Procedure guide
What rhinoplasty can change, how it is performed, and what recovery involves.
Written by Orr Shauly, MD, plastic surgery resident. Updated .
For information and education only, not medical advice.
The short answer.
Rhinoplasty reshapes the bone and cartilage of the nose to change its appearance, and septorhinoplasty also straightens the septum and opens the airway to improve breathing.1,2 In meta-analyses of the Rhinoplasty Outcome Evaluation, satisfaction scores roughly doubled after surgery, and functional rhinoplasty improved nasal obstruction and quality of life.3,4 Swelling fades over about a year, and serious complications are uncommon, with reoperation in 2.3% within 30 days in a national database.2,5
- 33.5 - 80.3
- satisfaction scores
- Average Rhinoplasty Outcome Evaluation scores before surgery and 12 months after, across 17 studies.3
- 1 Year
- for final swelling
- Time often needed for the last 10% of swelling to resolve, especially at the tip.2
- 2.3%
- 30-day reoperation
- Patients returning to the operating room within 30 days among 835 rhinoplasties in a national database.5
- 33%
- dysmorphic symptoms
- Rhinoplasty candidates with at least moderate symptoms of body dysmorphic disorder in a study of 226 patients.6
What rhinoplasty is.
Rhinoplasty changes the shape of the nose by reshaping its framework of bone and cartilage beneath the skin. It can reduce a hump, refine or support the tip, straighten a crooked nose and change length or projection.1,2 Appearance and breathing are linked, so a careful evaluation always includes the airway. Septorhinoplasty corrects a deviated septum or a narrow nasal valve at the same time.1
Rhinoplasty works within the limits of the skin. Thick skin contracts less over a reshaped framework, which can limit how much definition shows through.2 Computer imaging can help communicate goals, but it is a planning tool and not a guarantee of the result.1
Who is a candidate.
Candidates are bothered by the shape of the nose, have trouble breathing through it, or both, and have realistic goals. The evaluation covers the nasal anatomy, the airway, prior nasal surgery or injury, bleeding history and medications that cause congestion.1
Psychological readiness strongly shapes outcomes. In a study of 226 patients seeking rhinoplasty, 33% had at least moderate symptoms of body dysmorphic disorder, and a 2026 meta-analysis put the prevalence near 30% among Asian rhinoplasty candidates.6,7 A systematic review found that anxiety, depression and body dysmorphic disorder were consistently linked to lower satisfaction even after technically successful surgery.8
In a crowdsourcing study of 298 people, 57.84% of those interested in aesthetic rhinoplasty screened positive for a psychological disorder, which supports screening before surgery.9 Patients with psychiatric diagnoses also had more revision operations in a cohort of 961 patients, 18% vs 12%.10
Rhinoplasty techniques.
| Technique | Approach | Evidence |
|---|---|---|
| Closed (Endonasal)1,11 | All incisions inside the nose, with no external scar | Less swelling and a faster recovery, but less direct view of the anatomy |
| Open1,11 | Small incision across the columella to lift the skin and see the framework | Better visualization for complex changes, with more tip swelling and a small scar |
| Structural1,2 | Reshapes and supports the framework with sutures and cartilage grafts | Versatile for tip support and breathing problems |
| Dorsal Preservation12 | Lowers the bridge as a unit instead of removing the hump | Satisfaction rose from 62.13 to 91.14 across 30 studies and 5,967 patients |
No approach suits every nose. The choice depends on the deformity, the need for grafts and the surgeon's experience, and comparative studies show similar results when the approach is matched to the patient.1,11 Reoperation rates were similar after primary open and closed rhinoplasty in a 49-study review, 2.73% vs 1.56%.13
Preservation rhinoplasty keeps the natural bridge and the soft tissue envelope intact rather than removing and rebuilding them. Within it, the push-down technique had fewer residual humps and revisions than the let-down technique, although it was typically used for smaller humps.12
How rhinoplasty is performed.
- Anesthesia: General anesthesia is preferred because it allows time for an individualized operation and keeps the patient comfortable.1
- Incisions: Incisions are placed inside the nose, with a small additional incision across the columella in an open approach.1
- Framework: The hump is reduced or the bridge lowered, the tip cartilages are reshaped with sutures or grafts, and the nasal bones are narrowed if needed.1,2
- Airway: The septum is straightened and the nasal valve supported with grafts when breathing is affected.1
- Dressings: A splint is placed on the outside of the nose, and routine nasal packing is usually not needed.1
Medications reduce swelling and bruising. Perioperative steroids reduced swelling and bruising around the eyes in a meta-analysis of randomized trials, and tranexamic acid reduced blood loss, swelling and bruising in 11 trials with 841 patients.14,15 Preserving the lining of the bone during osteotomies and using piezoelectric instruments were also linked to fewer complications.16
Recovery.
Recovery milestones come from surgical textbooks and vary with the extent of surgery.2
| Time | What Usually Happens |
|---|---|
| Days 1 - 42 | Some bloody drainage from the nose, with no nose blowing or sniffing |
| Days 6 - 72 | The external splint is removed |
| Weeks 2 - 32 | Strenuous activity and heavy lifting are avoided for about 3 weeks |
| Week 42 | Glasses can rest on the nose again |
| Month 32 | Most swelling has resolved and breathing can be fully assessed |
| About 1 Year1,2 | The last swelling, mostly at the tip, resolves and the final result is judged |
The nose may feel stiff when smiling for several months, and it should be protected from heavy sun exposure for about 6 months.2
Risks and complications.
In 835 rhinoplasties in a national database, complications within 30 days were uncommon, led by reoperation in 2.3% and superficial infection in 1.1%. Male sex and higher anesthesia risk scores predicted complications.5 Most complications after rhinoplasty are aesthetic, such as irregularities or asymmetry, rather than medical.2
| Complication | Reported Rate | Context |
|---|---|---|
| Reoperation Within 30 Days5 | 2.3% | 835 patients in a national database |
| Reoperation After Primary Surgery13 | 1.56% - 2.73% | Closed vs open approaches across 49 studies |
| Superficial Infection5 | 1.1% | Usually treated with antibiotics |
| Reduced Smell17 | 2.7% | After septoplasty, septorhinoplasty or turbinate surgery across 102 studies |
| Revision10 | 12% - 18% | Lifetime revision in one cohort, higher with psychiatric diagnoses |
Other risks include bleeding, a blood collection in the septum, new or persistent blockage of the airway and skin problems.1 Breathing problems from a narrowed valve or collapsed bones can usually be assessed by about 3 months.2
Revision rhinoplasty is more complex than a first operation, often needing cartilage from the ear or rib, and patients undergoing revision were more often dissatisfied in a single-surgeon series.1,18
Results and how long they last.
Satisfaction improves substantially. Across 17 studies, Rhinoplasty Outcome Evaluation scores rose from an average of 33.50 before surgery to 69.60 within 6 months and 80.25 at 12 months.3 A second meta-analysis of 24 studies confirmed significant gains in satisfaction and quality of life, with differences by country that highlight the role of culture and expectations.19
Breathing improves as well. In 16 studies of functional rhinoplasty with 971 patients, nasal obstruction scores and sinonasal symptoms improved significantly.4 Results are permanent in the sense that the framework is changed, but the final shape is judged only after about a year of healing.1,2
Alternatives to surgery.
Nonsurgical rhinoplasty uses filler, most often hyaluronic acid, to smooth a hump or lift the tip temporarily. In a review of 9,657 patients, satisfaction was 99.08% and most side effects were mild, but serious vascular complications such as skin loss, blindness and stroke occurred in 0.27%.20 Filler cannot make a nose smaller or improve breathing.20
What we don't know yet.
- Long-Term Preservation Results: Preservation techniques are popular again, but long-term comparative data are limited.12
- Approach Comparisons: Studies of open vs closed rhinoplasty vary widely in design and measurement.11
- Psychological Screening: The best way to screen for and support patients with body dysmorphic symptoms is not standardized.7,8
- Revision Rates: Long-term revision rates are rarely tracked consistently across practices.13
Common questions.
Can rhinoplasty improve breathing?
Yes. When breathing is limited by a deviated septum or a narrow nasal valve, septorhinoplasty can straighten and support these structures. In 16 studies, functional rhinoplasty significantly improved nasal obstruction and quality of life.
What is the difference between open and closed rhinoplasty?
Closed rhinoplasty uses incisions inside the nose only. Open rhinoplasty adds a small incision across the strip of skin between the nostrils so the framework can be seen directly. A meta-analysis found similar satisfaction, breathing and complications with both.
What is preservation rhinoplasty?
Preservation rhinoplasty lowers the bridge of the nose as a unit while keeping its natural surface and the soft tissue intact, rather than removing the hump and rebuilding the bridge. Reported satisfaction is high, though long-term comparative studies are still limited.
How long does swelling last after rhinoplasty?
Most visible swelling settles over the first few months, but the last 10% can take about a year to resolve, especially at the tip and with thicker skin.
Will rhinoplasty leave a scar?
Closed rhinoplasty leaves no visible scar. Open rhinoplasty leaves a small scar across the columella, which usually heals well.
How common is revision rhinoplasty?
Revision rates vary by study and follow-up. In one long-term cohort, 12% of patients without psychiatric diagnoses and 18% of those with them had at least one revision.
When can I return to work after rhinoplasty?
The external splint usually comes off after about a week, and strenuous activity is avoided for about 3 weeks. Studies rarely measure return to work directly, so your surgeon can give a personal estimate.
Is rhinoplasty right for me?
Only an in-person evaluation can answer that. This guide is educational and cannot assess an individual case. A qualified plastic surgeon can review your goals, breathing, anatomy and health history with you.
Key terms.
- Septorhinoplasty
- Rhinoplasty combined with straightening of the nasal septum to improve breathing.
- Septum
- The wall of cartilage and bone that divides the inside of the nose into two sides.
- Columella
- The strip of skin and cartilage between the nostrils, where the open rhinoplasty incision is made.
- Dorsum
- The bridge of the nose, from between the eyes to the tip.
- Internal Nasal Valve
- The narrowest part of the nasal airway, which can collapse or narrow and limit breathing.
- Spreader Graft
- A strip of cartilage placed along the septum to support the middle of the nose and open the nasal valve.
- Osteotomy
- A controlled cut in the nasal bones to narrow or straighten them.
- Preservation Rhinoplasty
- Techniques that lower the bridge of the nose while keeping its natural surface and soft tissues intact.
- Body Dysmorphic Disorder
- A condition of persistent preoccupation with a perceived flaw in appearance that others do not notice or see as minor.
- Rhinoplasty Outcome Evaluation
- A validated questionnaire that measures satisfaction with the appearance and function of the nose.
Research by Dr. Shauly on this topic.
References.
- 1.Gilman RH, Warner J. Rhinoplasty. In: Chung KC, editor. Grabb and Smith's plastic surgery. 8th ed. Philadelphia: Wolters Kluwer; 2020. p. 519-37.
- 2.Ghavami A, Janis JE, Guyuron B. Rhinoplasty. In: Janis JE, editor. Essentials of aesthetic surgery. New York: Thieme; 2018. p. 581-619.
- 3.Rot P, Krzywdzińska S, Grab P, Jurkiewicz D, Chloupek A, Sobol M. The Rhinoplasty Outcome Evaluation (ROE) Questionnaire in Rhinoplasty: A Systematic Review and Meta-Analysis. J Clin Med. 2024;13(16):4642. PubMed
- 4.Chen K, Zhou L. The Effect of Functional Rhinoplasty on Quality of Life: A Systematic Review and Meta-Analysis. Aesthetic Plast Surg. 2024;48(5):847-54. PubMed
- 5.Knoedler S, Knoedler L, Wu M, Haug V, Broer PN, Kauke-Navarro M, et al. Incidence and Risk Factors of Postoperative Complications After Rhinoplasty: A Multi-Institutional ACS-NSQIP Analysis. J Craniofac Surg. 2023;34(6):1722-6. PubMed
- 6.Picavet VA, Prokopakis EP, Gabriëls L, Jorissen M, Hellings PW. High prevalence of body dysmorphic disorder symptoms in patients seeking rhinoplasty. Plast Reconstr Surg. 2011;128(2):509-17. PubMed
- 7.Chua NYM, Gao EZ, Loh SBJ, Yong CL, Pierro FD, Ong SPM, et al. The Mirror of Culture: A Systematic Review and Meta-Analysis of the Prevalence of Body Dysmorphic Disorder in Asian Rhinoplasty Seekers. Facial Plast Surg. 2026;42(3):383-95. PubMed
- 9.Shauly O, Calvert J, Stevens G, Rohrich R, Villanueva N, Gould DJ. Assessment of Wellbeing and Anxiety-related Disorders in Those Seeking Rhinoplasty: A Crowdsourcing-based Study. Plast Reconstr Surg Glob Open. 2020;8(4):e2737. PubMed
- 10.Tie K, Montañez-Azcarate V, Lin SJ. Association Between Psychiatric Diagnoses and Revision Cosmetic Rhinoplasty. Facial Plast Surg Aesthet Med. 2025;27(6):558-63. PubMed
- 11.Abi Zeid Daou C, Jalkh RM, Semaan ZM, Daou AM. Outcomes of Open Versus Closed Rhinoplasty, a Systematic Review and Meta-analysis. Plast Reconstr Surg Glob Open. 2025;13(8):e7047. PubMed
- 12.Wells MW, DeLeonibus A, Barzallo D, Chang IA, Swanson M, Guyuron B. Exploring the Resurgence of the Preservation Rhinoplasty: A Systematic Literature Review. Aesthetic Plast Surg. 2023;47(4):1488-93. PubMed
- 13.Crosara PF, Nunes FB, Rodrigues DS, Figueiredo AR, Becker HM, Becker CG, et al. Rhinoplasty Complications and Reoperations: Systematic Review. Int Arch Otorhinolaryngol. 2017;21(1):97-101. PubMed
- 14.Hatef DA, Ellsworth WA, Allen JN, Bullocks JM, Hollier LH, Stal S. Perioperative steroids for minimizing edema and ecchymosis after rhinoplasty: a meta-analysis. Aesthet Surg J. 2011;31(6):648-57. PubMed
- 15.Gutierrez RWH, Gobbo HR, Heringer LDFL. Tranexamic Acid in Patients Undergoing Rhinoplasty: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials. Aesthetic Plast Surg. 2024;48(11):2076-85. PubMed
- 16.Wu B, Chen S, Sun K, Xu X. Complications Associated with Rhinoplasty: An Umbrella Review of Meta-analyses. Aesthetic Plast Surg. 2022;46(2):805-17. PubMed
- 17.Favreau A, Favier V, Carsuzaa F, Besser G, Giroudon C, Legré M, et al. Olfactory Sequelae of Nasal Surgeries: A Systematic Review with Meta-Analysis. J Otolaryngol Head Neck Surg. 2026;55:19160216261416371. PubMed
- 18.Suresh R, Doval AF, Newstrom E, Pham T, Alford EL. Primary and Revision Rhinoplasty: A Single Surgeon Experience and Patient Satisfaction. Plast Reconstr Surg Glob Open. 2021;9(9):e3798. PubMed
- 19.Alotaibi E, Aldokhail L, Alotaibi G, Alshabnan R, Alamoudi A, Alsugair G, et al. Evaluation of Patient Satisfaction and Quality of Life in Patients Undergoing Rhinoplasty Systematic Review and Meta-Analysis. Ear Nose Throat J. 2025. doi:10.1177/01455613251400561. PubMed
- 20.Song D, Wang X, Yu Z. Nonsurgical Rhinoplasty: An Updated Systematic Review of Technique, Outcomes, Complications, and Its Treatments. Aesthetic Plast Surg. 2024;48(23):4902-15. PubMed