Case 42: Crooked noses can be one of the hardest things to correct in Rhinoplasty, especially if there has been significant trauma involved. The entire nose must be reconstructed in order to make the desired improvements. It took a lot of work to straighten and improve breathing in this patient’s nose. At the same time, his Beverly Hills Rhinoplasty was designed to make his nose a little smaller, more refined, and less down-turned while still looking natural. Even the scar on his tip was improved as part of his surgery.
Spread of toxin effects. The effect of botulinum toxin may affect areas away from the injection site and cause serious symptoms including: loss of strength and all-over muscle weakness, double vision, blurred vision and drooping eyelids, hoarseness or change or loss of voice, trouble saying words clearly, loss of bladder control, trouble breathing, and trouble swallowing.
Your plastic surgeon's experience and reputation make the greatest difference in the cost of rhinoplasty. Here in Manhattan, it is possible to undergo the procedure for as little as $3,000 when it is performed by surgeons-in-training, supervised by senior surgeons. Meanwhile, there are experienced surgeons who are not performing as many rhinoplasties as they would like, and may be willing to perform the procedure for $5,000 to $7,000. However, if rhinoplasty is your surgeon's specialty, this can provide the best chances of achieving the results you desire. His or her fees will reflect that, and depending on where the practice is located, the total cost of surgery can be upwards of $15,000.
Your nose is one of your most prominent features. If you are dissatisfied with the shape of your nose, and wish to refine it with cosmetic surgery, you should be prepared to define your goals, determine the surest way to achieve those goals, and make no compromises in your pursuit of the results you desire. Meet with several reputable and credentialed surgeons, ask questions, and make your choice based on the surgeon's ability to listen and educate, as well as his or her track record of providing beautiful results.
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. 
Although everyone heals at a different rate, most people will have very few signs of surgery at two weeks after rhinoplasty and feel comfortable returning to work. At this time most of the bruising has gone but there may be still some dark circles under the eyes that can be covered up with make up. There is usually some swelling on the tip of the nose and along the sides of the bridge. This will mostly be obvious to you and your surgeon but not the average person in the public.
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.
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.
Unfortunately, despite a surgeon's best efforts, in some cases a patient may be unhappy with the results of his or her surgery. This can result from numerous causes, including surgical error or unrealistic expectations on the patient's part. Because the final results of rhinoplasty can take up to a year to develop, patients should not panic if their noses have not taken their ideal shape in the first few months. If a patient is unhappy with the nose even after the final shape has stabilized, there are options for treatment and correction. Depending on the extent of changes that need to be made, a surgeon may recommend non-surgical nose reshaping or secondary (revision) rhinoplasty.
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.
Both open and closed rhinoplasty can be extremely effective. The doctor will determine the right technique for each patient, based on the natural shape of the nose and the goals for surgery. If the patient desires dramatic changes, or if the doctor is performing post-traumatic rhinoplasty, an open technique may work best. This method gives the doctor access to a larger part of the nose. In many cases, it also helps him or her to make small adjustments to the nasal tip. If a patient wants to address the bridge of the nose, closed rhinoplasty may work well. However, because each patient is different, there are no hard and fast rules regarding the "right" procedure to use.

The minimum age for rhinoplasty depends on both physical and emotional maturity. It's important to wait until your facial growth is complete, which is approximately at age 14 or 15 for women and in the late teens for men. There is no upper age limit for rhinoplasty, as long as you are in good general health. Many women and men come to Dr. Rival for nose surgery in their 40s and 50s.
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