As we age, our bodies undergo numerous changes. Gravity takes hold, and the skin’s elasticity weakens. This can result in drooping, sagging breasts. Over time, a woman’s breasts may lose their perkiness, and can also lose volume. Pregnancy and breastfeeding can exacerbate these effects. The changes in breast appearance can have a tremendous effect on a woman’s self-esteem.
If you’re having what’s called an open rhinoplasty, the surgeon will make an incision (about 6 millimeters long) in the skin between the nostrils. “Open rhinoplasty is a very common technique, where the skin is lifted upward like the hood on a car,” says Dr. Ronald Schuster, a Baltimore plastic surgeon, in a RealSelf Q&A about open vs. closed rhinoplasties. If you’re having a closed rhinoplasty, all incisions are placed on the inside of the nose, so there are no external scars.
A rhinoplasty, commonly called a nose job, is a surgical procedure that changes the shape and, often, the size of your nose. If your nose has a prominent bump, crooked bridge, or wide tip, or it seems too big (or even too small) in relation to the rest of your facial features, surgical rhinoplasty could be your best option to correct it. It’s sometimes combined (and often confused) with a septoplasty—the surgical correction of a deviated septum, a condition where the wall between your nasal passages is crooked. A septoplasty is performed to improve breathing, while a rhinoplasty is usually performed for cosmetic enhancement.  Both procedures can be performed simultaneously under one anesthetic, with one recovery period.
Case 96: To see how well our results last, see these photos of our patient 8 years after rhinoplasty and facial fat transfer! Her rhinoplasty involved softening her look and removing the convexity on the bridge that made her tip look downturned. Fat transfer under the eyes has stood the test of time and really helped to reduce her under eye hollows to noticeably brighten her appearance.

Case 33: For this young woman, the nose felt boxy and unrefined in comparison to her more defined facial features. Goals of rhinoplasty included lifting and definition of the tip along with subtle hump reduction to create a more sleek and streamlined nasal contour. Achievement of these goals creates a nose that harmonizes rather than dominating other features.
How much you’ll swell really depends on you and on your surgeon’s technique—not so much the type of rhinoplasty you had. Dr. William Portuese, a facial plastic surgeon in Seattle, says that “The amount of swelling after a rhinoplasty procedure depends upon the type of rhinoplasty performed [open versus closed], the thickness of the skin, the amount of alteration required to the nasal tip, and the patient’s variability with the healing process itself.” He notes that “Some patients require taping and steroid shots in the tip of the nose to reduce swelling in that area for the first several months after the procedure.” According to Dr. Miller, “A very clean open rhinoplasty can result in minimal swelling, while with a closed procedure that isn’t performed in the ideal tissue and cartilage, you can have a lot more swelling. If the dissection travels through soft tissue or muscle on top of the cartilage, more bleeding and swelling will develop.” He notes that most people can also expect some bleeding from days two to five, but it should lessen with each passing day.

Case 40: Excessive nasal width can cause the nose to dominate other fine, delicate facial features. In Ethnic Rhinoplasty, the key to obtaining a more refined nose is to create a nasal framework upon which the thick skin will wrap around. This pretty young Persian woman wanted to reduce her nasal width, the fullness in her tip, and the sense that her tip was downturned. These six month photos show significant improvements in achieving these goals and her nose will only get better yet.
Case 3: A curvature and droopy tip brings undue focus to this young man’s nose. Although there is still some swelling in these early post-operative photos, we can already see a nose that is now straight, has a smooth profile and no longer droops. A sense of length is preserved to match his oval face. More than that, because of these positive changes, he also looks younger.

Your breasts will be bruised and swollen for the first few weeks, and they’ll probably feel heavy and tight. According to Dr. Ted Eisenberg, a Philadelphia plastic surgeon, in a RealSelf Q&A, “women report minimal discomfort after breast lift surgery.” But you should have pain medication prescribed for the first few days, just in case you need it. After that, Tylenol should do the trick.


Case 29: Major concerns for this patient were widening of the tip with a marked lack of projection which made his nose feel flat and washed out. Nostril thickness and rounding was also something he wanted addressed. In this case, irradiated donor rib cartilage was used to project and support the tip along with alar base reduction removing a significant amount of nostril flare to create a natural tip and nostril contour that is ethnically appropriate. Fat transfer to the cheeks helps to balance out his flat mid-face to strengthen the cheek contour which can be seen nicely on the profile view. 

In addition to a breast lift, many women also consider having other procedures performed at the same time to enhance the overall result. For example, a “mommy makeover” is a combination of different surgical procedures reserved for women who have been pregnant and want to look like they did before the pregnancy. This may include a tummy tuck, liposuction surgery and breast enlargement or breast reduction. There is also a cost savings of having multiple procedures done at the same time.
If your doctor recommends breast reduction or breast augmentation, these are additional costs. Average cost of breast reduction is $6,500 to $12,000 while the average cost of surgery for breast augmentation is $5,000 to $10,000. In many cases, if your combining procedures there will be a discounted rate. Remember that the more experienced the plastic surgeon, the more expensive the surgery could be. However, you are investing in yourself by choosing an experienced surgeon.
Asian, Latin, and African American rhinoplasties require a special skill set. Surgeons say the challenge lies in reshaping and resizing the nose while retaining its distinct features and keeping it proportional to the face. “Typically, African American, Asian, and Latin noses have flat bridges and wide tips,” says Dr. Miller. “The number-one goal is to create a new tip [through cartilage grafting] that has better support.” Patients also often request a reduction in nostril size. 

Case 46: A hump and hanging tip cause the nose to dominate otherwise beautiful features in this young woman. In this case, a tip lift, hump reduction, and tip refinement preserves some of her rounded appearance, very naturally enhancing her pretty eyes. On the bottom view, we see a good example of how open rhinoplasty incisions should heal virtually undetectably when done with care.
Dr. Fouda Neel is one of the leading surgeons in the field of cosmetic surgery. Prior to your procedure he will explain what is involved in your aftercare. It is important that you pick up any prescriptions for pain medication or antibiotics before your surgery. Not all patients require post-surgery antibiotics and Dr. Fouda Neel will discuss this with you during your initial meeting.
Case 89: This patient had broken her nose with consequent severe loss of tip support, tip rounding, crookedness, and a traumatic bump. In this case, a lateral crural overlay technique was used to reduce and lift the tip along with a septal extension to help with support and straightening which has improved tremendously as seen on the base view. Even though she’s still swollen in these early photos, she already has a great result and it’s only going to get better.
A Bra Lift with Laser (Laser Bra Lift): Some doctors will want to use a laser bra lift as an insurance policy that your breasts won’t sag. It’s actually not really an alternative to breast lift surgery as it is an extra procedure. In the laser bra surgery, the laser is used to create a bra-like effect that protects the surgical results of the breast lift. Laser energy will always stimulate the production of new collagen fibers, which give you more support of any tissues. Always look at the before and after pictures to see whether or not you think there is enough improvement.

The results are usually permanent, aside from normal changes that come with the aging process. If you’re really not happy with your results or have breathing difficulties once your nose has healed, you may be a candidate for a revision rhinoplasty. In many cases, scar tissue is the main culprit. “The force of a scar is very strong,” says Dr. Miller. “It can pull a nose one way or another—push it in, pull it out, turn it.” When this happens, a surgeon has to go back in and tweak the work. 
A Bra Lift with Laser (Laser Bra Lift): Some doctors will want to use a laser bra lift as an insurance policy that your breasts won’t sag. It’s actually not really an alternative to breast lift surgery as it is an extra procedure. In the laser bra surgery, the laser is used to create a bra-like effect that protects the surgical results of the breast lift. Laser energy will always stimulate the production of new collagen fibers, which give you more support of any tissues. Always look at the before and after pictures to see whether or not you think there is enough improvement.
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