Rhinoplasty Washington DC

The decision to undergo a rhinoplasty is a very personal one.  In my practice I love to hear the motivation behind my prospective patients for seeking to have rhinoplasty surgery. Some of these stories are quite powerful.  The stories vary depending upon the age of the patient who is considering rhinoplasty.  One of my favorite reasons is because the individual had never really been happy or comfortable with the appearance of their nose but they were too self conscious and concerned with what others would say if they had rhinoplasty surgery.  When they come to see me and share that they have come to the conclusion that it is their life and no longer are concerned with the opinion of others and simply want to do their rhinoplasty for themselves I am thrilled for them.  I realize that I am going to be able to participate in a small but meaningful part of their life’s journey and take this responsibility very seriously.  So what do people want to know about rhinoplasty?

What is Rhinoplasty?

Rhinoplasty surgery, often known as a “nose job,” is an ancient plastic surgery procedure that has been performed for thousands of years. It is used to reshape and resize the nose to look more natural and proportional to the other facial features. Some of the most common requests from rhinoplasty patients include removing a dorsal “hump” from the bridge of the nose, straightening a crooked nose, or reducing the overall size of the nose. Other patients have trouble breathing, often due to a deviated septum, which is caused by crookedness in the nasal septum (the wall separating the nasal passages). Rhinoplasty can improve or correct this issue, which can result in better breathing for the patient. Overall, rhinoplasty is an extremely versatile procedure that can produce incredible results when performed by an expert.

Rhinoplasty Surgery Before & After Photos in Washington DC

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* Each patient is unique and individual results may vary.

Why Choose Rhinoplasty in Washington DC?

The nose plays an enormous role in facial aesthetics, due to the way it affects facial proportion and balance. Nose surgery is the best way to bring balance to the face and improve the overall appearance of the face. Even a small change in the nose can have big benefits, and an expert can create a result that enhances your best features. Choosing rhinoplasty for the right reasons can benefit you both emotionally and physically.

Am I a candidate for a nose job?

One of the most popular questions that I am asked is whether or not a particular individual is a candidate for a rhinoplasty.  Electing to have rhinoplasty surgery is a very personal decision.  The motivation behind one’s decision to pursue rhinoplasty surgery is unique to the individual and at times, similar to why others are seeking changes to their nose, but at times the stories are quite different.  Some people are concerned that their noses are too big for their face.  Others have issues with their noses being crooked.  While other individuals simply do not like the way their tip is shaped, their dorsal hump is too big, or their nostrils are either to big or misshapen.  All of these issues are certainly worthy of exploring the potential for rhinoplasty surgery.  Once you have set up a consultation, either live or virtual, we will examine your nose for any structural issues and then we will use computer imaging in order to help demonstrate the changes that you would like to see to the appearance of your nose.,  The consultation is a very interactive period of time where you can express your desires for the nose that you would like to see on your face and what nose job you do not want to see on your face.  You will also have the opportunity to get to know me and my philosophy about rhinoplasty, and I can get to know you so that we understand what your ultimate goals are.   Once we have met and discussed your rhinoplasty images then we can determine your candidacy for successful rhinoplasty.   

Other factors that we do take into consideration prior to rhinoplasty is your age.  Very few people are too old to have rhinoplasty.  Over the past several years I have seen a significant increase in requests for rhinoplasty from prospective patients in their 40’s, 50’s, 60’s, and even 70’s.  Aside from the patients who have had previous rhinoplasty years ago and are looking to have revision surgery many of these patients have simply wanted the appearance of their nose improved for many years but either felt self conscious about having a cosmetic surgical procedure performed, did not have the time in their lives to have the surgery, or did not have the resources available to them while they were building a business or raising a family.  On the other hand, a patient can be too young for a rhinoplasty.  I feel that the prospective rhinoplasty patient needs to be mature both physically and mentally to undergo a life changing procedure.  Men should be at least 16 years old as they are not quite physically mature until that age.   Women can be as young as 14 years old if they are both physically mature and fully understand the implications of the procedure.  

Your Rhinoplasty Consultation in Washington DC

If you are considering moving forward with rhinoplasty Washington DC, then your next step is to schedule an initial consultation with an expert plastic surgeon like Dr. Schoenfeld to discuss your goals for the procedure and find out whether or not you are a good candidate for rhinoplasty. During your consultation, you’ll have the opportunity to get to know Dr. Schoenfeld and learn more about the rhinoplasty process. He will generate images of your nose and enhance them to give you an idea of the types of changes you might expect from the nasal surgery. You’ll be able to ask any questions you may have about the procedure or about Dr. Schoenfeld and Renu. Your initial consultation is a valuable learning experience, so come prepared to discuss your goals and ask lots of questions. Consider taking a look at some rhinoplasty before and after photos before you come in so you can identify what you do and don’t want from the nasal surgery.

The Rhinoplasty Procedure

It is typical to perform rhinoplasty under general anesthesia on an outpatient basis, as it is a fairly invasive procedure. Depending on the extent of the nasal surgery, the procedure will take between one to three hours to complete.

Nose surgery can be performed using an “open” or “closed” technique. The open technique, which is the most popular, involves the surgeon making a small incision between the nostrils in order to lift up the skin and have unobstructed access to the tissues beneath. The closed method involves incisions made inside the nose, resulting in no visible scars but less visibility and a decreased ability to manipulate the tissues. You and your surgeon will discuss the technique to be used prior to the procedure. Once the incisions have been made, the surgeon will graft and reposition cartilage to reshape the nose and remove bony material if necessary, while ensuring the nose maintains function and structural integrity.

Once the incisions are closed, a dressing will be placed on the nose and the patient can return home shortly afterward to begin the healing process.

Real Rhinoplasty Patients

How much does a nose job cost?

The price of a primary rhinoplasty (nose job) will vary depending upon several factors.  The location of the practice, the experience of the surgeon and the complexity of the nose to name a few.  Our surgical fee for rhinoplasty cost starts at around $11,500.  There are other associate costs for rhinoplasty that includes facility fees and anesthesia fees.  If you are having functional work, such as septoplasty, inferior turbinoplasty, or repair of nasal valves performed at the same time we do accept insurance coverage for these procedures if your insurance will cover the procedures.  Insurance coverage for functional issues performed at the same time will significantly decrease the cost of anesthesia and facility fees for your rhinoplasty but will not cover any of the rhinoplasty surgeon fees you will be quoted. 

What is the perfect nose?

Quite simply, the perfect nose is the nose that will look best on your face not just in the short term, but for many years to come.  My philosophy is that no two faces are alike, and although noses can be similar in appearance, every nose I create is unique to that individual.  I do not try to put a “Dr. Schoenfeld” nose on every patient I treat.  I put the best nose that you can have on your face.  I also see myself as a bit of a nose architect.  In other words, I want you to bring me your “plans” for your ideal nose.  I will build that nose for you but probably discuss some subtle changes to the nose that would make he nose look more appropriate for your face.  I think the perfect nose is a nose that absolutely does not look “operated” or “done”.  The nose should not draw attention but rather enhance your other facial features.  I also think the perfect nose is one that helps to create the best you that you can be.  

Recovering from a Nose Job Surgery

Recovery from a rhinoplasty is not a particularly awful experience!  I have found that education and preparation are extremely important to a stress free and uneventful recovery.  For the first few days you will likely experience pressure and some pain that will be managed by a pain medicine regimen we will prescribe to you.  We have a detailed post operative instruction sheet that you can click on and download so that you get a good idea of what you should be doing for a successful surgical outcome.  For the first few days we encourage you to ambulate during your waking hours for at least a brief period of time.  Even this minor activity will help you feel “normal” and help decrease the stress of just having had surgery.  It will also help you with some bloating and constipation you may experience from pain medications that you have taken.  

Most of my patients want to know what pain and discomfort are like following rhinoplasty.  Pain is a very individual experience but I would say that after more than 3,000 rhinoplasty surgeries pain is moderate.  If you have had abdominal, tonsil, or bone surgery, then nasal surgery is nothing compared to that post operative discomfort.  The pain can be relieved with mild pain medications and after a few days I permit my patients to take Ibuprofen.  At times patients can also experience pain that is related to anxiety and in these cases a little oral sedative is actually more effective than oral pain medications.  The pain does go away after a few days and the majority of rhinoplasty patients require only Tylenol or Ibuprofen after a few days.  
Swelling and bruising of the nose is another concern that all rhinoplasty patients have and all rhinoplasty patients can expect swelling and bruising to some degree.  We attempt to decrease both of these post operative occurrences in several ways.  First, we encourage you to eat pineapple prior to surgery and we give you both Arnica, and Bromelain (a pineapple extract).  Both of these supplements have been clinically shown to reduce both bruising and swelling.  We are extremely meticulous during surgery but moving skin, muscle, cartilage, and bone will result in swelling and bruising.  Because this will inevitably occur, to help speed up the resolution of these symptoms we encourage you to keep your head elevated on three or more pillows while resting after surgery.  We also have you use several small bags of frozen peas placed on your eyes, forehead, and cheeks, but not on your nose.  Frozen peas you say?  Yes! Frozen peas!.  They are light, inexpensive, readily available, are not too heavy, and will not get too cold to create issues to your skin while keeping post operative swelling to a minimum.  Rotate the bags throughout the day and throw the old ones out after a couple of uses.    You can expect swelling to subside gradually.  All of my rhinoplasty patients leave the operating room with tape and a nasal splint.  After the first post operative visit, the splint is removed, any non dissolvable sutures are removed,  and the tape is changed.  I have my patients keep the new tape in place for another 5 days so that taping is a total of 13 days.  I realize that other practices require taping to take place for longer than that, but I realize that people need to get back to their daily lives and longer taping has not proven to be of any more benefit.  Some of my patients will also receive either oral steroids or injectional Kenalog to the nasal tip following surgery.  Usually, this is reserved for those patients with extremely thick nasal skin and this is discussed prior to surgery.  Complete resolution of swelling is a gradual process.  You will look completely presentable after just 12 days but your nasal swelling, especially at the nasal tip can take up to one year or longer to fully resolve.  

Activity after rhinoplasty is also a gradual process.  Walking is encouraged following rhinoplasty surgery.  Not for exercise but to keep your body moving.  Full activity can start after three weeks following surgery.  We do not expect you to engage in your toughest workouts at that time, but to gradually increase your activity.  Activities that could place your nose at risk of being hit, and even activities that require your head to be inverted, like yoga, should be delayed until around week 5-6 after surgery.  Please remember to listen to your body.  If your nose starts to hurt, or swelling looks worse than it did prior to starting your activity, please SLOW DOWN!  

What is the difference between an open rhinoplasty versus closed rhinoplasty? (find photo of columella incision)
I have been performing rhinoplasty surgery for over 20 years.  During this period of time I have performed  both open and closed rhinoplasty procedures.  I would say that the majority of primary rhinoplasty procedures that I perform, especially involving complicated nasal tip work are open and almost all revision rhinoplasty is performed open.  The difference between the two procedures is essentially one small incision underneath the nose on the portion of skin between the two nostrils that is called the columella.  This incision is closed meticulously and heals imperceptibly.  A poor scar is not acceptable and unless there is extenuating circumstances leading to scarring, this is not usually an issue.   I feel that the advantages to using this approach far outweighs any potential disadvantages of this surgical approach.  A lot of discussion surrounding open versus closed rhinoplasty is based on here say and not facts.  Post operative pain, swelling, edema, and bruising are identical with both surgical approaches.  There is definitely going to be some tip numbness following the open approach but there is also potential for numbness of the nasal tip following the closed approach.  The surgical access that the open approach affords me is unparalleled especially in complicated nasal tip work.  I still perform about 20% of primary rhinoplasty using the closed approach.  I teach my residents both the open and closed approach,  but my feeling is that  short term tip numbness associated with the open approach is a very small inconvenience in exchange for a long term beautiful surgical result in complex cases.

What happens if I don’t like my nose?

You will love your nose! However, statistically speaking, the revision rate for primary rhinoplasty is close to 7%. Revision rhinoplasty surgery actually has an even higher revision rate, but that is for another discussion.  There are several factors that account for this high revision rate.  The three biggest factors are poor surgical execution,  poor healing, and unrealistic surgical expectations.  The best way to avoid revision surgery is to seek out the rhinoplasty surgeon with the most experience.  Rhinoplasty is the number one procedure that I currently perform in my surgical practice.   I have pre operative conversations with regards to risks, potential complications, and limitations of rhinoplasty several times a day.  Everyone’s first concern is whether or not they will look “botched” if something should go wrong. No you will not look botched!!  After over 20 years of rhinoplasty I can promise that there will be no botching,  However, like all busy rhinoplasty surgeons minor revisions following complicated rhinoplasty can occur but in the 1% range not the 7% range.  I am very upfront about these potential complications and you will hear about these prior to surgery.  Unrealistic surgical expectations is a very real phenomena.  Most of my rhinoplasty patients have spent thousands of hours surfing social media sites, many times mine, looking at photos of nose jobs from surgeons they do not know and photos that are non validated hoping to be able to get the ideal nose they had seen during their search.  I encourage my preoperative patients to show me noses that they like or have seen.  It is helpful in that it tells me what nose they are really hoping to achieve.  It also gives me an idea of how close your nose can actually come to creating the nose that you have seen on the internet.  Factors such as skin thickness, cartilage strength, and facial structure will all play a part in the eventual surgical result that you can achieve and it is my job to communicate this with you.  Using computer imaging during your initial surgical consultation really helps with this process so that we both understand our agreed upon surgical goals.  I would much rather have a patient choose not to have rhinoplasty surgery with me because I have provided them an image of realistic surgical expectations than to come back to the office post surgery only to be upset with the surgeon for not providing the nose they designed in preoperative computer imaging but unfortunately, could never be achieved.  

One final phenomena that contributes to patient dissatisfaction is the “selfie”.  Studies have been done and validated that show the distortion in all facial features with up close selfies.  Noses all come with some imperfections, even perfect noses.  Selfies will inevitably bring your attention to small distortions and imperfections that are likely not there and from anywhere more than 2 feet from your face and nose, will also be imperceptible.  

If you are not thrilled with the appearance of your nose because the nose simply does not look like the nose we had discussed pre operatively, or there is a minor bump or bulge that detracts from an otherwise great result, we will fix it but we will need to wait almost a year to see how the nose will settle out.  No surgeon fees to you but there are facility and anesthesia fees involved.  If there are minor imperfections that are not immediately apparent and do not distract from the overall rhinoplasty result then I will of course entertain your concerns and we will collectively discuss whether these issues are worth addressing.  “The enemy of good is better”. Faces and noses will settle over the course of many years and changes can occur after many years.  Revision rhinoplasty in these circumstances will be discussed but are not performed for free.

How do I prepare for my rhinoplasty?

The best way to get yourself prepared for your rhinoplasty is understanding that you are going to be having surgery and that surgery is going to positively change the appearance and perhaps the function of your nose.  Having surgery is a commitment both mental and physical.  You should be excited for your surgery and being a little stressed or worried prior to surgery is a normal response.  Educating yourself and asking either me or my office questions that you may have prior to your surgery can help reduce your anxiety.  You can be confident that the discussions that we had in consultation with regard to what you would like your nose to look like are very meticulously documented in your chart and photos are available to me during surgery for reference.  

Eating healthy and avoiding inflammatory foods such as excess sugar, high fructose corn syrup, trans fatty acids, excess carbohydrates, and alcohol prior to your surgery will help with the healing process.  Increasing your intake of pineapple, which contains bromelain, a powerful natural anti inflammatory, both before and after surgery will really help with the healing process by reducing swelling and bruising.  

FAQs about the Nose Job Procedure

Rhinoplasty Surgery Related Articles

• Choosing Between Surgical and Non-Surgical Rhinoplasty
• What happens in the post-operative visit following a rhinoplasty?
• Are you wondering what to expect after a Rhinoplasty?
• Will my nose look like all the other rhinoplasty patients.
• I feel like my nose droops down in between the nostrils, can this be leveled off?

Choose an Expert Plastic Rhinoplasty Surgeon in Washington DC

Because rhinoplasty is an extremely difficult, complex, and custom procedure, it should only be performed by an expert plastic surgeon. Dr. Schoenfeld is double board certified in Otolaryngology/Head and Neck Surgery, and Facial Plastic and Reconstructive Surgery. He has the skill and experience to help you achieve beautiful, natural-looking results from rhinoplasty. If you would like to learn about rhinoplasty at Renu in Washington DC, Chevy Chase, and Maryland, call our office at 301-652-7368 to schedule your consultation with Dr. Schoenfeld.

Why choose Dr. Schoenfeld

• Double board-certified in Otolaryngology
• Double board-certified in Head and Neck Surgery
• Double board-certified in Facial Plastic and Reconstructive Surgery
• Medical degree from New York Medical College
• MINDBODY Visionary Award