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Open Rhinoplasty

An open rhinoplasty is a procedure that is done through nostril and columellar incisions, the overlying skin is separated from underlying structures, and then cartilage, nasal bones and septum are exposed. Dr. Rad modifies those structures to change their shape, and then places the skin back down. This approach is called “structural” rhinoplasty and is different from closed preservation. Open rhinoplasty may be useful in difficult corrective rhinoplasty.

“The beauty in a face should be noticed, not the work that went into it.”

- Ariel N Rad, MD, PhD, FACS

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01Artistry

Artistry is at the heart of rhinoplasty because each face is unique and requires unique attention to the nuances that make up one’s identity. Dr. Rad’s eye has trained his eye to evaluate faces both holistically and with nuance, envisioning how to restore a face to prior youth and even look more naturally attractive than ever. During consultation Dr. Rad will gain insights from what bothers you the most while weighing on the best plan to achieve your goals. This often requires a combination of procedures with open rhinoplasty as the primary approach, and jaw reshaping and fat grafting to ensure blended contours. Each procedure is intended to correct subtle signs of aging. But keep in mind that the art lies in the hands performing the procedures, not the procedures themselves. Just as a beautiful piano concerto stands in its own beauty, it’s the pianist who brings it to life, some better than others. Likewise, surgeons have different skill levels and aesthetic nuance, and bring to life the best results to varying degrees of ability. The level of artistry required to achieve natural, beautiful and long lasting results requires tremendous nuance. As Dr. Rad frequently says, “millimeter changes throughout the face can synergize beautifully into stunning yet natural results.” These details are reflected in surgeons’ before/after photographs which is why you must evaluate these with an aesthetic eye. You have only 1 face and so listen to your instincts when you look at surgeons’ results.

02safety

Rhinoplasty surgery in skilled hands is very safe. Dr. Rad takes every precaution to minimize risk through careful pre-surgery preparation and exceptional post-surgery care. Rather than performing surgery in a small office surgicenter that cannot handle potential, albeit rare, complications from anesthesia (such as airway obstruction), Dr. Rad performs surgery at hospitals in DC and northern Virginia wherein Dr. Rad works only with Board-certified anesthesiologists and experienced staff. This assures the lowest risk of complications.

03Technique

Dr. Rad employs the following technique when performing an open rhinoplasty surgery:

  1. Dr. Rad makes incisions in the nostril and columellar,  the overlying skin is separated from underlying structures, and then cartilage, nasal bones and septum are exposed.
  2. He then modifies those structures to change their shape, and then places the skin back down. This approach is called “structural” rhinoplasty and is different from closed preservation. Open rhinoplasty may be useful in difficult corrective rhinoplasty.

04recovery

05Aftercare

06longevity

frequently askedQuestions

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What is rhinoplasty?
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Rhinoplasty (“nose job”) surgery aims to improve external nasal appearance and to improve nasal breathing. Particularly in Washington DC, limiting downtime is often as important as the result itself. Dr. Rad specializes in minimally invasive rhinoplasty with “closed” (no external scar) “preservation” and “endonasal” approaches. These two different but related approaches offer multiple advantages: no visible scars, minimal tissue trauma, recovery time is minimized, nasal stability is optimal, and results can be excellent.

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Can an open rhinoplasty improve my breathing?
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About 80% of people have a deviated septum, large turbinates or some other anatomical reason for impaired airflow. Poor nasal airflow impairs sleep which can lead to fatigue, lack of concentration and poor work performance. Rhinoplasty and septoplasty can significantly improve airflow through nasal passages which can improve sleep and restfulness. Even in the absence of a deviated septum, Dr. Rad employs airway preserving techniques, called “dorsal preservation,” as well as other methods such as “spreader grafts” (cartilage pieces placed in the internal nasal valve) to open the airways further. Improved breathing and beautiful aesthetic results are always Dr. Rad’s goal for his patients.

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Should other procedures be considered with an open rhinoplasty?
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If you have concerns for improving other areas of the face then Dr. Rad will advise you. While rhinoplasty can improve the appearance of the nose itself, facial balance and proportion are crucial to consider. Dr. Rad will evaluate your facial architecture to determine if you would benefit from enhancement or refinement of other areas of your facial skeleton. The most popular adjunct to rhinoplasty is chin augmentation (genioplasty) for a receded or diminutive chin. When the chin is too small the nose often looks disproportionately large. Chin augmentation can improve the projection, shape, and size of the chin. In combination with rhinoplasty, the facial balance can be improved. Facial width is also important to consider: some patients benefit from enhancement of the cheekbones either through facial fat grafting or malar (cheek) implant augmentation, whereas others may benefit from slimming of “chipmunk” cheeks via buccal fat pad removal. Patients in later years may combine facelift or neck lift surgery with rhinoplasty. The bottom line is that combining surgeries is generally safe and requires careful assessment of your facial architecture and your goals. Overall combining procedures are generally safe, cost-effective, and involve one recovery period, making it a popular approach.

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How do I choose a rhinoplasty surgeon in Washington DC?
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Particularly in rhinoplasty, surgery can’t be reversed and correcting inexperienced work is more challenging (but not impossible), so choose right the first time. When vetting a plastic surgeon, use this checklist: S/he should be certified by the American Board of Plastic Surgery, trained in an accredited (by ACGME) program at renowned institutions, have years of experience performing rhinoplasty regularly (every week), show extensive before/after photos of patients, and the surgeon’s aesthetic should resonate with you. Patients should always be well informed and it is important to spend time in consultation to discuss your goals, examine your nose, and answer questions and address concerns. Surgery is a significant undertaking with many details to review, and your consultation should be unhurried. Sometimes Dr. Rad offers computer simulations however primarily for hump reductions. Attention to detail is crucial. Note how the surgeon addresses the details of your surgery. Also pay attention to the cleanliness of the office, friendliness and competence of office staff, presentation of information on the website, and other clues to how attentive to detail the surgeon is. Rhinoplasty revision surgery is not uncommon and can be costly. Invest in quality rather than focusing solely on cost. This will give you the best chance of a successful result for the long term.

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What is the cost of an open rhinoplasty at SHERBER+RAD?
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Cost is multifactorial and starts at $9,500, increasing with complexity and length of surgery. We cannot give detailed quotes before consultation.

Note that pricing is customized for each patient and these guidelines do not necessarily apply uniformly. These are approximate ranges and total cost depends on multiple factors: your unique anatomy, goals, complexity of the procedures, recommended techniques, whether corrective work is needed, in-office or hospital-based operating facility, and combining multiple procedures (increasing concessions apply for multiple procedures).

Although you may receive varying cost estimates from other practices, keep in mind that your surgeon’s education and training, plastic surgery board certification, his/her experience (at least 8 years of experience after residency is recommended), and aesthetic artistry and surgical skill (i.e., talent) of your surgeon are important factors in pricing. Dr. Rad’s practice is solely focused on facial aesthetic surgery and his artistry is unmatched. His goal for every patient is to achieve nuanced and natural results with minimal recovery, and we have mechanisms in place to bring them within financial reach.

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