6)What else is included with your surgery?  Some are bare bones deals - you get your implants and good bye, while others include a comprehensive pre-surgical assessment, and a thorough post-surgical follow up.  (we've heard from other patients about their friends getting their BA elsewhere, and after the surgery they saw their surgeon only at one week after surgery and never again!  We don't do that ... at our clinic you are welcome to come back and see us as often as needed, and we have a schedule of follow up visits for a full year after your surgery to ensure you get the best results possible.)
Case 37: Achieving a beautiful, natural change in an already beautiful woman is one of the great challenges we love in rhinoplasty. In front view you see a beautifully defined, natural change that simply looks great. Then on profile and 3/4 views, you see an elegant change where the tip is deprojected (made smaller) but retains a beautiful, natural aesthetic- this is finesse rhinoplasty.
However, if a patient underwent surgery in another country, but experiences post-operative complications, he or she will need to pay to travel back to the same destination if they wish to have the same doctor oversee any revisions. Revision surgery performed by a different surgeon is extremely difficult, and thus more expensive. In fact, it can cost 50 percent more than the original surgery. Therefore, it can actually be far more economical to pay for a surgery within the U.S.

This 45-year old female patient came to us frustrated with furrows between her brows. As we have with many other patients, we created and recommended a treatment plan that started with Botox injections. As you can see, even holding the same expression as before, the lines have nearly disappeared in these forehead lines before and after pictures. Results this powerful are possible for you, too.


As stated above, these complications are unlikely. However, patients can take steps to reduce their risks even further. First, they should choose a qualified surgeon, according to the guidelines listed above. Selecting an outstanding doctor, who maintains proper safety standards, can minimize the chances of infection, perforation, and other difficulties. An experienced surgeon can also ensure aesthetically pleasing results.
Patients who are unhappy with their previous nose job results are candidates for secondary rhinoplasty. Whether the nose is deemed too small, too large, or improperly shaped, a skilled surgeon may be able to correct the problem. Patients who experience breathing difficulties following rhinoplasty may also opt to undergo a second procedure. Factors influencing candidacy for revision rhinoplasty include:
Case 92: This procedure was all about correction of a droopy twisted tip. This patient was especially bothered by the tip’s tendency to drop and spread when she smiled, with a twist that made one nostril look higher than the other. After surgery, her nose is about as straight and symmetric as can be and the straighter bridge line makes her look younger.

This 37 year old female patient was troubled by the furrows that were appearing between her brows. These furrows are one of the unavoidable signs of aging, but we were able to roll back the clock a little with a quick application of Botox. We have more Botox ‘forehead lines’ before-and-after photos available at our clinic if you’re interested. You can also schedule your consultation for a Botox treatment, here.

For my patients, I also provide a post-operative packet. This includes arnica and other ointments, gauze and tape, an ice pack, and nasal decongestant spray. If your surgeon does not provide these items to you before or after your surgery, they are all helpful during the healing process. I encourage my patients to get anti-nausea medication for the first few days following surgery as well.


Case 26: Narrowing a wide tip can really soften the face. The challenge in Ethnic rhinoplasty is in making a nose smaller while still maintaining good structure and support so that definition is enhanced. In these 15-month photos, you can now see how tip narrowing along with reduction of the bridge convexity has created a very pretty, feminine nose that enhances her beauty.
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.
Once your bone and cartilage have been resculpted, your surgeon pulls the skin back down and stitches it along the open-rhinoplasty incision across the columella (the tissue that links the nasal tip to the nasal base). “When done properly, that incision is extremely hard to see, once it’s healed,” says Dr. Miller. With a closed procedure, the incisions are made inside your nostrils, so there’s no visible scarring, and the sutures are usually dissolvable. 
Dr. S. Valentine Fernandes, the Conjoint Senior Clinical Lecturer, at the Department of Otorhinolaryngology, Newcastle University, conducted a comprehensive study about the risks of rhinoplasty. According to Fernandes, the complication rate of nose surgery falls between 4 and 18.8 percent. While this may seem an alarming number, Fernandes reports that there is a much lower 1.7 to 5 percent risk of life threatening complications. He also notes that the complication rate falls in proportion to the doctor's surgical experience.
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.

The geographic location of the surgeon's practice can greatly affect the cost of rhinoplasty. More affluent cities and neighborhoods, such as Manhattan and Los Angeles, are plastic surgery hubs where some of the best surgeons in the world practice. Meanwhile, these areas also have a higher cost of living, which means higher overhead costs (rent, staff wages, utilities), and that translates to a higher overall price of rhinoplasty.
Rhinoplasty is a highly personal procedure that can affect a person's mental well-being, as well as his or her appearance. Therefore, it is vital that patients choose a surgeon with whom they feel comfortable. They should select a doctor who truly listens to their concerns, answers their questions, and creates a treatment plan that will address their specific goals. Patients should never choose someone who makes unrealistic promises or pressures them to undergo more surgery than they actually want.
Dr. Miller says it’s also important for patients to have realistic expectations. “It’s not a good idea to take a wide, thick nose and turn it into one that’s thin and tiny,” he says. “But if the steps are done properly, we can make the desired changes.” Thick nasal skin that makes it challenging to refine the nasal tip needs to be thinned out, for example. It’s important to find a board-certified facial plastic surgeon who specializes in ethnic rhinoplasties. 
In addition to the physical benefits of rhinoplasty, the procedure has psychological benefits as well. Individuals who are unhappy with the size or shape of their nose often feel self-conscious about their appearance and may suffer from low self-esteem. After undergoing rhinoplasty surgery, however, many patients report a marked boost in confidence. This benefit alone can be a great reason for patients to choose rhinoplasty.

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.
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.
1. Is your surgeon a board-certified plastic surgeon by the ABPS? The American Board of Plastic Surgery is the only certifying board in Plastic Surgery that is a member of the American Board of Medical Specialties.There are unfortunately quite a few physicians out there making money performing surgeries they have no training or experience to perform. Super low prices and wide open surgery scheduling availability are other bad signs this physician may not be up to standard.
Dr. S. Valentine Fernandes, the Conjoint Senior Clinical Lecturer, at the Department of Otorhinolaryngology, Newcastle University, conducted a comprehensive study about the risks of rhinoplasty. According to Fernandes, the complication rate of nose surgery falls between 4 and 18.8 percent. While this may seem an alarming number, Fernandes reports that there is a much lower 1.7 to 5 percent risk of life threatening complications. He also notes that the complication rate falls in proportion to the doctor's surgical experience.
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Dr. Richard Rival, a rhinoplasty surgeon in Toronto, has both certifications. While board certification is an essential prerequisite, make sure your surgeon has extensive experience performing the procedure and does so on a regular basis. Ask to see photos of previous patients. While these photos will likely show only the "best results," you will able to determine whether the surgeon is able to produce the improvements you want by paying attention to cases in the photo gallery that are similar to yours.
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.

5) What kind of anesthesia will you be getting and who will be doing it?  Like surgeons, different anesthetists charge different fees, and use different anesthetic agents.  At the Toronto Cosmetic Surgery Institute our anesthetist come with probably the most extensive cosmetic surgery experience in Toronto.  And the medications we use are more expensive than others, but we use them not to have an excuse to charge you more, but to keep you more comfortable, in less pain, and minimal to no nausea and vomiting after surgery.
You are a good candidate for rhinoplasty if you are in good general health. You have been bothered by the appearance of your nose for some time (years). You are generally happy with yourself but just don't like your nose. You are doing the procedure for yourself, not because of outside pressure from friends or family. You expect significant improvement but not perfection.
Both anesthesiologists and registered nurse anesthetists can administer anesthesia. An anesthesiologist is a specially trained physician who will administer anesthesia and monitor your vital signs during surgery. A registered nurse anesthetist has specialized training to do the same.  However, while a registered nurse's services can cost about $300 per hour, an anesthesiologist's services can cost closer to $500 per hour.
As with almost all forms of plastic surgery, there is a possibility for scarring following rhinoplasty. In closed rhinoplasty, all incisions are made inside the nostrils and will therefore not leave behind any visible scars. In open rhinoplasty, an additional incision made across the columella may leave a small scar behind. Fortunately, due to the size and location of the incision this scar is usually unnoticeable.
To apply for insurance coverage for a functional rhinoplasty, your surgeon can perform one of several tests. A CT scan shows irregularities within the nose that are not visible to the naked eye. An acoustic rhinometry is a test that maps the inside of a patient's nose. A rhinomanometry tests the level of airflow within the nostrils. In some cases, insurance companies require that patients show that they have attempted to treat nasal obstruction with other treatments. These may include antihistamines, allergy desensitizing injections, and steroid spray.
"Sometimes, a good reputation is well deserved, and sometimes it's merely hype and marketing," Dr. Naderi said. "There are reality show plastic surgeons who charge high fees, for example, based on their television exposure and publicity. Then, there are well-known plastic surgeons in the field who focus mainly on nose surgery and are true specialists."
"Many times, the cost of rhinoplasty or other surgery in New York City would be three times the price as in a smaller town, but it is not three times better necessarily," Dr. Park said. "At the same time, I would warn patients to beware of a physician in a small town that costs a fraction of what an average rhinoplasty would cost. In general, when a surgeon is throwing in discounts, I would be very wary."
Case 12: One of the things that we love about rhinoplasty is that we can combine dramatic changes such as straightening this patient’s nasal twist, and at the same time create some subtle enhancements such as refining and slightly deprojecting the tip while reducing the sense of columellar show. At 6 months, her nose now balances with her face and really brings out her beautiful eyes.
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.
After surgery, patients should be prepared for the cost of any pain medication they will take during recovery. These costs are not typically included in the overall cost of surgery. At my practice, we provide homeopathic medications as part of our total surgical package. Your surgeon can explain to you any prescription or homeopathic medications you may be prescribed and discuss their cost.
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