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Rhinoplasty (Nose Job) in Los Angeles, CA

Dr. Neavin has advanced training in rhinoplasty surgery and revision rhinoplasty surgery from an advanced aesthetic surgery fellowship under world renowned rhinoplasty and fat grafting surgeon, Dr. Richard Ellenbogen.

Rhinoplasty, or nose surgery, is one of Dr. Neavin’s favorite surgeries. It is literally surgery of sub millimeters. Patience, precision, and attention to detail are the keys to beautiful, long lasting results with rhinoplasty. Dr. Neavin’s  approach might be different than many other plastic surgeons.

The nose should not be viewed as an independent unit on the face. The nose is just one subunit of the entire face including the chin, mid face, and lips. Therefore, one should always evaluate the chin projection and mid face projection and lip aesthetics so that all units are in balance. A balanced face is important to frame a beautiful nose. And a beautiful nose is the centerpiece of a beautiful face.

When we look at the nose, we actually measure it in our minds to its base at the mid face and its relation to the chin. Therefore,   facial fat grafting is often included at no additional cost with  rhinoplasty to balance the mid face with the nose. Surprisingly, sometimes patients who want a nose job don’t really need one. Large noses can sometimes be “corrected” by augmenting the chin and mid face with fat and small chin implants. The result is often a more balanced face and a rejuvenated, younger face.

Depending on whether the septum was corrected or portions of it were used for grafting, the nose may or may not be packed for as long as five days.  If the nose is fractured, a Rhinoplasty (nose job)

Rhinoplasty refers to the reshaping of the nose mainly for cosmesis.  Because the nose is the centerpiece of the face, an unattractive nose can make on feel self-conscious, and not pretty or handsome.

The areas generally addressed, when it comes to nose reshaping, include the dorm (hump  or bump), the tip, the ala (area that surrounds the nostrils, the columella (the column between the nostrils), the projection (how far the nose sticks out from the face, then angle (how much is the nose upturned or tilted, and many other features.

Rhinoplasty almost always includes an analysis of the chin,  cheeks, and lips.  Chin projection (or lack thereof) will necessarily change the relative size of the nose and even influence the shape.  Small chins make a nose look more projected.  Also, flat cheeks will have the same effect.  The lips can also affect how we perceive the nose.  The upper lip, in particular, is intimately related to the nose and can either complement one another or steal its partner’s beauty.

Corrective breathing can be one component of rhinoplasty.  Enlarged inferior turbinates or a deviated septum can reduce airflow through the nose making breathing difficult.

For more information on commonly, asked questions visit the FAQ section.

Am I a candidate?
Candidates for this procedure may have a hump, a pinched nose, boxy tip, bulbous tip, plunging tip, hanging columella, widened nose, or some cosmetic deformity.  The list of potential disharmonious features that can rob a face of its inherent beauty is indeed long.

A large percentage of rhinoplasty patients fall into the category of revision or secondary procedures.  This is because Rhinoplasty is a surgery of sub-millimeters, and, there is some component of healing unpredictability that affects the outcome in about fifteen to twenty percent of patients.  Often, it may take years for unpredictable healing to manifest in the nose causing some visible deformity.  Thus, experience in technique and plan are crucial.
Often, potential future issues such as dropped tip, plunging tip or inverted V deformity can be predicted and accounted for. The addition of such things as spreader grafts to maintain a natural looking shape to the mid-nose, columellar struts for extra tip support, and division of the depressor nasals muscle to avoid tip drop with smiling, etc.

The best candidates are men or women who have an obvious deformity that is correctable with either surgery or injectables.  For more information about non-surgical rhinoplasty click here.

Patients must also be willing to accept the trade-off of prolonged swelling of the nose after surgery.  Final refinements, particularly of the tip, will not be one hundred percent visible for months following surgery.  Nasal tip edema can persist for a year in both open or closed approaches.  For more information on open and closed rhinoplasty visit the FAQ page.

Poor candidates include men or women who recently had rhinoplasty surgery.  Because the nose stays swollen for a prolonged period, it is sometimes necessary to wait at least six months or even up to a year to operate.  The swollen tissue is not only harder to dissect, but they also hide or camouflage irregularities that will otherwise be visible when swelling subsides.

The Consultation
Plan for about a 1 to 1.5-hour visit to the office for your consultation with Dr. Neavin. He will want to review your medical history, medications,  and any prior nasal surgeries.  Dr. Neavin will examine your nose and may even take photos to render potential “after’ nose shapes.

Patients who have had a prior rhinoplasty have to wait until swelling subsides before going under the knife again. This can range from a couple of months to up to a year depending on region and type of prior surgery. Small deformities may be correctable simply with injectables and may not necessarily need months to address. During the visit, you may wish to have your nose injected the same day. Because the procedure can be performed in 30 minutes or less, this request often doesn’t need additional scheduling.

During the consultation, you will be asked very specific questions about the shape and size of your nose that bothers you.  Many men and women will bring in photos of noses that they like, or wish to “have.”  This is helpful because it helps set the stage for expectations.  Some noses are easier to shape than others, depending on skin thickness (which is next to impossible to change).

Often, men or women don’t know precisely what they want to be changed.  They may only ask for a prettier or more handsome nose that fits their face.

Chin projection, face projection, neck, and the lips will all be assessed together since the nose is often treated congruently with the surrounding facial features.  Renderings of stronger chins or tighter necks can help deliver to the potential patient a good idea of how small modifications in these areas can contribute to improving nose shape.

Surgical details
Rhinoplasty can be performed either “open” or “closed”.  Dr. Neavin uses both approaches depending on the goals and plan.

Open procedures will allow better visualization of the tip area and allow for some skin defatting to help refine the nose.  The open approach uses an incision in the columella (tissue between nose).  The scar that results from this is almost always not visible.  The open approach may result in longer swelling.

In a closed approach, the tip is not visualized unless one performs a cartilage delivery technique.  However, even with this modification of a closed rhinoplasty, less precise tip work can be conducted.  And, one can’t easily de-fat the nose without opening it.  The only real advantage to a closed rhinoplasty is no potential scar on the columella and less post-operative edema.

For cases where the tip needs no refinement, and the majority of the surgery is focused on a hump, the closed approach is often the best approach.  If tip work or defatting is involved, then the nose is almost always opened.

In cases of revisions, the nose may be open or closed depending on the correction desired.

The surgery is performed under general anesthesia and can take up to three hours.  Often, fat grafting and chin augmentation is performed during a rhinoplasty better to frame the new centerpiece of the face.  Other combinations commonly performed include lip lift or lip augmentation in women and neck lift in men.

Sometimes, cartilage is taken from the nose (septum or lower later cartilages) and used for either nasal support (as is the case with a columellar strut) or cosmetic grafting (such as a tip graft to refine the tip) or spreader grafts to improve the shape of the middle of the nose.

Recovery
Depending on whether the septum was corrected or portions of it were used for grafting, the nose may or may not be packed for as long as five days.  If the nose is fractured, a splint will be placed for a week.  If it is not fractured, then tape will be worn on the nose for a week.  Stitches in the nose would be removed on day 7 in the office if an open approach was performed.  If a closed approach were performed, all of the stitches would dissolve.

For the first week, it is wise to sleep with pillows.  Some minor bleeding or “oozing” may occur for a few days following rhinoplasty.  Any significant bleeding is unusual and would warrant a call to 911 or Dr. Neavin immediately.

The nose, especially the tip, will remain swollen for months.  The majority of the swelling will subside within a few weeks.  But persistent tip edema is common for up to 6 months or more.

Asymmetry from swelling is not uncommon. Also, diet will play a role in swelling.  High salt diets for the day will result in more tip edema the following day.  Sleeping with the head elevated will help relieve morning swelling.

If the nose is fractured, there is a high likelihood of bruising around the eye.  Usually, this will dissipate within a week.

If chin augmentation, neck lift, or fat grafting is performed with the rhinoplasty, please refer to their respective sections to learn more about their recovery.

Results
Final results in the tip region may take up to a year to see.  The tip will stay sightly swollen and a little form for six months or more.  The nose will probably appear over-rotated for the first month or two.  Much of this is due to swelling.  The nose will drop a hair after swelling subsides.

Scars
A closed rhinoplasty will leave no visible scars unless Weir excisions are performed.  A weir excision is the excision of a portion of the ala to reduce the width of the nostril area.  This procedure, because it can be performed under local anesthesia, is commonly done in the office after the nose has healed since healing can slightly change the nostrils.

Schedule
To schedule your consult with Dr. Neavin, call the office 310.858.8811.  Be sure to ask about free parking or a valet option.

View More Rhinoplasty Before & After Photos

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Part of the aging face is actually seen in the nose. Young noses are thinner and perkier with an obtuse angle from the lip to the nose. As we age, the nose tends to widen and drop. Combination fat grafting to the face and rhinoplasty is a very powerful combination to take years off either a man or woman’s life.

OPEN VS CLOSED RHINOPLASTY

Rhinoplasty can either be performed open or closed.  Open rhinoplasty will include a small incision in the columella.  The tissues in an open rhinoplasty are dissected off the underlying cartilage framework and bone and allows a very good view of these components.  Because of this wonderful exposure, open rhinoplasty is often used for tip surgery (such as a boxy or bulbouse tip).  The incision heals nicely and scars here are almost always virtually imperceivable.  The small downside to the open approach is perhaps prolonged tip swelling.  While a closed rhinoplasty tip may be swollen for 6 to 9 months, an open approach may result in swelling up to a year.  However, the majority of swelling that results from both approaches subsides in the first 3 months.

The closed approach spares an incision through the columella.  The operation for the most part is performed with limited visibility.  However, with a solid understanding of anatomy, not all of the structures need be visualized.  For instance, the tip can be reduced internally without exposure of the entire cartilage framework.  In other forms of the closed technique, the cartilage can be “delivered” for exposure.  While the nasal tip is poorly visualized in a closed approach,  the dorsum and its hump can be visualized quite readily and reduced without difficulty.  For this reason, it often makes sense to perform a closed rhinoplasty when only humps need to be taken down or the nose needs to be narrowed.

Dr. Neavin performs both closed and open rhinoplasty depending on the patient’s anatomy and desires.

With an evaluation for rhinoplasty, Dr. Neavin will discuss a surgical plan that may include facial fat grafting, chin augmentation, neck contouring,  or lip enhancement.  While not all rhinoplasty procedures “need” improvement of these areas, when they are in balance the nose necessarily will look better in relation the face.  This is at the heart of the art of rhinoplasty.


Non-surgical rhinoplasty or liquid rhinoplasty

What is a non-surgical rhinoplasty?

A non-surgical rhinoplasty refers to correction of a nasal deformity using injectables (fillers) rather than surgery. It can be done in the office under local anesthesia in just under 30 minutes.

What products are used?

Hyaluronic acid such as Restylane®, Jevederm®, Perlane®, Lift®, or Voluma® can be used. Radiesse® which is calcium hydroxylapatite is also a good product for this procedure.

How is it done?

In a non-surgical rhinoplasty, one must ADD volume. Surgery is generally subtractive in nature where cartilage is removed and bones are either broken or filed down. With “humps” on the nose, the deformity can be viewed 2 ways: One, the hump sticks out too far. Two, The area above the hump doesn’t protrude enough. When we think of humps as the latter, the solution can be as simple as fillig in the “depression” above the nose. This in turn will blend the hump into the nose without making it look bigger.

Product is simply injected into the dorsum of the nose , under the skin, up to where the nose takes off from the forehead.

Another use of this technique is to correct “pinched tips” from prior rhinoplasty. Or, create symmetry on front view. Product added to the sides of the nasal tip will fill in the pinch. Often in cases of asymmetry volume addition to one nasal sidewall will fix the deformity.

Am I a candidate?

Candidates for this procedure have a hump, a pinched nose, or some type of deformity. Collapsed noses from over resection from a prior rhinoplasty may also benefit. Men and women who have had a rhinoplasty within the last 6 months may still be too swollen for this procedure.

The Consultation

Plan for about a 1 to 1.5 hour visit to the office. Dr. Neavin will want to review your medical history and any prior nasal surgeries. Patients who have had a prior rhinoplasty generally have to wait until swelling subsides. This can range from a couple of months to up to a year depending on region and type of prior surgery.
During the visit you may wish to have your nose injected the same day. Because the procedure can be performed in 30 minutes or less, this request often doesn’t need additional scheduling.

ResultsThe results are immediate. The photo below was taken immediately after injection. Unlike surgical rhinoplasty that has some unpredictable element of healing, a non surgical rhinoplasty is “what you see is what you get” immediately. Depending on the product, the correction can last 1 to 2 years.

Procedure Details for Non-Surgical RhinoplastyTopical anesthesia will be placed on the nose. With a fine needle, the product will be injected into the deformity.  The most commonly used fillers used are Restylane, Juvederm, or Radiesse.  For more on specific properties of fillers, please visit the “injectables” section (link)

Depending on the area, tape may be applied for a couple of days to a week to “hold” the product. While this isn’t always necessary, the tape can help stabilize the product if a significant amount was injected into the glabella area (where nose joins forehead). After the procedure, you may go home. Pain medications can be prescribed but are not necessary.

Recovery
Unlike surgical rhinoplasty, the swelling is minimal, and bruising is unlikely. Depending on the product, correction may last a year to 2 years.

Results
The results are immediate. The photo below was taken immediately after injection. Unlike surgical rhinoplasty that has some unpredictable element of healing, a nonsurgical rhinoplasty is “what you see is what you get” immediately. Depending on the product, the correction can last 1 to 2 years.

Scars
A small needle is used. This leaves no scars.

Lint will be placed for a week.  If it is not fractured, then tape will be worn on the nose for a week.  Stitches in the nose would be removed on day 7 in the office if an open approach was performed.  If a closed approach were conducted, all of the stitches would dissolve.

For the first week, it is wise to sleep with pillows.  Some minor bleeding or “oozing” may occur for a few days following rhinoplasty.  Any significant bleeding is unusual and would warrant a call to 911 or Dr. Neavin immediately.

The nose, especially the tip, will remain swollen for months.  The majority of the swelling will subside within a few weeks.  But persistent tip edema is common for up to 6 months or more.

Asymmetry from swelling is not uncommon. Also, diet will play a role in swelling.  High salt diets for the day will result in more tip edema the following day.  Sleeping with the head elevated will help relieve morning swelling.

If the nose is fractured, there is a high likelihood of bruising around the eye.  Usually, this will dissipate within a week.

If chin augmentation, neck lift, or fat grafting is performed with the rhinoplasty, please refer to their respective sections to learn more about their recovery.

Schedule
If you think you may be a candidate for rhinoplasty and would prefer a minimally invasive approach, schedule a consult my calling 310 858 8811. Be sure to ask about free parking or a valet option.

Nose Job Before & After Gallery