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521 Park Avenue, New York, NY 10065
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Steven J. Pearlman, MD, FACS Dual Board Certified in Facial Plastic Surgery

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Rhinoplasty Surgery


Rhinoplasty, also known as a nose job, is a surgical procedure that improves the appearance of the nose. Nose surgery, septoplasty, or septorhinoplasty can also correct breathing problems associated with structural issues involving a deviated septum and nasal wall support called the nasal valve. Rhinoplasty can refine the shape, angle, width, structure, and other nasal features for individuals who are dissatisfied with the appearance and function of their noses. At his New York, Park Avenue practice, Dr. Steven Pearlman regularly performs rhinoplasty for men and women from across the United States as well as many international patients. He also frequently instructs other surgeons on both primary and revision rhinoplasty, lecturing on the most up-to-date techniques used for nose surgery around the world.

Who Can Benefit From Rhinoplasty?


Patients who are dissatisfied with the appearance of their nose can benefit from rhinoplasty. Rhinoplasty can correct the outer shape, size, and projection (how far the nose sticks out from the face) of the nose and/or nostrils to balance the facial features and improve facial harmony. Aesthetic issues that may lead a person to pursue rhinoplasty include genetic abnormalities, congenital deformities, and injuries. Mirror® 2D and Vectra® 3D Computer Imaging are made available for patients to view the projected outcome of their rhinoplasty during their consultation. Dr. Pearlman performs rhinoplasty to achieve the best aesthetic results for the patient’s unique anatomy, personal preferences, and ethnicity.
The shape and position of the internal structures of the nose have a tremendous effect on the patient’s ability to breathe. Patients who have difficulty breathing through their nose can undergo nose surgery to straighten a crooked wall between the two sides of the nose. This procedure, known as septoplasty, can straighten a crooked septum to improve the nasal airway without altering the outward appearance of the nose. If desired, septoplasty and rhinoplasty can be combined (known as septorhinoplasty) to improve both the function and aesthetics of the nose.
Individuals who have undergone one or more prior rhinoplasties with less than ideal results may benefit from revision rhinoplasty with Dr. Pearlman. Revision rhinoplasty restores the form and function of the nose and is ideal for individuals who may have a pinched or upturned nasal tip, notched nostrils, collapsed or narrow bridge, breathing difficulties, or other related issues. Any patient seeking a secondary rhinoplasty should only work with a surgeon who is experienced in performing revision rhinoplasty, as it requires an advanced level of technique and surgical skill.

Rhinoplasty Options


Traditional (Surgical) Rhinoplasty


Surgical rhinoplasty may be performed using an open or closed technique. The appropriate technique will depend on the patient’s specific needs and preferences.

*Closed Rhinoplasty
  • Performed under general anesthesia or twilight sedation
  • Extremely low chance of visible scarring; all incisions are internal
  • Less postoperative swelling
Open Rhinoplasty
  • Performed under general anesthesia or twilight sedation
  • Allows the surgeon the most visibility throughout the procedure when there is distorted anatomy, such as in revision rhinoplasty
  • Incisions are made on the underside of the nose
  • Dr. Pearlman’s primary reasons for performing open rhinoplasty are a crooked nose, marked reduction in nasal tip projection, and complex revision rhinoplasty
*Although Dr. Pearlman can expertly perform both techniques, he uses closed rhinoplasty for many primary rhinoplasties and has over 30 years of experience doing so. Equal (if not better) results can be obtained without an incision across the bottom of the nose when the surgeon has experience in thousands of rhinoplasties and an in-depth understanding of nasal anatomy.

Non-surgical Rhinoplasty


Some individuals choose to have their rhinoplasty completed without invasive surgery. Fillers such as Restylane® and RADIESSE® can be injected into the nose to add volume, camouflage a nasal hump, raise the tip of the nose, and hide minor imperfections. This procedure works well but produces only short-term results, and the effects are not long lasting like they are with surgical rhinoplasty.

Non-surgical rhinoplasty can temporarily treat:
  • Bumps on the bridge of the nose in patients who have a deep nasal root
  • Under-projected nasal tip
  • Minor depressions on the nose
  • Asymmetry of the nose

Septorhinoplasty


If you have a deviated septum and would also like to improve the appearance of your nose, septoplasty and rhinoplasty are very commonly performed together as one operation, known as septorhinoplasty:

  • Achieves functional restoration and cosmetic improvement
  • Addresses both architectural form and function of the nose
  • Alters the septum (the bone and cartilage that separate the left and right airways of the nose) as well as the outer shape, size, and projection of the nose and/or nostrils
  • May include both open and closed (endonasal) surgical approaches

Rhinoplasty Procedure Details

Preoperative Surgical Preparation


Patients should undergo a medical evaluation before undergoing surgery. Dr. Pearlman also asks his patients to refrain from smoking and taking certain medications for several weeks before and after rhinoplasty to ensure a safe and effective procedure.

Surgery Day


We perform most of our rhinoplasty and revision rhinoplasty procedures in our AAAHC certified operating facility and have done so safely for over 16 years. The procedure is performed with the patient under either general anesthesia or twilight sedation administered by an anesthesiologist. Dr. Pearlman will use either the closed or open surgical approach as determined during your consultation. After adjusting and reshaping the nasal cartilage and bones to improve the appearance of the nose, Dr. Pearlman will close the surgical incisions with dissolvable internal sutures. For open rhinoplasty, external sutures need to be removed approximately one week later.

Postoperative Recovery


An external splint will be used to hold the nose in place, and bandages will be applied for protection. External sutures and the nasal splint will be removed at a later date during a follow-up appointment with Dr. Pearlman. Internal sutures do not need to be removed. Prescribed medication can alleviate any discomfort during recovery. Swelling and bruising will be noticeable after surgery and will persist for a few days to a few weeks. Some swelling of the nasal tissues may continue for several months. We utilize delicate surgical techniques and Arnica Montana to reduce swelling and healing time. Patients should carefully follow all of Dr. Pearlman’s recommendations for taking medications, changing bandages and dressings, returning for follow-up appointments, and notifying Dr. Pearlman of any unusual developments. Most patients will be able to go back to work a little over one week after surgery.

Results


As the nose heals over the weeks and months after surgery, patients can anticipate an improved appearance that will be long ­lasting. Patients who undergo septorhinoplasty can also enjoy improved nasal breathing after swelling subsides. The results are meant to be permanent, although the nasal cartilage and tissues may shift slightly over time due to the natural process of aging. Most patients will see 85% of the final result at one month, 95% by six months, and 98% by one year. The tip of the nose is the last part to show swelling and may continue to get smaller for a year or more, especially in patients with thick skin.

Before & After Images


Move arrows to see before and after images
Before-1 After-1

**Results May Vary

Before-2 After-2

**Results May Vary

Before-2 After-2

**Results May Vary

Before-4 After-4

**Results May Vary

Dr Pearlman did a great job and I would recommend him to anyone for facial surgery. I thought he could have answered my questions and concerns a little more in depth before the surgery and even after, but he really knows what he is doing. I didn’t feel like I could totally ask him anything I want without being annoying, but maybe I am just used to people in that business who are a little more chatty. In the end, I was very happy I chose him."

Frequently Asked Questions


Open rhinoplasty allows better visualization of distorted nasal anatomy when the nose is very crooked, when the nose is significantly over-projected (sticks out very far), or when Dr. Pearlman is performing a complex revision rhinoplasty. In these cases, the open technique allows for more precise correction and easier manipulation of the nasal cartilage and graft placement. The incision is very tiny; in most circumstances, it is visible only up close to the trained eye. With sunscreen protection, the scar should fade.
During your rhinoplasty consultation, Dr. Pearlman will examine the inside of your nose to check for a deviated septum, a narrow internal valve, and/or inflammation or swelling of the turbinates. This examination will reveal whether septoplasty is necessary to improve nasal breathing.
The best age for rhinoplasty candidates begins in late adolescence or early adulthood. However, patients may undergo rhinoplasty earlier in life as long as nasal growth is complete. The procedure may be appropriate for girls who are at least 15 or 16 years of age and boys who are 16 or 17. It is important for teens to be emotionally mature and prepared for the procedure. Visit our page on teenage rhinoplasty for more information. We have also performed rhinoplasty on patients into their 70s for functional and associated cosmetic reasons. Tip rhinoplasty can make an aging face appear younger.
Traditional heavy nasal packing is not necessary after most rhinoplasties. Dr. Pearlman usually applies a very light internal dressing for the first night only.
Mirror® 2D and Vectra® 3D are great tools that allow Dr. Pearlman and his patients to effectively communicate what they would like to achieve with surgery. They also give patients a reasonable expectation of the potential results. Dr. Pearlman has been successfully using computer imaging in conjunction with rhinoplasty since starting in practice almost 30 years ago.
Rhinoplasty is not usually covered by medical insurance. However, septoplasty may be partially or fully covered depending on your insurance policy. Patients who choose to undergo septoplasty or septorhinoplasty should contact their insurance providers to determine their eligibility for coverage and out-of-network benefits. We can help with this process and have an insurance expert who can help determine benefits.

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