Published
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By Landon S. Pryor, MD, FACS, board-certified, triple fellowship-trained plastic surgeon, Boca Raton, FL.
Yes, in many cases breathing and the shape of the nose can be fixed in one surgery. Many patients who see me about their nose have something specific they want to change, like a bump on the bridge; others are more focused on breathing problems caused by a deviated septum or other structural issues. Our rhinoplasty in Boca Raton page covers each on its own. This article is about doing both at once.
Functional rhinoplasty is surgery done to help you breathe better, not to change how the nose looks. It can fix problems with the septum, nasal valves or weak cartilage. The septum sits between the two nasal passages, and when it is deviated, the operation that straightens it is called a septoplasty. Surgery can also strengthen a weak nasal valve, and grafts can support the nasal airway. Cosmetic rhinoplasty, by contrast, is all about how the nose looks: smoothing the bridge, refining the tip, or adjusting the nostrils.
Yes, in many cases. When septoplasty and cosmetic reshaping are combined, the operation may be called a septorhinoplasty. Appearance, support and breathing all work together in the nose, so we plan them as one operation.
When there are two goals, I rank them. Getting you breathing better is priority number one. Priority two is the appearance of the nose. We go over that order with you at the consultation so there are no surprises. A mentor of mine used to say there is no such thing as surprises in surgery, only surprise surgeons. At the consultation I examine the bridge and nasal tip, nostrils, skin thickness, cartilage, septum and airway. I also look at your profile as a whole, since chin projection can change how prominent the nose appears. Photographs and imaging help us agree on a plan, though they cannot show the exact final result, and we can't make any promises or guarantees.
Open rhinoplasty means incisions inside the nostrils plus a small incision under the nasal tip. That gives me a full view of the framework and room for more extensive reshaping or grafting, and the external incision usually heals as a fine line beneath the nose. Closed rhinoplasty keeps the cuts inside the nostrils, so there is no visible scar, but it gives less access to the nose's structure. Both techniques are useful; I choose the approach based on what your nose needs.
Cost depends on the complexity of the surgery, anesthesia, facility fees, and whether functional or revision work is needed. A revision can be more complex because of scar tissue and changes to the cartilage, and sometimes cartilage from the septum, ear or rib is needed to rebuild support. More complexity means more cost. You receive a personalized estimate after your consultation, and payment plans are described on our financing page.
Rhinoplasty usually takes two to four hours under general anesthesia. In the first few days you can expect stuffiness, pressure, swelling and some bruising; swelling is usually worst around day two or three, then starts to go down. Most patients describe pressure, congestion and soreness rather than severe pain. A small external splint protects the nose for about a week.
Most patients can return to a desk job or school in 7 to 10 days, and bruising usually fades in 10 to 14 days. You avoid exercise, heavy lifting and anything that could bump the nose until we say it is safe, and glasses may need to stay off the bridge for a few weeks. Some minor swelling can last up to a year, and thicker skin or a revision may take longer to heal. Risks include bleeding, infection, visible scars, changes in feeling or smell, breathing issues, uneven results, or needing another surgery, and we go through those with you before you decide.
A good candidate has finished growing, is healthy enough for surgery, has realistic expectations, and stops nicotine as advised, because nicotine can slow healing and affect blood flow. Surgery isn't for everybody. What we do is elective surgery, so we don't want to have any medical complications related to surgery or recovery. We check your health, medications, breathing issues and any past nose injuries or surgeries ahead of time, and if a medical issue turns up we address that first. Safety first. Setting appropriate expectations is the first thing we do in plastic surgery, whether it is rhinoplasty or anything else.
I love rhinoplasty, and here is why. In my experience it is one of the more technically challenging surgeries, and these patients are some of the happiest after surgery and some of the most realistic, because they have a specific, long-held anatomic concern about their nose.
I'm certified by the American Board of Plastic Surgery, with fellowship training in pediatric and craniofacial surgery, aesthetic surgery, and breast reconstruction. This background informs how I approach rhinoplasty, considering appearance, structural support, and breathing together.
I do everything through the lens of helping people not only look better but feel better. Do your homework, get as much information as you can, and make a decision that is right for you. I see rhinoplasty patients in Boca Raton and also work with select patients in San Diego. If you want to talk it through, I am happy to have a conversation about it: read more about rhinoplasty in Boca Raton or schedule a consultation.
Insurance generally does not cover cosmetic surgery. Some insurers cover an approved functional portion when surgery is considered medically necessary to correct a documented breathing problem, but our practice does not bill insurance directly. Rhinoplasty here is self-pay, including the functional part, and we go over the full cost at the consultation so there are no surprises.
Most patients feel pressure, congestion and soreness rather than severe pain. Discomfort is usually most noticeable during the first few days and improves from there. Most people say the procedure is uncomfortable but not very painful.
Possibly. Grafts can support the tip, the bridge, or the nasal airway, and the cartilage usually comes from the septum. Ear or rib cartilage may be needed for a complex revision.
Glasses can put pressure on healing nasal bones. You might need to keep them off the bridge for a few weeks, and we tell you how long based on the work performed.
This article is general information, not medical advice. A consultation is the only way to know what is right for you.
