rhinoplasty techniques shy away from removing the important structural elements from the nose.
Figure 10
Before and After thin skin rhinoplasty by Dr. Bustillo. Note excellent tip definition
Instead of removing cartilage, Dr. Bustillo reshapes it using specialized techniques. With the use of special sutures, the nasal tip cartilages are reshaped, to give a more defined nasal tip.
Because the sutures allow the surgeon to control the exact shape, this technique allows more predictable results. By placing the sutures on different locations on the nasal structure, the surgeon can change the shape of the cartilage without removing or cutting them.
Candidacy for Rhinoplasty Surgery
The decision to move forward with the rhinoplasty operation is a very important and personal one. You should consult with your surgeon and your family before scheduling the surgery.
For most patients that undergo the procedure, the results are life-changing. Patients describe an increase in confidence and boost in self-esteem. They can become more comfortable in social settings and feel better about how they photograph. In fact, many of our rhinoplasty patients wonder why they waited so long to have the procedure done.
The ideal candidate for nose surgery is a healthy person who is dissatisfied with their nose appearance, breathing problems or has deviated septum, and would like to have these issues improved. There is no ideal age for rhinoplasty, as Dr. Bustillo performs rhinoplasty in patients ranging from age fifteen and on. Female patients can undergo the rhinoplasty operation at age fifteen and male patients from sixteen on.
The patient must have proper expectations before undergoing surgery. Although with modern rhinoplasty techniques, results are better than they ever were, there are still limitations. It is important that the patient has a good understanding of what can be achieved. Clear communication between the patient and the surgeon is very important.
Surgeons are human and therefore are not perfect. While most rhinoplasty patients enjoy the benefits of an improved nasal contour and profile, it is important to remember that surgery, like all other human actions, is not perfect.
A skilled rhinoplasty surgeon can achieve near perfection. This achievement results from the coming together of artistic skill, impeccable surgical technique, and proper healing forces within the nose.
The Rhinoplasty Consultation in Miami
The consultation process begins with a discussion about the specific issues and concerns regarding the appearance of the nose, deviated septum, or breathing problems. Any functional problems are discussed at this time. For example, the patient should communicate whether there is nasal obstruction. This is often corrected during the rhinoplasty procedure.
A thorough physical examination is then performed. The nasal cavities are examined. The septum is examined for any deviations and any inflammation or swelling of the turbinates is noted. The patient is asked to inhale through the nose to observe the internal and external nasal valves. Any collapse found here will be addressed in the surgery to help improve breathing.
Figure 11
Before and After thick skin rhinoplasty by Dr. Bustillo. Note good tip definition
Figure 12
Wide and bulbous tip
The external nose is then carefully examined and palpated. The dorsum, or bridge of the nose, is examined for any humps that may have to be reduced. The nasal bones are then palpated for irregularities, asymmetries, or curvatures. The nasal tip is then examined and palpated. The tip is examined for support, fullness, and width (Figure 12).
Figure 13
Overprojected tip
The tip projection, which is the length of the tip from the base of the nose to the end of the tip, is examined. Tips that are too projected (Figure 13), or long, need to be reduced and those that are too short, may need to be lengthened. Tip rotation, which is the angle of the tip in relation to an imaginary horizontal line drawn at the base of the nose, is analyzed.
Tips that are under-rotated, or “droopy” (Figure 14) need to be rotated up, while tips that are over-rotated and appear “piggy” need to be de-rotated or brought down. Certain nasal tips that move when the patient talks or smiles may require strengthening.
Pre-operative pictures are then taken and computer imaging is done. Computer imaging involves the digital manipulation of the patient’s picture to evaluate the nose.
This is a fantastic communication tool that allows the wishes of the patient to be aligned with the surgeon. Dr. Bustillo wants the patient to participate in the process so that he can have their input when making the computer-generated image.
Using computer imaging will allow the surgeon to have a clear understanding of the patient’s aesthetic goals and help set the patients’ expectations. Dr. Bustillo will always give the patient a computer-generated image that he believes is achievable. In fact, he guarantees that the result will be extremely close to the computer-generated image.
Figure 15
Nasal hump and droopy tip (Pre-operative)
Figure 16
Rhinoplasty computer morphing
Figure 17
Rhinoplasty result by Dr. Bustillo. Note similarity to computer image
Figure 18
Bulbous nasal tip (Pre-operative)
Figure 19
Rhinoplasty result by Dr. Bustillo. Note enhanced tip definition
Preparing for Rhinoplasty Surgery
Patients undergoing cosmetic nasal surgery, are required to obtain pre-operative labs prior to surgery. If the candidate is over the age of forty-five or has certain medical conditions, Dr. Bustillo will request a medical clearance to be done before the rhinoplasty.
Patients should stop all aspirin, anti-inflammatory products (naproxen, ibuprofen), and vitamins such as A, ginkgo biloba, and St. John’s wort ten days before undergoing the rhinoplasty surgery. These products limit blood clotting and can cause excessive bruising around the nose and eyes.
Alcohol should also be avoided for five days before surgery to decrease swelling. Patients are required to start taking 2000 mg of vitamin C a day, starting one week before the surgery and then for two weeks after the rhinoplasty. This helps to reduce the swelling around the nose and speed the healing process.
Anesthesia
Dr. Bustillo performs rhinoplasty surgery on an outpatient basis in his certified surgical facility. The anesthesia is provided by board-certified anesthesiologists (MD), who are part of the Baptist Hospital Anesthesiology Department.
The rhinoplasty surgery is performed with general anesthesia. Dr. Bustillo and the anesthesiologists believe that this is the safest method to provide anesthesia for patients undergoing nasal surgery.
General anesthesia allows the anesthesiologist to protect the airway. In this way, any blood or secretions that may travel to the back of the throat do not enter the lungs and cause irritation.
IV sedation anesthesia, on the other hand, does not protect the airway during nasal surgery. Any secretions that travel towards the back of the throat may enter the lungs and cause irritation and coughing. The surgery usually takes about 2 hours to perform.
Risks of Having Rhinoplasty
Like every surgical procedure, there are some possible complications that can follow the rhinoplasty operation. Bleeding after the surgery is rare, but if it occurs, it can be controlled with measures such as cauterization or packing.
The risk of postoperative bleeding is about 1%. There is also the risk of infection, which is extremely rare and occurs less than 1% of the time.
Recovering From Rhinoplasty
The patient should spend the night of the nasal surgery relaxed. Activity should be kept to a minimum. A liquid diet is best for the first eighteen hours after anesthesia. The head should be kept elevated using two pillows to help reduce swelling of the nose and eyes.
Patients should place small zip lock bags with frozen peas on the eyes for 10 minutes, for every hour spent awake for the first 48 hours. This is done to help reduce swelling around the nose and eyes, which typically resolves in five days.
The postoperative period after rhinoplasty is not painful. Tylenol is usually enough to control any minor discomfort. You will be provided with additional pain medication, in the event that you need it. Occasionally, cotton is placed in the nose, which is removed on the first day after the surgery.
There is a small cast that is applied to the bridge of the nose. This is removed on the fifth postoperative day. Most patients can return to school or work six days after the rhinoplasty surgery.
There is a variable amount of swelling that occurs on the nose after the rhinoplasty operation. About seventy percent of the swelling resolves in the first three weeks.
It is recommended that physical activity, such as running or lifting be resumed only after the fourth week. The remainder of the swelling can take up from four to twelve months to completely resolve.
While the final results of the surgery may not be completely evident until several months after the surgery, most patients look better than before surgery right when the cast comes off. In about ten months or so, Dr. Bustillo will take before and after pictures of your nose and print them for you, so that you can them, along with the surgical record and drawings if you wish. Patients that undergo rhinoplasty are, by and large, extremely happy.
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Rhinoplasty Videos
Rhinoplasty FAQs
Dr. Bustillo performs the rhinoplasty procedure in an AAAASF certified facility.
Dr. Bustillo takes about two hours to perform the rhinoplasty procedure. Revision rhinoplasty may take longer.
Dr. Bustillo performs the rhinoplasty procedure using either the open or closed approach. If the open approach is used, a small incision in the columella is made. This incision heals very well and will not be noticeable once it is fully healed.
The closed approach is performed with incisions inside the nose. Dr. Bustillo will discuss with you what the best approach is for you.
Most patients who undergo the rhinoplasty procedure experience a mild pressure above the nose for about two hours after the procedure. From then on, most patients do not experience any pain.
Patients are generally able to return to work about one week after the rhinoplasty procedure.
If the rhinoplasty was performed via an open approach, the stitches will be removed on the fifth postoperative day.
The rhinoplasty procedure is not covered by insurance. Dr. Bustillo does accept insurance for functional surgery (such as septoplasty) that may be combined with your rhinoplasty procedure.
Today’s state-of-the-art rhinoplasty is very different from the rhinoplasty performed severalopen or a closed fashion years ago. One of the biggest changes that have occurred in the area of rhinoplasty is the use of grafts. Grafts are structural elements that are used to help shape the nose. As far as rhinoplasty is concerned, grafts are made of cartilage. By placing cartilage grafts in certain areas, Dr. Bustillo can change or alter the shape of the nose into a more pleasant one. While he does not use grafts in every rhinoplasty, he does use them in many procedures. The best cartilage grafts for rhinoplasty are obtained from the nasal septum, inside the nose. This is because the cartilage from the septum is strong and maintains its shape. These two qualities are not found in any other cartilage found in the body. If the patient has had a previous septoplasty, the doctor may take the cartilage grafts from the ear. This is done through a small incision that is hidden behind the ear. The ear does not change in shape or appearance after the cartilage is taken. The downside of using ear cartilage in rhinoplasty is that it is not as strong and it has an irregular shape.
The skin and the soft tissue that covers the bone and cartilage is an important part of the nose. It is important to understand how the thickness of the skin influences the result of the rhinoplasty. For example, patients with thin skin can achieve relatively good tip definition. In fact, great care must be taken with these patients so that all of the cartilage and bony edges are rounded, so there are no sharp edges. Dr. Bustillo avoids the use of certain types of grafts in these patients, so as to avoid any showing through the skin. The contouring of the bony and cartilaginous framework must be impeccable. Any small irregularity will be noticeable once the post-operative swelling has subsided. On the other hand, patients with thick skin are limited in the definition that can be achieved. Dr. Bustillo employs various techniques in order to attempt to achieve the maximum tip definition possible. For example, he may use tip grafts to help “push” the thick skin and obtain definition or use the support from the septum to provide nasal tip support. In addition, he will thin the skin from the inside to help improve the definition. The use of structural rhinoplasty is very important in patients with thick skin. The nasal tip must be strengthened in order to combat the extra weight of the thick skin. If the nasal tip is not strengthened, the extra weight of the skin will tend to drop the nasal tip, thus losing definition, projection, and rotation. Patients with thick skin may also encounter prolonged swelling and scar tissue formation. Dr. Bustillo will sometimes use steroid injections to help bring the nasal swelling down.
Most patients that undergo the rhinoplasty procedure experience a mild pressure above the nose for about two hours after the procedure. From there on after, the patients do not experience any pain.
Ethnic rhinoplasty refers to a rhinoplasty performed on a nose that is not of Caucasian origin. Dr. Bustillo believes that this is actually a term that applies to a great majority of patients today. Fifty years ago, the population of the United States was primarily of Caucasian descent. Today, the population of the United States is much more heterogeneous and has changed quite a bit. While there is a large Caucasian population, there is also a large population of many ethnic races. It is interesting to note the differences in nasal shapes and sizes among different races. For example, if you examine noses that originate in people from the northern part of the globe, you will find that they tend to have very thin skin, strong nasal tip cartilages, and nicely shaped tips. Think of a Swedish or Norwegian nose. As we go south to the Mediterranean, the skin becomes thicker and the tips become larger and droopier. Think of an Italian nose. As you go further south, into the Middle East, the skin becomes even thicker, with weaker nasal tip cartilages, and even droopier tips. Think of a Saudi Arabian nose. As you can see, ethnic rhinoplasty is a very broad term. It is important to select a rhinoplasty surgeon that is well versed in performing rhinoplasty in different types of noses, not just the Caucasian nose. Operating different ethnic noses requires that the surgeon be knowledgeable in the different nuances of the specific ethnicity with regards to their noses. Dr. Bustillo uses very specific rhinoplasty techniques for each different type of ethnic nose that he operates on.
What most patients say after having the rhinoplasty procedure with Dr. Bustillo is that they all wished they could have had the surgery sooner. Another common statement that Dr. Bustillo’s patients say is that they thought the recovery was going to be much worse. Both of these common statements say a great amount about how Dr. Bustillo takes great care to craft a beautiful nose while ensuring that the patients recover quickly and easily from their nasal surgery.
An ever-increasing number of patients travel to have surgery with Dr. Bustillo. Approximately 25% of the rhinoplasty surgeries Dr. Bustillo performs are from patients that travel from outside the United States; Central and South America, and Europe. Many patients travel from New York City, where the cost of rhinoplasty surgery is extremely high. Dr. Bustillo delivers excellent rhinoplasty results at a fraction of the cost of New York surgeons.
Dr. Bustillo has performed thousands of rhinoplasties and has many before and after photographs of his patients. He will be happy to show them during your consultation for your rhinoplasty. He will show you results that may be similar to yours so that you can have an idea of what your nose will look like after surgery.
The truth is that there is no one best rhinoplasty surgeon in Miami. Dr. Bustillo has been in practice for over ten years and has made thousands of patients very happy with his natural and conservative results. There are several things that a person should look for in a rhinoplasty surgeon. Facial plastic surgeons are dual boarded in otolaryngology (Ear, Nose, and Throat) and in Facial Plastic and Reconstructive Surgery and know the nose better than any other surgical specialty. It usually takes five to seven years for a surgeon to gain experience in aesthetic surgery. While there are many top surgeons, not everyone will have an aesthetic that may be in line with what you want. Make sure there is good chemistry and you believe that the surgeon can accomplish your aesthetic goals.
More questions about getting a Nose Job in Miami?
Schedule your rhinoplasty consultation with Dr. Andres Bustillo to learn more about your candidacy. Contact us today to schedule an appointment.
About Dr. Andres Bustillo
Dr. Andres Bustillo performs over 300 nasal surgeries a year, making him one of the most experienced nasal surgeons in South Florida. In addition to creating a beautiful nose, he provides incredible functionality.
Dr. Bustillo has been practicing facial plastic surgery for over ten years. He is one of the few double board-certified facial plastic surgeons, meaning he does not perform any breast or body surgery. Approximately 50% of his practice is devoted to rhinoplasty and revision rhinoplasty.
The doctor is known for providing the most natural and conservative rhinoplasty results. He delivers a “look” that fits and blends harmoniously with the patient’s facial features. Dr. Bustillo has enormous experience in rhinoplasty with different types of noses, such as Caucasian, Asian, Hispanic, African American, and Middle Eastern.
Andres Bustillo teaches students, residents, and other physicians the art and craft of rhinoplasty. He has been invited to Asia, South America, and the Caribbean where he has taught other plastic surgeons his rhinoplasty techniques. He has written and published several chapters on nose surgery.
He also holds the following credentials:
Why Choose plastic surgeon Dr. Bustillo?
- Castle Connolly Top Doctor for more than 10 years
- American Board of Facial Plastic and Reconstructive Surgery
- American Board of Otolaryngology-Head and Neck Surgery
- Facial Plastic & Reconstructive Surgery Fellowship at The New York University
- Otolaryngology – Head & Neck Surgery Residency at The University of Miami, Jackson Memorial Hospital
- General Surgery Internship at The University of Miami, Jackson Memorial Hospital
Our Practice in Miami, FL
Address
6705 Red Rd #602
Miami, FL 33143
Hours of Operation
Monday-Friday: 9:00am – 5:00pm
Saturday-Sunday: Closed