Surgical Rhinoplasty

There is a reason why rhinoplasty (or “nose job”) is consistently ranked among the top three most popular cosmetic procedures each year. When performed by someone with the proper training, talent and skill, a rhinoplasty can bring overall balance to your face, and in many cases, also make you look younger.

The art of rhinoplasty involves more than merely making your nose smaller. Your nose needs to look natural and complement all of your facial features with the right size, width and angles. The procedure is highly individualized because both the left and right sides of the nose need to match as much as possible, so it looks smooth and natural from all angles.

The face is comprised of three equal sections: the upper, middle and lower face. In a good profile, all features are in proportion with one another.

Upperface: A forehead that isn’t entirely round or flat.
Middleface: A straight nose that has some concavity to it.
Lowerface: A slim and defined neck and soft jawline.

1. The Consult

   We start with a consult where Dr. Esmail or his assistant will take detailed medical history and a complete nasal exam often including an endoscopic exam of the nose. We will discuss what you don’t like or want to change about your nose, and any breathing issues. We then take a set of 3D VECTRA photos as well as high definition 2D photos. Using the latest technology we are able to take precise measurements and analysis of your nose and provide morphing to show you what an expected outcome may look like.

2. Surgery

   We have three options for surgery. For those cases where there is a medical component, the operation can be done under general anesthesia at the Victoria General Hospital. For purely cosmetic cases the surgery can be done under general anesthesia at the Western Surgical Center across the street from our clinic or under deep sedation inside our state-of-the-art operating theatre.

3. Post-Op

   We see you post-op on visits at one week, one month, three months, six months and one year. At each visit we will take photos and will monitor your progress at the one month visit we can discuss any concerns and can start injections of steroids to help reduce scar tissue and swelling in areas that need more definition.

Even a small adjustment or tweak can make a world of difference in how your nose blends with the rest of your face, drawing less attention to it and putting more focus on other features like the eyes.

Most patients who choose to undergo rhinoplasty do so because they feel embarrassed or inhibited by the size, shape, or projection of the nose. As it is the central feature of the face, there is no hiding a flaw, whether it is a hump on the bridge, droopy, large, or bulbous tip, or an aesthetic problem related to overlarge, wide nostrils, or a flat bridge or asymmetrical shape.

1. Primary (Surgical) Rhinoplasty

   If this is your first surgery, you fit under primary rhinoplasty. Depending on what is required, what type of anesthesia is chosen and if any of the procedure is covered by insurance, the price will vary.

2. Ethnic Rhinoplasty

   In the past ethnic rhinoplasty was done to give patients a more Western-looking nose, but today the surgery is performed in a way that enhances the appearance of the nose while maintaining ethnic features. You are able to change the way your nose looks to become more attractive according to your standards without losing any ethnic distinction.

3. Revision Rhinoplasty

   Revision rhinoplasty is a difficult surgery to master and unfortunately it is often performed with poor results by surgeons who are not rhinoplasty specialists. If you have previously undergone a rhinoplasty and are unhappy with your results, schedule a consult with Dr. Esmail and see how we can achieve your goals.

4. Micro-Rhinoplasty

   Often we see patients who have a small bump or imperfection they would like fixed. This includes some revision cases with ridges or bumps or that may require narrowing of the nostrils. Dr. Esmail uses specialized 2mm micro rasps to shave the nasal bones through tiny incisions, so small they don't even require stitches. We can perform these procedures often with freezing and no sedation at all. Some patients may prefer to take a short acting oral sedative. Micro Rhinoplasty is often combined with liquid non-surgical rhinoplasty.

5. Alar Reduction

   Alar reduction is a component of Rhinoplasty; a specific technique that addresses the width of the nostrils only. The Alar is the area of the nose that extends from the tip of the nose and rounds outwards towards the cheek. An incision is made on either the exterior or interior of the Alar region in order to remove excess tissue.

6. Liquid Rhinoplasty

   Liquid or Non-Surgical Rhinoplasty is a powerful procedure that involves the use of dermal Fillers and Botox to re-shape the nose. Not everyone is a good candidate for nonsurgical rhinoplasty so a consult with Dr. Esmail essential prior to treatment. This procedure is good for camouflaging bumps on the nose as well as fixing a droopy tip and providing more tip definition. This procedure is not good for fixing crooked noses. non-surgical rhinoplasty should only be performed by surgeons with a knowledge of rhinoplasty. It is one of the most dangerous areas to inject. Because of this, Dr Esmail is the only injector allowed to perform this procedure at his Visage.

7. Ultrasonic Rhinoplasty

   A mini Ultrasonic Rhinoplasty is performed through a closed approach with a tiny incision inside the nose so there are no external scars. The special instrument used, called a Piezotome, enables the surgeon greater precision and less soft tissue damage.

As with any procedure, there are risks associated with rhinoplasty. Given the unpredictability of the way the nose heals a change of a few mm can create an undesirable result. Because of this given in the most experienced hands rate of revision rhinoplasty is 10-15%.

Any patient undergoing a rhinoplasty should be mentally prepared to have to require a second, most often much smaller, procedure to correct any irregularities. Other risks include prolonged bleeding, infection, and prolonged stuffiness. Most of these are minor and resolve with time.

The art of rhinoplasty is more than merely making noses smaller. Your nose needs to look natural and complement all your facial features, balancing size, width and angles.

Cosmetic surgery on the nose is a highly individualized procedure that focuses on one or more of the features that contribute to your overall appearance. Those seeking a well-balanced and youthful face should aim for a nose that’s symmetrical within itself, as well as overall facial symmetry.

Rhinoplasty is generally an outpatient procedure performed in a hospital, ambulatory surgical facility or in-office surgical suite. To determine the areas of your nose that will be addressed, your overall facial appearance, proportion and structure, as well as your goals, medical history and ethnicity will be taken into account.

With rhinoplasty, your profile complements your other facial features. Otherwise, your nose can appear too big or too short and draw too much attention. No face is perfectly symmetrical, but certain asymmetrical features, like the nose, tend to be more evident. The nose is a bilateral structure, you want both the left and right sides to match as much as possible, so the nose looks the same from the front and side views. Symmetry is crucial.

Patients generally wear a splint for the first week. There will be bruising and swelling under the eyes and nose that will be there for a few days to a few weeks following surgery. Patients should avoid strenuous activity for 2–3 weeks.