Shapely Nose

Did you get your Papa's nose instead of your Mama's?

Noses can be tweaked with non-invasive fillers or threads, but long-term or larger changes need surgery. Below, you can read more about your options, and we have questions and answers for you... As a craniofacial surgeon, Dr. Gill has expertise in refining and shaping noses to fit individual faces, for bringing out your uniquely beautiful self.

For our help with your own nose, come in for a consultation at Pulsar Health in West Palm Beach, FL, with Dr. Gill.

Traditionally noses have required surgery to make them more shapely, but there are non-surgical options available as well. Let us know the aesthetic you want, and we can guide you on the simplest path there.

1. Liquid rhinoplasty - here fillers are used to improve the profile of the nose. Fillers can correct asymmetries, be used to change the shape such as softening a hump, or add height to where the nose meets the brow. Fillers do "melt" over time and need to be used carefully in the nasal area due to concerns over blood supply to the nose. Where there has been previous injury or surgery, a safer filler is a "bio-filler" with platelet rich plasma +/- hyaluronic acid although the results don't last as long. Traditional filler can be repeated every couple of years on the nose for maintenance. In addition, fat can be used as a more permanent filler. The Lipocube allows us to more precisely size fat gathered by liposuction, to get a finer homogenous emulsion for filling, but sometimes the fat "take" (how much survives) can be uneven so it is not our first choice.

2. Nose thread lift - Lifting threads can be used to raise the tip of the nose and improve the symmetry of the "dorsal aesthetic lines" on the front of the nose. They can also be used to help a "hanging columella" on the undersurface of the nose. There is a risk of infection with nasal threads so antibiotics are usually recommended. The nasal lifting effect does fall as the thread dissolves over time, but it leaves behind some collagen long term. The nose thread lift can be repeated once / year if required as long as the blood supply permits this.

3. Closed rhinoplasty - this is a traditional "nose job" but there isn't an external scar with a closed rhinoplasty, just small incisions that are inside the nostrils. It is a good option for smoothing out a small dorsal hump on the bridge of the nose but most times a more complex reshaping is better done with an open rhinoplasty. 

4. Open rhinoplasty - here there is a small stairstep or V-shaped incision in the skin between the nostrils as well as the small incisions inside the nostrils. This allows the whole "skeleton" of the nose to be seen better for fine tip work or support to the front surface of the cartilaginous framework. Sometimes, we reshape the bones of the nose, which may require a couple more small incisions (about 3mm) on the face to mobilize the bones, although this can also be done from the inside as well. 

Here are some questions and answers you might have:

Q: How painful is it to have the nose treated?

A: There is some discomfort from the fillers and in the numbing for the thread lift, but no pain afterwards, just discomfort from swelling. The more traditional closed and open rhinoplasties are typically done using general anesthesia. Afterwards, there is a feeling of fullness but usually not a lot of actual pain. Sometimes the nose is "packed" to support the healing inside, which can get uncomfortable, so packing should be removed within a few days. It can be difficult to breathe through the nose when it is swollen, so breathing through the mouth may be helpful for a while until the swelling improves.

Q: Does it matter if I have a "deviated septum" or trouble breathing on one side?

A: You may need to have the septum (midline cartilage supporting the nose) or turbinates (bulges on the inside of the nasal cavity) addressed if you are having trouble breathing, although it could also be related to other issues such as polyps. Many people have a deviated nasal septum which does not affect their breathing so it's not necessary to correct that if it is not causing a problem.

Q: How long do the results last and will I need more work?

A: Fillers typically last a year or two and gradually fade away in the liquid rhinoplasty. The nose thread lift tends to last a year unless infection loosens the threads prematurely. Closed and open rhinoplasties last your lifetime, but the cartilage of the nose loses elasticity over time, which is why ears and noses seem bigger on older people. You may need a touch up to correct this. Also, about 10% of clients choose to have a second rhinoplasty procedure to further refine the results.

Q: When do you use implants or cartilage in the nose?

A: Some noses can require more complex repairs or strengthening, and in these cases, we can use either cartilage from the client (such as from the inside of their nose, ears or even their ribcage) or grafts from donated tissue / synthetic grafts. This is more likely for clients who have had accidents or prior surgeries.

Q: How long is the recovery?

A: For liquid rhinoplasties and thread lifts, there is some swelling for a few days and then you are good to go. For surgical rhinoplasties, swelling tends to last longer, typically two to four weeks, and you may need to wear a splint outside the nose if bony work was done, or inside the nose if septal work was required. The splints are in place for about 10 days, and internal nasal packing comes out sooner at 3 days. Stitches on the outside of the nose come out at around a week, and the ones on the inside dissolve over a couple of weeks. Taping of the nose may be recommended for the first few weeks. The nose continues to heal for about three months. 

Rhinoplasties are among the more complex surgeries done by plastic surgeons due to the three-dimensional nature of them, where a mm or two either way makes a big difference, and many plastic surgeons and otolaryngologists do not do the procedure. Dr. Gill is fellowship trained in craniofacial surgery as well as having extensive experience in cosmetic plastic surgery, so enjoys performing rhinoplasties and other nasal corrective procedures.