Rhinoplasty, or nose reshaping, is the second most popular cosmetic surgery procedure performed in the U.S.A. Sometimes this operation is performed for cosmetic reasons and sometimes to improve breathing through the nose. At his clinic in San Francisco, CA board-certified plastic surgeon, Dr. Leonard Gray, performs the procedures for both reasons.
Rhinoplasty can be performed using either a closed or an open approach. Closed rhinoplasty is performed most often when the tip of the nose is neither very large nor very asymmetric. It is the more appropriate surgical approach when the tip is not excessively droopy or ptotic. With the closed approach, the tip’s cartilage can be trimmed from inside the nostrils. Open rhinoplasty is more suitable for patients that have a bulbous tip, a drooping tip, or an asymmetric tip. During this cosmetic procedure, the nose is opened with an incision between the nostrils. This exposes the cartilages of the tip where they can be worked on.
"Second Time Around - Dr Gray performed my surgery 18 years ago and back then I knew he was the best . My results were incredible and his office was so welcoming and kind. I have moved out of the country to Europe but knew I would only trust him once again . Almost 20 years later the office staff still remains the best Cherisse his nurse is one of a kind and makes the whole process seamless even from out of town. I felt like I knew her for years. I did all my communication through emails until the surgery. So anyone who is considering from out of town it can be done. And Dr Gray is the best out there im sure of it, on a scale of 1-10 I give him a 11! I would very confidentially say he's probably the Picasso of plastic surgery and a real perfectionist."- K. / RealSelf / Aug 27, 2017
"This review is for my consultation only. The women who worked the front desk were so kind and welcoming. Made me feel really comfortable. Reading through the other reviews, it makes it very hard for me to believe that these people had a bad experience. Dr. Gray walked through his office like it was his home and treating everyone in it like they were part of his family. My consultation with him went above and beyond my expectations. He was very thorough and had very kind bedside manner. Sometimes when I read bad reviews, I will look at those people's profile to see what else they have reviewed and more times than not I will see that that person just can't be happy no matter what...anyways, this was for a consultation only, and mine was amazing."- L.N. / Yelp / Jun 29, 2017
"Amazing perfectionist plastic surgeon - I am so happy I found Dr. Gray! He is amazing and so is everyone at his office. One of my implants broke (it was 10 year old). I had a consultation and decided to remove them and then go back after I am done having kids for new implants and more work if need it. I am very happy with my results. Dr. Gray is a perfectionist. You can barely see the scar - it's been 3 weeks! The prices were..."- C. / RealSelf / May 27, 2017
"Amazing! - Ive had a few surgeries with Dr. Gray for breast implants. Going smaller then larger and small again. Dr. Gray and his nurse Cherrisse are wonderful. He is a talented surgeon and I have several friends who have had surgery with Dr. Gray all with perfect results. I trust him because I know I will be safe and have a beautiful outcome. He is also my go to for botox."- B. / RealSelf / May 21, 2017
"Dr Gray did my surgery in 2010 and I am still extremely happy with the results, he was patient and available for several follow up appointments and his skills are incomparable, no scars and a very natural feeling. I definitely recommend him!"- V.B. / Google / May 21, 2017
There are several techniques used for rhinoplasty. The approach taken will be based on the complexity of the surgical case and the overall goal of the patient.
With an open rhinoplasty, the incisions are made on the tissue between the nostrils or on the natural crease of the nose just above the lips. This allows for greater access and view of the confines of the nose. Dr. Gray precisely stitches, trims, and grafts the nose's cartilage to remake the tip. The dorsal hump and nasal bones are then treated the same as the closed approach. The hump can be reduced and the nasal bones can be made narrower. Stitches on the inside of the nose dissolve gradually on their own. Stitches in the area between the nostrils are removed at 5 days. During recovery time, a splint is also worn for 1 – 2 weeks.
During a closed rhinoplasty surgery, incisions are made to the inside of the nose through the nostrils to allow cartilage to be trimmed. As a result, the tip will be elevated conservatively, and become more refined. Dr. Gray will reduce the dorsal hump of the nose slowly and carefully. He neither wants to over reduce or under reduce the hump, and he takes it down until it is just right. Some people prefer a straight nose, while others prefer a very slight curve. In either case, Dr. Gray will adjust the dorsum to meet that patient’s expectations. Nasal bones can be made narrower, as well. Stitches are in the inside of the nose only, and dissolve slowly over time, and on their own. A splint is worn on the nose for a recovery time of 1 – 2 weeks.
For minor reshaping, some patients may opt to try an injectable filler to achieve results. These come in a variety of liquid substances, and sometimes a fat transfer can also be utilized. A filler can help add volume to hide small deformities, such as a bump or a bony appearance. It is important to note that fillers can only do so much in the reshaping process. For most patients, surgery is a better option and will offer a permanent solution.
Rhinoplasty is performed in an accredited surgical facility under general anesthesia. The procedure lasts up to 2 hours and is considered outpatient. After surgery, there will be swelling and soreness around the nose area. Bruising is also a side effect of surgery. The nose will be placed in a splint for additional support. During the first 7 – 10 days following surgery, the side effects will begin to disappear and the splint will be removed. Patients will be able to see their results immediately; however, it may take several months for the full results to appear.
Plan Your Procedure
- Average Cost
- $7,000 - $9,000
- Recovery Time
- 6 weeks
- Average Procedure Time
- 2-6 Hours
- Post-op Follow-up
- 12 Months
- Procedure Recovery Location
Is It Risky?
All surgical procedures carry some form of risk. These risks can be greatly minimized if an experienced nose surgeon is chosen to perform the surgery. While rhinoplasty is one of the most commonly performed procedures in the U.S., surgeon skill is critical so that a beautiful, satisfactory outcome can result.
Around half of all rhinoplasty cases will include some form of nose breaking in order to allow the surgeon to reshape the cartilage and bone. This is primarily intended for patients who have nasal asymmetry. The broken bone or cartilage will be reshaped and reattached, and then supported by splints during recovery.
Nasal packing is done to help with bleeding, especially if the surgery involves the septum. Gauze or cotton packs are inserted into the nasal chamber during this process. Patients find it uncomfortable, but the packing is only in for a short-term during the immediate recovery phase.
Surgical Or Nonsurgical?
This depends on the patient’s nose structure and what aesthetic result is trying to be achieved. For significant reshaping, the surgical approach will be performed as this allows the surgeon to manipulate the cartridges and bones. If the patient is looking for a subtle improvement, adding volume to the area may suffice.