Plastic, Reconstructive and Aesthetic Surgery in Paris

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Rhinoplasty, nose reshaping surgery (nose job)

Rhinoplastie avec résection bosse et affinement de la pointe, Dr Masson

Rhinoplasty with hump resection and tip refinement, Dr. Masson.

Rhinoplasty is the modification of the morphology of the nose for the purpose of aesthetic improvement.

We refer to cosmetic rhinoplasty, but rhinoplasty can also be functional and aimed at correcting discomfort that is not aesthetic, such as difficulty breathing or snoring. This is called septoplasty (septum or nasal septum surgery, to correct a deviation of the septum).

The aesthetic and the functional can be combined during the same operation and we then speak of rhinoseptoplasty or septorhinoplasty. This is the typical case of the aftereffects of trauma to the nasal pyramid with fracture of the nose’s own bones where the nose is deflected causing aesthetic discomfort and the nasal septum is twisted, leading to deviation of the septum and functional discomfort to breathing.

Defects of the nose can be:

  • Congenital (present from adolescence such as a bump, an oversized tip or a deviation).
  • Malformative (malformative syndromes in children such as a cleft lip or cleft lip-palate).
  • Traumatic (secondary to a shock, a fracture, most often causing a deviation that did not exist before).
  • Linked to aging (fall of the tip and appearance of a hump by sagging of the skin and cartilage).

Doctor Vincent Masson is a plastic surgeon specializing in rhinoplasty in Paris.

From what age can you have nasal surgery?

Nose growth ends at the end of puberty at 16 years of age on average. So we do not operate before, except in the rare cases of birth defects. If the deformation of the nose is major, a rhinoplasty performed early on can help the adolescent to overcome a complex and to develop and flourish. In all cases, the parents’ authorization is essential for cosmetic surgery in a minor. There is no age limit for performing a rhinoplasty. In the majority of cases, the operation is performed between 18 and 35 years of age or after 60 years of age. The majority of patients between the ages of 18 and 35 want to correct the following defects: tip too wide, drooping tip, deviated nose or bump. After 60 years of age, patients look for a rejuvenating effect with a correction of the fall of the tip, the length of the nose and the hump. In all cases, it is always a delicate and meticulous surgical procedure and it is advisable to contact a specialist plastic surgeon.

What are the different types of rhinoplasty?

We can differentiate 6 types of rhinoplasty:

Rhinoplasty for congenital malformation

These include the sequelae of angiomas and other vascular malformations, cleft lip (cleft lip and palate or labio-maxillo-palatine), Binder’s syndrome, nasal hypoplasia, facial clefts, cysts and fistulas of the back of the nose. The nose shape anomalies are very diverse and often serious. They are present from birth or in early childhood and often require several reconstructive surgery procedures combining techniques of cartilage grafts, bone grafts and flaps. Doctor Masson was trained in reconstructive rhinoplasty in children in the pediatric plastic surgery department of Trousseau Hospital in Paris which is one of the few centers specializing in this area in France and will be able to advise you.

Post-traumatic rhinoplasty

Trauma occurred at the level of the nasal pyramid. A fracture of the bony skeleton (bones of the nose, rising branches of the maxillae, vomer) or cartilaginous skeleton (septum or nasal septum) has occurred with a shift in the normal anatomy of the nose. There may be a deviation of the nasal septum, which will obstruct the nasal cavities and therefore cause respiratory discomfort (nasal obstruction) up to snoring and a deviation of the entire nasal pyramid which is deviated to the right or the left (boxer’s nose). The purpose of rhinoplasty is to straighten a crooked nose and is often associated with a septoplasty (septum surgery or nasal septum) in order to place the septum in the right position and reduce the difficulty in breathing. This surgery (rhinoseptoplasty) is sometimes covered as compensation by social security after prior agreement. Doctor Masson was trained in post-traumatic rhinoplasty in the maxillofacial and plastic surgery department of the Pitié Salpétrière Hospital in Paris, the benchmark center in Ile de France in the field of facial trauma.

Ethnic rhinoplasty

It is of interest to Asian, Middle Eastern and African patients.

  • African patients generally want to correct the overly broad aspect of the nose, the lack of projection (nose too flat) and the width of the nostrils (wings of the nose). Ethnic rhinoplasty techniques for patients of African descent almost always use augmentation cartilage or bone grafts.
  • African patients generally want to correct the overly broad aspect of the nose, the lack of projection (nose too flat) and the width of the nostrils (wings of the nose). Ethnic rhinoplasty techniques for patients of African descent almost always use augmentation cartilage or bone grafts.
  • Finally, patients from the Middle East most often have a broad, deviated nose, with a large hump and poorly defined and drooping tip of the nose. The correction uses classic rhinoplasty reduction techniques with osteotomies.

Rejuvenation rhinoplasty

After the age of sixty, the tissues of the nose relax (skin, muscles, ligaments, cartilage) and the nose tends to dip (drooping tip), lengthen, and develop a hump in the dorsum under the effects of aging. The correction uses classic rhinoplasty methods. The change should not be too radical, otherwise the patient’s body image will be altered, the nose should remain natural at all costs.

Aesthetic rhinoplasty

This represents the vast majority of rhinoplasties in cosmetic surgery. Patients are most often between the ages of 18 and 35 and are often very complexed by their noses. The defects became visible at the end of puberty and quickly became invasive. The most frequent requests concern a bump that is too marked, a deviated nose, a tip that is too wide (ball or champagne cork), a drooping tip, a nose that is too long.

“Failed rhinoplasty” or, more precisely, secondary rhinoplasty

15 to 20% of the rhinoplasty requests I receive in Paris relate to noses already operated by another surgeon but considered by the patient as unsuccessful. Rhinoplasty failures are very disabling for patients and can significantly affect their social life. Rhinoplasty is a very fine and meticulous surgery which requires a certain know-how. The failure may correspond to a lack of communication between the surgeon and the patient (the surgeon did not understand what the patient wanted), an unreal expectation of the patient as to the expected result, an excess or insufficient correction of the anatomical structures or a problem with tissue retraction, fibrosis, skin tightening and scarring after the procedure. Correcting a “failed nose” (secondary rhinoplasty) is often difficult and involves reconstruction techniques, most often with cartilage grafts. In all cases, it is advisable to wait 1 year after the primary rhinoplasty to consider a correction under the best conditions.

Among the main faults observed, we can cite:

  • Polly beak. The nose takes the shape of a ball in profile at its tip. It is either cartilaginous (insufficient resection of the septum) or cutaneous (excess resection of the septum with thick or excess skin). The cartilaginous beak is treated by resection of the septum and the cutaneous beak by graft of cartilage at the level of the septum.
  • The inverted V. The nose takes on an inverted V aspect from the front to its middle part. This is due to a disinsertion of the triangular cartilage. The treatment consists of reinserting these cartilages and sometimes performing cartilage grafts (spreader grafts).
  • Saddle nose. In profile the nose appears to no longer have a dorsum. Linked to an excess of hump resection, grafts are needed for treatment.
  • Tip deformations. From hollow asymmetry to rotation. Linked to the alar cartilages (excess resection, interruption, disinsertion, retraction phenomena and fibrosis, most often unpredictable). There are many correction techniques.
  • Localized and discreet faults. Hollow, bump, roughness under the skin, minor asymmetry. These faults are normally easily corrected.

Rhinoplasty in practice

Rhinoplastie avec résection bosse et remontée de la pointe photo avant après Dr V Masson

Rhinoplasty with hump resection and ascent of the tip. Before and after photos, Dr. V Masson.

Two consultations with the cosmetic surgeon are compulsory. During the first consultation, you will be given an information sheet as well as a consent from and a quote indicating the price of the rhinoplasty. The minimum time between the first consultation and the cosmetic rhinoplasty operation is 15 days (the legal period of reflection). The surgeon, after examining you and listening to your requests, will explain to you what you can expect from the operation, aesthetically, functionally and psychologically. He will give you his opinion on you undergoing a rhinoplasty, whilst keeping in mind that the role of a cosmetic surgeon is also to advise you not to perform the operation if he considers that you will not benefit from it. Medical photographs are taken systematically and a simulation of the result (morphing) can be carried out on photographs or on a computer. A pre-operative assessment is prescribed to you based on any possible health problems you may have and a consultation with an anesthesiologist will take place at least 48 hours before the rhinoplasty is performed.

How long is the stay at the hospital or clinic?

Generally, you are hospitalized in the morning and can leave in the evening or the following morning.

What type of anesthesia is used?

Typically, it is general anesthesia. In some cases, local anesthesia supplemented with sedation (a relaxing intravenous drug) may be offered.

How long does a rhinoplasty last?

Depending on the procedures to be performed (osteotomies, cartilage grafts, septoplasty, etc.) between 45 minutes and 3 hours.

Is it painful?

The pain is generally very moderate and lasts from 24 to 48 hours. It is controlled very well by the usual analgesics. Current techniques consist in performing so-called ultrasonic interventions, that is to say that the bone is no longer broken as it used to be with a hammer and scissors, but a machine that delivers ultrasound. Modern ultrasonic rhinoplasty surgery is less painful than it used to be. The discomfort that the patients describe is mainly due to the wicks which are put in the nostrils for the first 24 hours after the intervention to avoid bleeding and to the fact that the nostrils are blocked for the first few days after the operation (you need to breathe by mouth). The wearing of glasses is possible but the visual field is slightly modified due to the plaster which obliges the patient to wear glasses more on the tip of the nose than usual and requires a short period of adaptation.

Are there any scars?

In any case, scars inside the nose are essential. They are located at the nostrils either at the junction of the alar and triangular cartilages (intercartilaginous route), or at the level of the alar cartilages (transcartilaginous route) and along the septum behind the columella (interseptocolumellar route). The nose is then worked on from the inside, this is called the closed rhinoplasty approach. The scars are absolutely invisible because they are located inside the nose. The threads are absorbable in all cases.

In some more complex cases (secondary rhinoplasty, cartilage grafts, etc.) it is necessary to make an incision at the level of the columella (skin between the two nostrils under the tip of the nose) in order to lift the entire skin of the nose to work on the bony skeleton and cartilage. This is called the open rhinoplasty approach. The scar is invisible because it is in a shaded area. Very fine threads are then used so as not to mark the skin and are removed around the 5th day.

In cases of ethnic rhinoplasty with reduced width of the nostrils a scar is placed on the side of each nostril in a fold. The threads are removed around the 5th day and the scar is invisible.

Finally, in cases where a cartilage sample is necessary, it may be necessary to take some conch cartilage from the ear. There is no visible deformation in the ear and the scar is hidden behind the ear and, therefore, very discreet.

What normally happens after the operation?

In the vast majority of cases, a plaster is placed after the operation. It will be removed by your cosmetic surgeon between the 6th and the 10th day after the intervention depending on the procedure performed. Showering and shampooing are allowed, but take care not to get the plaster wet.
A wick is placed in each nostril to prevent bleeding and will be removed the evening or the day after the rhinoplasty.
The threads are absorbable except in the case of an incision at the level of the columella (open rhinoplasty approach). The threads will then be removed around the 5th day.
A solution for washing the nasal cavity will be prescribed. The nasal cavity should be rinsed four to six times a day to remove the scabs that form on the scars.
Breathing through the nose is difficult during the first week after the operation and you will have to breathe through your mouth (the sensation is equivalent to that of having a cold).
Bruises on the eyelids and cheeks are common and fade in 5 to 15 days. Swelling is also common and completely normal.
The nose is often sensitive to cold, insensitive to touch, and the skin hard for the first few weeks, sometimes for several months afterwards.
It is not recommended to engage in any sporting activities for three weeks after the operation (two to three months for violent sports where there is risk of trauma to the nose).
It is recommended to take 7 to 15 days off work after the operation.

When will I see the result?

The nose remains swollen for one month after the plaster is removed and the final result is only visible after one year (which is the duration of the scar maturation).

Is it possible to perform rhinoplasty without surgery and without anesthesia?

In some (rare) cases, an injection of hyaluronic acid can fill a small defect such as a hollow. This procedure does not require hospitalization or anesthesia but remains transient (the product is absorbable, its lifespan is 6 to 12 months). Sometimes fat taken from the patient (lipofilling) can replace the use of hyaluronic acid.

Are there any potential complications ?

General complications from surgery and anesthesia are still possible, although extremely rare. Mention must be made of hematomas, abnormal bleeding, keratitis, infection, pathological scars, skin necrosis.

In practice, the real complications of rhinoplasty concern the imperfections of the result. According to international scientific studies involving thousands of rhinoplasties, the resulting imperfection rate is 5 to 20%. They result from a misunderstanding between the surgeon and the patient concerning the objectives of the rhinoplasty, technical defects (over or under correction), unusual scar phenomena, or unexpected tissue reactions (poor skin retightening, retractile fibrosis). A touch-up can in most cases be considered.

What is the price of a rhinoplasty?

The price of the rhinoplasty will be indicated to you on the quote given to you by Doctor Masson for consultation. It is variable because of many factors (difficulty of the procedure, foreseeable duration of the operation, osteotomy, transplants, whether or not it is covered by social security, etc.). From 7000 euros.

Rhinoplasty summary sheet

Before the operation

  • 2 consultations with Doctor Vincent Masson (for a precise definition of your expectations)
  • Preoperative assessment
  • 1 consultation with the anesthesiologist
  • Realization of medical photographs, simulations of the result (photo or computer morphing)

The operation

  • Outpatient or overnight hospitalization after the rhinoplasty
  • Most often general anesthesia is used
  • Duration of the rhinoplasty: 45 min to 3 hours depending on the case
  • Plaster and wicks in the nostrils

After the operation

  • Removal of plaster between the 6th and 10th day
  • Removal of wicks the day after the rhinoplasty
  • No threads to remove except open track (threads to be removed on the 5th day)
  • Normal low abundance bleeding for a few days, very moderate pain
  • Swelling and bruising up to 15 days
  • Difficulty breathing through the nose for a week
  • Washing the nasal cavity 4 to 6 times a day for one week
  • No violent sport for 2 to 3 months
  • Final result after one year
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