Rhinoplasty: Everything you need to know about getting a nose job

Commonly known as a nose job, rhinoplasty is one of the most common and in-demand cosmetic surgeries worldwide.

It's a procedure that alters the "size or shape of the nose" to improve the appearance and symmetry of the facial features, according to Johns Hopkins Medicine.

In the Philippines, going under the knife has become more socially acceptable compared to a decade ago. In fact, some public figures have been open about their rhinoplasty journeys, including Alex Gonzaga, Geneva Cruz, and "Pinoy Big Brother: Celebrity Collab Edition" alum Xyriel Manabat, to name a few.

In this GMA News Online exclusive, we spoke to two board-certified doctors who break down everything you need to know and more if you're considering getting a nose job.

Why do people get rhinoplasty?

People undergo rhinoplasty for both cosmetic and functional reasons. As Dr. Kaycee Reyes, an aesthetic dermatologist and the founder and CEO of Luminisce, explained, "Some want to improve how their nose looks for aesthetic reasons, while others need to fix breathing problems or structural issues."

Echoing Reyes' statements, Dr. Eduardo Yap, a resident EENT facial plastic surgeon and rhinoplasty expert at Belo Medical Group, said "certain techniques also improve breathing and overall nasal function, making the procedure both aesthetic and functional."

For the cosmetic side, Reyes said that "rhinoplasty is essentially nose sculpting."

"Imagine your nose as a piece of art that's already 90% perfect: the surgeon works like a skilled artist who makes careful, precise adjustments to improve the balance and harmony of your face," she said.

"They're not rebuilding your entire nose from scratch; they're refining what's already there," she added.

Preparing for surgery

Reyes noted that those planning to undergo rhinoplasty should be at least 90 to 95% of adult size, "which typically happens around 15 to 16 for girls and 16 to 17 for boys."

Before the surgery, Yap stressed that patients should be mentally "prepared that the surgical result varies with different individuals."

"Surgery is only an improvement of whatever structures the patient has," he said.

Agreeing with Yap's statement, Reyes highlighted that aside from being physically ready for the surgery, "emotional readiness is equally important."

"The patient should be in a stable place mentally and not dealing with major life changes like parents divorcing, switching schools, or ending significant relationships," she said.

She also advised patients to postpone rhinoplasty if they have recently experienced trauma or injury, are undergoing treatment for depression or anxiety, feel pressured by others instead of deciding for themselves, or hold unrealistic expectations about how surgery will change their lives.

The surgery proper

The length of surgery depends on the doctor and clinic but typically lasts between one and four hours.

At Luminisce, patients can choose to remain awake during the procedure without anesthesia, or they may opt for intravenous sedation or general anesthesia if they prefer to rest through it.

"Most of the work happens through tiny incisions inside your nose, so there are no visible scars," Reyes said.

"In some cases, surgeons make a small incision under the tip of the nose, but this heals to become nearly invisible," she added.

At Belo, however, patients need to be sedated under intravenous anesthesia.

"Since this surgery is lengthy, patients need to be monitored by an anesthesiologist," Yap said.

So what is exactly is being done? Doctors commonly use your own tissue, such as ear cartilage, to further define the tip of the nose. Sometimes, synthetic implants are used, such as silicone, but these have higher risk of complication.

"Once the tip is projected, the bridge is augmented to blend to the new tip," Yap said. "Occasionally nasal bones are  in-fractured to make the bridge narrower."

Road to recovery

Soon after the surgery, patients are advised to rest for a few weeks, though not remain confined to bed. Recovery is a gradual process that can take up to a year.

"Patients can have a daily bath from the neck down. Face can be cleansed with wipes. Dry shampoo may be applied to hair if needed," Yap said.

By weeks two to four after the surgery, Reyes noted that 60 to 70% of swelling subsides, allowing patients to get a glimpse of their new nose shape.

"While they can return to work or school, the nose remains tender and contact sports are still off-limits," she said.

"Between two to six months, the refining phase, the nose continues to settle as swelling gradually decreases and definition improves," she added.

The final look of the nose should be more visible after a year post-surgery.

At this point, Reyes explained, "The result looks like this is how the nose was always meant to be – people won't be able to tell the patient had surgery."

She also advised keeping an open communication with your doctors before and after the surgery.

"Ask questions during consultations, express concerns honestly, and maintain contact during recovery," she said.

Are there any risks to rhinoplasty?

While rhinoplasty is generally safe when performed by experienced, board-certified surgeons, there are still risks, as with any surgery.

"Synthetic materials may cause reaction, rejection, extrusion, and infection; however, the incidence is less than 1%," Yap said.

Meanwhile, Reyes said "serious complications are quite rare in rhinoplasty, especially when performed by a qualified plastic or facial surgeon."

However, Reyes said that it's possible to have a nosebleed during or after surgery.

"Some oozing in the first few days is normal, but significant bleeding is a risk, though not very common," she said. "If it happens, doctors can usually manage it with packing or cauterization."

"The key is to choose a surgeon with lots of rhinoplasty experience and follow all pre- and post-operation instructions, which together minimize risks," she added.

As with any surgery, Reyes also said there's a risk of infection, "though rhinoplasty infections are quite rare."

"Signs of infection to watch for would be increasing redness, warmth, swelling, or pus from incisions, or fever," she said. "It's uncommon, but it's something to be mindful of."

Is rhinoplasty permanent?

Rhinoplasty results are permanent, but aging still affects the nose over time.

According to Yap, "one has to consider the aging factor of the facial bones and skin system."

"The nose may lose a bit of the tip projection as one ages. However, it is still good-looking even in his/her senior years," he said.

In a similar sentiment, Reyes said that "aging effects are inevitable but predictable."

"Over 10-20 years, all noses experience some tip drooping due to gravity and ligamentous stretching," she said.

She also noted that 10 to 15% of rhinoplasty patients "undergo revision procedures" after their initial surgery.

"However, most revisions involve minor refinements rather than major reconstructions," she said.

Advice for first-timers

For those undergoing a nose job for the first time, Reyes emphasized the importance of taking one's time when making the decision.

"Rhinoplasty is an elective surgery that permanently alters your facial appearance," she said.

Reyes recommends a three to six months of "cooling-off period" between consultation and surgery, especially for patients under 25, to allow time for reflection.

"Choose your surgeon carefully, not your procedure location," she advised, noting that the cheapest option is rarely the best value.

Reyes also urges first-time patients to set realistic expectations.

"Your nose should look like a refined version of your natural anatomy, not like someone else's nose," she said.

Last but not least, Reyes advised that if patients feel uncertain, the best choice is to wait.

"Uncertainty suggests more time is needed for consideration, research, and emotional preparation," she said.

"The right time for surgery is when you've thoroughly researched your options, chosen an excellent surgeon, prepared financially and emotionally, and feel confident about your decision without external pressure," she added.

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