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.
On average, RealSelf members paid about $7,500 for a rhinoplasty. This includes the cost of the surgeon, anesthesia, and surgery center. Your cost will depend on your surgeon’s geographical location, their expertise level, and the complexity of your surgery. Insurance doesn’t cover rhinoplasty when it’s purely cosmetic, but it can help if you’re looking for structural corrections to alleviate medical problems. “Insurance will typically cover procedures to help improve nasal function [i.e., septoplasty, nasal valve repair, turbinate reduction],” says Dr. Sam Naficy, a Seattle facial plastic surgeon. “The extent of coverage varies, based on the details of the insurance plan.” 

The closed vs. open rhinoplasty technique concerns only how the surgeon gets inside the nose to make the required changes, not what’s accomplished with the rhinoplasty procedure itself. Reshaping your nose may include breaking and removing bone and cartilage. If cartilage needs to be added, say, to rebuild the tip of the nose, it’s often taken from the septum, the middle portion of the nose—a technique called a cartilage graft. Cartilage may also be taken from other areas of your body, such as your ear. In some cases, a synthetic material, like a silicone implant, is used; but studies have shown that there may be more complications with synthetics. Cartilage grafts, nasal-bone osteotomies (removal of parts of the bone), dorsal-hump removal, and suture techniques applied to the nasal tip cartilages can all be performed with either the closed- or open-approach rhinoplasty.
Case 71: Tip and nostril width and overall nasal projection made the nose feel dominant for this young woman. Rhinoplasty involved making her whole nose smaller by deprojecting, refining the tip, and removing some nostril flare. At the same time, a nasal fracture and breathing concerns were addressed. Neck Liposuction also helped to define and re-balance her jawline to create the improved facial proportions that she desired.
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 87: This young woman had broken her nose and was noticeably crooked with poor nasal breathing. In addition, she disliked her nasal hump and length. She preferred an aesthetic with a slight supra tip break to soften her profile. Beyond straightening and improving her breathing, you can see how we were able to remove the nasal hump and lift her tip to transform her look while still looking completely natural.
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 4: Some might think that this patient had had previous rhinoplasty with tip collapse, but she did not. Occasionally, the shape of the tip cartilages is very vertically-oriented, causing a deep groove in the nostril. She felt this, along with her marked tip crookedness, drew unwanted attention to her nose. Now, her nose is smaller, smoother, more defined, and just blends with the rest of her face.
Case 61: The concerns in this case were crookedness and a significant breathing issue due to a severely deviated septum. She also felt her nose was over-projected and a little too big for her face. Here we can see resolution of her crooked septum on base view. The tip has been defined and de-projected and the bump brought down to create a naturally pretty and more balanced contour.
As with most plastic surgery, getting more than one procedure done at one time can save you money in anesthesia and facility fees. Prices will vary by surgeon, but it is always best to look for the most qualified doctor rather than the lowest price. Also, some doctors will offer discounts to patients who agree to give testimonials or allow the doctor to use their before and after photos.
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.
Case 22: This young woman was happy with her profile but wanted to reduce nasal width, tip boxiness, and nostril flare on front and three-quarter views. The combination of narrowing her bridge, tip refinement, and nostril reduction helped bring her nose into balance. At the same time, fat transfer to the under eye hollows did a fantastic job of brightening her eyes and giving her a more youthful look.

The surgeon makes incisions in the skin, usually on the crease under the breast, around the areola and along the underside of the breast. After removing excess skin, the doctor will move the areola and nipple to a new, higher position, pull the skin down to reshape the breast, and then stitch the incisions. Usually, the procedure requires general anesthesia. The American Society of Plastic Surgeons[1] provides a detailed description of the surgery.
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.
Case 4: Some might think that this patient had had previous rhinoplasty with tip collapse, but she did not. Occasionally, the shape of the tip cartilages is very vertically-oriented, causing a deep groove in the nostril. She felt this, along with her marked tip crookedness, drew unwanted attention to her nose. Now, her nose is smaller, smoother, more defined, and just blends with the rest of her face.
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. 
The statement usually encouraged positive remarks about the potential communal meaning of a mixed-race member of the royal household. Markle declared that she’d give up work from drama, and started the procedure of becoming a British resident. The personal service, conducted with water in the River Jordan, happened in the Chapel Royal in St James’s Palace.
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