WHAT IS RHINOPLASTY?
Rhinoplasty is the procedure where the nose is reshaped so that form and/or function of the nose is changed. Without question, rhinoplasty requires a surgeon who specializes in plastic surgery of the face. Dr. Anil Shah has a unique approach to rhinoplasty, based not just on developments he has published in the scientific literature, but many techniques which have not been described elsewhere. His expertise in rhinoplasty is seen in the large amount of patients who travel from all over the world to have Dr. Shah perform their surgery. He is trusted by “beauty insiders” for his keen aesthetic eye. As a testament to his quality of work, Dr. Shah is one of the most requested rhinoplasty surgeons in the world. Last year he performed 308 rhinoplasty procedures, putting him in the top 1% of plastic surgeons internationally.
Rhinoplasty Results Before-and-After
The before and after gallery represents a small fraction of the patients Dr. Shah has operated on. He has many more example of his work in his office. The gallery is intended to show a variety of aesthetics. All pictures shown are patients of Dr. Anil Shah.
Philosophy: How Is Dr. Shah different?
Dr. Shah’s aesthetic values in the nose distinguish him from his colleagues. He does not believe in a singular form of beauty and as such has a wide aesthetic range. He believes in a customized approach for rhinoplasty. As such, he performs limited rhinoplasty cases per day. This is in part due to the massive amount of preparation and detail work required to create a nose at the highest standards. Dr. Shah has a diverse breadth of training in both open and closed rhinoplasty. He is well published in the scientific literature in facial plastic surgery and rhinoplasty, however, many of his techniques have not been published, presented, or performed elsewhere.
Types of Nose Job
REVISION RHINOPLASTY
Revision rhinoplasty, also known as redo rhinoplasty, is when additional surgery is required after a previous rhinoplasty has been performed. Patients seeking revision rhinoplasty may be looking for improved breathing, a change similar to their previous nose, or improvement on their existing rhinoplasty result. Read more about Revision Rhinoplasty
ETHNIC RHINOPLASTY
The term “ethnic” is often used to describe any patient who is of non-caucasian origin. Most patients are seeking a nose which will work with their facial features and ethnicity, not to change their racial identity. Dr. Shah has subdivided ethnic rhinoplasty into a few backgrounds because the differences between the nasal characteristics can be quite large. Even within specific ethnicities, there is a very wide range of what an unoperated nose will look like. Read more about Ethnic Rhinoplasty
SEPTOPLASTY
Septoplasty is the alteration of the nasal septum to straighten the airway and/or remove cartilage for cartilage grafting. The nasal septum is a structure composed of cartilage in bone in the middle of your nose. Ideally, the septum divides the nose in half so that equal and symmetric airflow can occur. In 80% of the population, the septum is deviated, meaning a portion of the septum goes into the airway. One third of those patients are symptomatic with signs such as mouth breathing with sleep, exercise,snoring, and a a dry mouth. Read more about Septoplasty
RHINOPLASTY WITHOUT USING AN OSTEOTOME
Rhinoplasties in the past have often used a traditional instrument known as an Osteotome, or chisel, to help shape the nose. The problem with using an Osteotome is its blunt nature. Typically, Osteotomes are used for control breaks and could lead unwanted outcomes for the patient. The delicate nature of the nose requires precision. Dr. Shah uses specialized tools to help achieve the nose that his patients seek. Read more about Osteome
PRESERVATION RHINOPLASTY
Preservation Rhinoplasty is an approach that uses three principles of preservation for patients seeking a rhinoplasty with natural results instead of being overly grafted and would require future revisions. When seeing his patients, Dr. Shah will implement these principles to give his patients the natural nose they want. Read more about Preservation Rhinoplasty
SCARLESS RHINOPLASTY
Scarless rhinoplasty is where an incision is made inside the nose instead of externally. This leaves the patient with no visible scarring. Dr. Shah uses this technique for patients seeking to adjust the bridge of their nose and maintain their nasal tip. Read more about Scarless rhinoplasty
NONSURGICAL OR LIQUID RHINOPLASTY
Nonsurgical Rhinoplasty, or Liquid Rhinoplasty, is when filler or gel is used to shape the nose instead of having a surgical approach. This procedure is often used for patients seeking to give their nose more volume and not a reduction. Dr. Shah is an expert injector who understands the facial anatomy and gives his patients that desired fuller look they have been looking for. Read more about Nonsurgical Rhinoplasty
THREAD RHINOPLASTY
Thread Rhinoplasty is the use of threads to help support the nose either along the tip of the nose along the bridge. Read more about Thread Rhinoplasty
INSTA RHINOPLASTY
Insta Rhinoplasty is a technique adopted and adapted by Dr. Shah to give his patients an immediate view of their nose immediately after surgery, while on the OR Table. This technique helps give Dr. Shah’s patients have peace of mind on what their outcomes are instead of waiting a year of healing. Read more about Insta Rhinoplasty
Open versus closed rhinoplasty
Open rhinoplasty and closed rhinoplasty are two approaches to reshaping the nasal tip. Open rhinoplasty means that there is an incision along the columella (soft tissue between the nostrils), while closed rhinoplasty means that all of the incisions are inside of the nostril. However, there are many more differences than just an incision and both approaches have pros and cons. How do you know what approach is right for you?
Open rhinoplasty has the distinct advantage of direct visualization of the cartilages. However, perhaps more important is the ability to manipulate and alter nasal shape with more control, precision, and even in ways not possible with closed rhinoplasty. Patients who need large amounts of projection (nose sticking out from face) or deprojection (pushing nose closer to face) are often better served with an open rhinoplasty.
Some nasal variants also warrant open rhinoplasty including cephalic oriented cartilages. Cartilages which are oriented to the top of the head rather than the ears (vertically oriented) will have weakness on the outside portion of the cartilage. With an endonasal approach, often times roundness is accentuated and patients develop pinching along the outside of their noses.
Closed rhinoplasty has the advantage of decreased operative time, less swelling and postoperative healing and avoidance of a scar along the columella. Many patients with closed rhinoplasty will have less swelling early on. In some patients with a minimal tip modification approach, patients will almost no nasal swelling by two weeks postoperatively. However, the goal of rhinoplasty is to shape the nose to the desired shape. Most patients will care more about their ultimate result than whether or not they had to contend with swelling.
The patient seeking rhinoplasty is best suited if his surgeon is able to perform closed and open rhinoplasty without bias. Closed rhinoplasty offers significant advantages in less downtime and swelling, while open rhinoplasty may be necessary in cases requiring increased structure or have variant nasal anatomy.
Rhinoplasty for Children
Functional nose surgery in children is fairly uncommon. The most common cause of nasal obstruction in children is enlarged adenoids. Clinically, deviated septums are really not seen as common causes of nasal obstruction until at least seven or eight. I performed a radiologic study which confirms that nasal deviation is not seen until after the ages of five. (See Radiologic Study). Most children would respond to surgery to fix either their adenoid pads or reduce their turbinates
The main reason why septoplasty is performed uncommonly in a child is that their hypothesized growth centers within the nasal septum. If these growth centers are disrupted, it is thought that there may be the potential for change in nasal shape.
On the other hand, if a child is having significant decrease in breathing which is effecting his or her ability to sleep at night, receive oxygen, exercise, etc. In addition, chronic mouth breathing can lead to skeletal changes in the face often called the adenoid facies, but can occur with any nasal obstruction.
So, in summary either way it seems the surgeon and patient seem to be trading one problem for another. So what can be done. First of all, if surgery is determined to be beneficial for the patient it can be done in a specialized format. The growth centers of the nose can be avoided if possible. Now no one really knows where the growth centers are humans but it has been studied in animals. Extrapolation from that data, has lead most scientists to believe that the growth centers are located along the nasal floor posteriorly. If the surgeon can avoid disrupting this center, long term cosmetic nasal issues will theoretically be minimized. In addition, if the surgeon replaces the crooked portion of the septum after straightening it, the cartilage of the nose is now straighter but still intact.
Cosmetic issues are a completely different story altogether. Due to the potential for disruption of growth centers of the nose (see link), surgeons need to determine when has the nose stopped growing. A simple, yet surprisingly accurate method is to determine when the patient’s shoe size has changed last. If it has been over two years, there is a strong likelihood that the patient’s nose has also stopped growing and that a nasal operation would be possible.
However, the physical component of changing a patient’s nasal appearance is not the only factor. Emotional and mental maturity are probably the rate limiting factor in most teenagers. Patients must be the driving force behind wanting the rhinoplasty and not parents. The surgeon should explain to the patient that this is surgery and is a permanent action. The evaluation of teenagers at this point is extraordinarily complex. Some are highly mature and are very clear about what portions of their nose they wish to change. Others bring in pictures of the latest pop star and explain that this is the nose that they desire. The surgery is not intended to create a trendy nose, but a nose which will continue to look good with age.
Tip Reshaping in Rhinoplasty
The nasal tip represents one of the most important aspects of change in rhinoplasty. It is said that he who masters the nasal tip masters the nose. So what makes transforming the nasal tip such a difficult endeavor?
The nasal tip is composed of lower lateral cartilages. These cartilages can take a variety of nasal shapes, which includes convexity, concavity and excessive fullness. The bulbous nasal tip can be one of the more difficult endeavors because it requires appropriate diagnosis of the root cause of bulbosity or fullness of the nasal tip.
Causes of the bulbous nasal tip:
- excessively thick nasal skin
- excessively convex nasal tip cartilages
- too much cartilage along nasal tip
Changing the shape of the nasal tip is often described in the rhinoplasty literature in terms of 2d terminology. This includes such descriptors as projection, nasal tip rotation, length of nose, etc. The problem with this terminology is that it does not accurately describe what the patient may or may not like about his or her nose.
The nose is best described and seen in three dimensions. Three dimensional intrepretation of the nose is how we see our noses in real life and how we see others.
Photographs do play a role in describing the nose, but they do not do it as well as how we look in person. As is the case, sometimes a patient will note how his/her nose may not be photogenic with some cameras. The reason for this may have more to do with light, shadowing, and lens distortion than it does of an actual interpretation of the nose. A cell phone camera lens will not accurately depict a nose. This is why standardized photographs play such an important role in looking at nose and nasal anatomy.
So if seeing the nose in 3 dimensions is the best way to see the nose, how does one see the nose. This requires a vision of the nose to help reshape the size AND shape of the nose so that the appearance of the nose can be altered.
Nasal tip bulbosity as a result of thick skin will often require projection of the nose. This is to have the nose stick out further. While some patients may not desire a more projected nose, it may be the best option for patients with thicker skin.
Nose Job Alternatives
Every nose is different, and thus, every rhinoplasty is different as well. Learn about various types of rhinoplasty including Male Rhinoplasty, Alar Base Reduction, Deviated/Crooked Nose, Septoplasty, Finesse Rhinoplasty, Saddle Nose Deformity, Broken Nose and more.
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Nose Job resources
KNOW YOUR NOSE
Nasal anatomy plays an important role in both diagnosis and the underlying cause of the nasal problem. A simplified version of external points on the nose are illustrated to facilitate communication. Nasal analysis is where a series of measures are taken to help see how a nose compares to an ideal nose. While this may provide both the patient and surgeon with some useful information, it definitely should not be interpreted as cold hard science or facts. These angles are meant merely to serve as a guide. In fact, some of the angles and measures are disputed by surgeons, myself included. It serves a purpose in communication amongst surgeons and patients. A beautiful nose can not be created by formula and needs an artistic vision and collaboration between surgeon and patient.
NASAL PHYSICS
For many patients who can’t breathe from their nose, the last thing they want to think about is physics. However, it is the precise understanding of several principles in physics which allows a nose to function and breathe as ideally as possible.
Read more.
PROCEDURE TIMELINE
Many of our rhinoplasty Chicago patients ask at what age can a patient have a rhinoplasty (or other procedure)? This timeline is intended to serve as general information on the ages at which patients may seek a procedure such as a rhinoplasty. See more.
RHINOPLASTY INCISIONS
Incisions play a significant role in rhinoplasty. Learn about the different types of incisions used in rhinoplasty. Read more
GUIDE TO GRAFTS
What are grafts? Do I need them in my nose? Dr. Shah has authored an informative guide to help patients better understand what a graft is. See more.
Nose Job Recovery time
PRE AND POST OPERATIVE INSTRUCTIONS
Dr. Shah’s office will help you through you pre and post operative preparation and recovery. On this page, you will find an overview of instructions, as well as medications to avoid before and after a procedure and more. Read more.
ARTICLES BY DR. SHAH
We’re constantly updating our Rhinoplasty to keep you up-to-date on new procedures and answer any questions we hear regularly. Read more
RHINOPLASTY GLOSSARY
Understanding your nose can seem daunting. Use this guide to help to know your alar base from your bridge or your glabella from your columella. Understanding your nose can seem dauntingLearn more.
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Frequently asked questions
Typically rhinoplasty is not considered to be painful. Most patients describe nasal congestion to be the main complaint postoperatively.
I have a variety of people who have influenced me through there approach to their work. I find that athletes like Michael Jordan are not only talented individuals but extremely hard working, dedicated people with a passion for what they do. Even when they are the best in the world, they are willing to learn and improve. The goal is simply to be the best and always reach for loftier goals and expectations.
My singular goal is to provide the best possible results and techniques in every procedure that I do. Being content with a procedure would mean to do every procedure the same, do it how the “book” says. I have dedicated myself to perform procedures on a high level and constantly improve upon results with followups and close examination of my results. I perform numerous research papers on facial plastic surgery so that not only my results improve, but that of the community of surgeons improves as well. Anyone who thinks they are doing the perfect procedure is in my opinion not being critical enough of their results. Results and techniques, even when performed at the highest level, can always be improved.
It depends on what your specific characteristics of your nose and your goals. Although the term rhinoplasty is a singular term, it is broad in its description and actually describes techniques and operations which are quite different. Some patients seeking nose job will clearly benefit from a closed approach rather than an open. Some patients will clearly benefit from an open rather than a closed approach. A third category of patients may benefit from either technique depending on their specific goals. See section on open versus closed rhinoplasty.
It depends on what is being done and the aesthetic goals. There are instances when nasal reshaping is preferred to formal osteotomies.
Since no two noses are alike, Dr. Shah has a price which is reflective of the difficulty of the case. If there is a functional component to the procedure such as nasal obstruction, that portion may be covered by insurance. The cost of rhinoplasty in Chicago and nationwide varies tremendously.
Dr. Shah has been trained by several of the most prominent figures in the rhinoplasty world including arguably the top two endonasal rhinoplasty surgeons in the world and one of the world’s revision experts. From this background in rhinoplasty, Dr. Shah has developed a reputation as having a keen aesthetic and the ability to perform the full breadth of rhinoplasty procedures. He has written many seminal articles and continues to perform research on nasal airway, nasal aesthetics in order to further the entire field of rhinoplasty.
Dr. Shah performs both techniques and does so without bias.
Many patients seeking cosmetic correction of their noses have underlying functional issues. Dr. Shah will perform a thorough clinical exam to determine if there is a functional issue. Insurance can cover functional changes to the nose, but not aesthetic (cosmetic) changes to the nose.
Fifteen is generally considered to be the youngest age. However, every patient matures at a different time and pace. Generally speaking, once the patient has not changed shoe sizes for two years, it is safe to perform a rhinoplasty from a physical standpoint. The patient must be mature enough to understand the implications of rhinoplasty and the decision must come from the patient not pressure from the parent.
Dr. Shah has one of the most thorough and thought out consultations available. During the consultation the following take place:
-pertinent history and physical
-high quality photographic stills
-examine inside and outside of nose
-determine best individualized approach to your nose (open vs closed, technique)
-“blueprint” of technique I would recommend
-explain rationale behind technique chosen
-computer imaging and simulation (important to determine what is best approach)
-review pre and post instructions
-answer questions
The most valuable piece of information as the patient, is to receive the technique and rationale behind it. Dr. Shah uses a wide variety of techniques including open and closed, costal cartilage, auricular cartilage, etc. Dr. Shah does not recommend surgery unless he believes it is warranted and can improve the function or appearance of the nose.
The short answer on this is no. Most fillers in the nose can cause a lot of problems. If they are to be used in the nose, they must be done under extreme care and with the expectation that the patient will not need a future rhinoplasty. Click here to learn about facial fillers in the nose. I think of using someone advertising a non-surgical rhinoplasty as a screening tool to eliminate them from my search as a rhinoplasty surgeon. It is in my opinion not a procedure I would recommend to a prospective patient seeking rhinoplasty and does not make sense from a variety of reasons. The exception to this rule is some post rhinoplasty patients who may need a smalll amount of Restylane or Juvederm in a very small amount in one area or another.
Whether you are male or female, your nose should not look unnatural. The key to rhinoplasty is to improve the existing structures of the nose in a balanced haromonious fashion with the rest of the face.
Chicago is located in the central portion of the United States and is a travel hub and headquarters for many airlines and businesses. The airports are conveniently located near the downtown which is accessible by either a cab ride or public transportation. Our office can help arrange for every travel detail from Hotels and Extended Hotel Suites, Nursing or Medical Assistants if necessary, to having food and supplies stocked.
The best solution is to use an electric nose trimmer. Tweezing nasal hair can lead to traumatic insult and infection and/or boils to the inside of the nose. The inside of the nose is where “bad” bacteria can live such as MRSA and others. The incidence of MRSA is on the rise in the general public with the overuse of antibitoics. I would wait 2 months before using an electric trimmer and 6 months before tweezing if tht is a procedure you feel necessary.
It depends on the individual and training. Only a surgeon whose practice devotes signficant attention to rhinoplasty should be considered. It is by far the most challenging operation.
The procedure as a whole is safe from an a medical standpoint where such complications are rare. However, the most significant issue with rhinoplasty patients is poor aesthetic result. Even surgeons who place results which they would consider some of their better work may qualify as a complication for other surgeons. Although the revision rate quoted for nose surgery is about 10-20% nationally, I think that this number may be signficantly higher for some surgeons who don’t offer long term followup.
Most likely not. Anosmia or loss of smell is frequently caused by a virus. Once there is loss to the delicate smell nerve, called the olfactory nerve, the loss is typically permanent. Some cases, improving a septal deviation will lead to improved smell but I would not count on it.
Rhinoplasty takes place in a formal operating room setting. An anesthesiologist is present throughout the case.
No one can tell you whether or not you should or should not have a procedure done. Many patients may have breathing issues and seek to correct the appearance of the nose at the same time. Dr. Shah will advise about the procedure, potential risks, and whether or not undergoing such a change will enhance your appearance during the consultation.
Most patients are able to return to work at one week. While some of the changes are evident immediately after surgery, many of the changes take time over several months to manifest.
Every rhinoplasty performed by Dr. Shah is tailored to the patient. There are over 1000 techniques which can be individualized to each patient. It is important that your surgeon is knowledgeable in a variety of techniques as each nose may require a a unique set of procedures for optimal outcomes.
Gentle technique, ice, and avoidance of blood thinners are the best ways. Some patients may take Arnica Montana, Bromelein, Pineapple extract or other homeopathic medicines which can help but are not critical in reducing bruising.
Most of our patients are taking Extra-Strength Tylenol on the first day after the procedure with minimal discomfort. However, each patient has a different experience.
Typically, you can verify a physician’s board certification by checking the board’s website or calling the boards toll free number. For example, Dr. Anil Shah is certified by The American Board of Facial Plastic and Reconstructive Surgery, which has a certification website. And he is also certified by the American Board of Otolaryngology, which was a phone number to call to check certification (713-850-0399). Most physicians will also place board certification in their office.
Patients can go swimming 2 weeks after a rhinoplasty in clean, chlorinated water with Dr. Shah’s permission.
Dr. Shah often compares rhinoplasty to architecture. There are some parallels in building a nose and building a skyscraper (there are many in New York). It wouldn’t be prudent to just jump into construction without a well planned approach or a blueprint. There is science to ensure that the building will function is safe and not collapse. However, there is artistry in designing the building, creating the building, and interpretation of glass and light and space. There have been significant advances in buildings over the time, with builders now able to buildings taller and with shapes and materials not possible in years past. Just as an architect for your house or company’s skyskraper would welcome your input, so should your surgeon.
He is one of the few surgeons who uses complex computational measures prior to every nose surgery to assess symmetry, projection, angles. Of course, these complex measures work in conjunction with Dr. Shah’s artistic eye. The idea is for Dr. Shah to guide you through this process and let you know what is and is not possible and what would look appropriate and function in balance and harmony with the rest of the face and body. He is using the most advanced rhinoplasty techniques available with state of the art planning and technical precision to help in creating your new nose.
One of the key steps of performing revision rhinoplasty is a clear idea of what the patient wants and communication. Dr. Shah uses computer imaging to facilitate a clearer understanding between himself and the patient.
The computer imaging serves as a guide to create various noses and determine an aesthetic level of acceptance. For example, a patient may want her nose deprojected, and Dr. Shah will present multiple options to determine what the patient finds satisfactory or not. If the patient and Dr. Shah do not come to an understanding during his consultation, he will meet with them as many times as necessary to better understand and clarify each others aesthetic goals. If Dr. Shah does not feel like he “understands” the patient’s aesthetic he will not operate on the patient.
Dr. Shah does not believe in trends for the nose. His desire is to create a natural nose in appearance and shape specifically created for that patient. He does not have a preference to his nose (strong, projected, etc), but just creates nose which match a person’s face in a natural appearance. “Fashion passes, style remains.” Coco Chanel
It is typically okay to have a spray tan one week after all of the sutures have been removed from the exterior portion of the nose. However, each case is different and speak to Dr. Shah for your specific case.
Patients can typically go swimming two weeks after the procedure in both chlorinated, salt water and fresh water. Patients who engage in potential traumatic activities such as surfing, tubing, body boarding should restrain until further notified by Dr. Shah.
Dr. Shah does not advocate any scar products at this time. Several products such as Vitamin E or Mederma have not been shown to improve scars. There are patients who have used such products in the past on other scars and have noticed improvement. For these patients use of these products may be okay. Scarguad MD has been used with some success by some patients. The vast majority of scars will heal to a fine thin line with or without a scar product.
Dr. Shah usually recommends waiting at least 3 months but in some cases longer depending on the type of rhinoplasty. The reason is that some extractions can push debris further into the nose and cause an infection. Patients who are concerned with excessive sebum and clogged pores should consider the use of skin care products such as retinols, astringents, and other products.
that some extractions can push debris further into the nose and cause an infection. Patients who are concerned with excessive sebum and clogged pores should consider the use of skin care products such as retinols, astringents, and other products.
The question here is on the type of rhinoplasty and the type of LASER. Soon after a rhinoplasty, LASER resurfacing procedures (i.e. C02 laser, Erbium laser, Fractionated C02 laser) must be performed with caution as the skin takes some time to revascularize. In some cases, patients must wait 6 months or longer to receive some type of LASER procedures. Lasers used to target blood vessels can be utilized earlier with conservative settings. It is best to speak to your surgeon to help determine a timetable that maximizes the risk to benefit ratio.
