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Cosmetic Surgical Procedure

The nose is one of the most important determinants of our appearance. Historically, it helps define beauty and attractiveness. Features like a bump, crooked bridge and large or drooping tip can upset the delicate aesthetic balance. Rhinoplasty, or nose job can restore that balance. Nasal surgery can be cosmetic or medical to improve function or breathing. Both are commonly done together. The cosmetic portion requires a keen aesthetic sense and the surgical technique of an experienced surgeon.

Indications for Rhinoplasty

Cosmetic reasons include personal desire for a different shape or size nose or appearance after an injury. Medical reasons include breathing and functional problems. It's important to balance nasal appearance with your facial aesthetics. Dr. Gewirtz will help you plan your procedure based on that balance and your desires.


Dr. Gewirtz will help you define your goals and explain the best way to achieve them. Patients often return after initial discussion to further refine their goals. Your general health will be assessed. Possible functional problems will be assessed by history and internal nasal exam

The Surgery

Rhinoplasty can be performed by open or closed technique. The classic closed procedure uses incisions inside the nose with no external incision or possible scar. The open technique adds a small external incision in the base of the columella, which separates your nostrils. That incision usually heals imperceptibly. The open technique allows direct vision of the anatomy. More precise alteration of the nasal structures is possible. Dr. Gewirtz performs both types. Open rhinoplasty is more suited to a very asymmetric nose which may need a cartilage graft. Neither technique allows for narrowing of the base of the nose and nostrils. This may require alar base resections which use an external incision. Common problems include a nasal bump or hump, wide bridge of the nose and the nasal tip not being refined or sharp enough. The tip can also droop too low, especially with smiling and talking. The procedure is usually done under general anesthesia, although local anesthesia with sedation is possible.


A splint on the bridge of your nose and sometimes packing within the nose is placed. Pain is modest but internal swelling impedes nasal breathing for about one week. Swelling is variable and can be minimized by application of ice and keeping upright. Appropriate pain medicine will be prescribed for your comfort. The external splint is removed at one week. Most people return to school or work at one week and contact sports at six weeks. It's best to sleep on your back or side for several weeks. Bruising can last about two weeks and minimal swelling up to six months.

Can Nasal Surgery Improve Breathing?

Cosmetic rhinoplasty doesn't improve breathing. If a structural problem such as deviated septum, enlarged turbinate or sinusitis exist they are usually treated at the same time and this can improve breathing.

Is There Much Bruising? 

If the bones are fractured to narrow the nose, bruising is more common but really varies from one person to another. Covering make up can be used after a week.

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