Rhinoplasty is the medical term for any operation that reshapes the nose. What makes a rhinoplasty “open” as opposed to “closed” is when the surgeon makes an incision across the soft piece of tissue between the nostrils, known as the columella and joins with incisions within the nostrils. This incision allows for improved visibility, precision and control during the procedure. The rhinoplasty procedure steps are detailed here.

There’s a variety of reasons why patients undergo open rhinoplasties, from medically necessary reconstructions to cosmetic alterations. Oftentimes, the steps in these operations can be remarkably consistent.

The sequence of your rhinoplasty procedure begins with preparation from the surgical team. Precise planning well beforehand is of the utmost importance. Your surgeon and their assistants will coordinate and set up equipment, position you properly and prepare your face with antiseptic and local/topical anesthesia. Once you have been administered anesthesia, your surgeon will begin the operation. The steps begin with making an incision in the nose, gaining exposure to the noses’ component parts, reshaping the nose, fixing any functional issues, potentially adding supportive structural grafting and then closing the incisions.

An Overview of the Rhinoplasty Process

The following is a step-by-step overview of the rhinoplasty process, from initial consultation through recovery.

Your Research and Questions.

  • This initial step allows you to move to the decision phase: deciding if surgery will benefit you and achieve your goals. Your rhinoplasty surgeon should take time to meet with you in an unrushed consultation to answer your questions. Your surgeon will examine you and be interested in learning your goals for your nose. The best rhinoplasty surgeons will be completely honest with you about risks vs benefits of rhinoplasty. If your desired outcome from your nose job is unrealistic, an expert rhinoplasty surgeon will let you know.
  • The surgeon will provide workable alternatives so that you clearly understand the expected outcome. Then, you can decide if it will fulfill your needs and goals for your nose. In some cases, a dedicated rhinoplasty specialist will suggest that you wait and give the procedure some more thought. The best surgeons will not try to “sell” you on surgery but will help you discover the possibilities.

The Decision Phase: Deciding if Rhinoplasty is Right For You. 

  • The best surgeons are not focused only on performing surgery. If rhinoplasty cannot give you the result you want, your surgeon should recommend against surgery. A great surgeon will only go forward when the benefits to you well outweigh any risk. Not all surgeons and patients make a great team, nor is surgery right for every patient.
  • You can be sure, however, that when you and an expert surgeon agree to work toward the rhinoplasty results you’ve discussed together, your surgeon (based on years of experience in the field) fully expects a successful outcome. You can go into your surgery confidently when you choose a top rhinoplasty specialist. The best surgeons will not be happy unless you are happy. If you’re planning to have rhinoplasty surgery–look for this quality in your surgeon.

Tailored Surgical Strategy for Rhinoplasty.

  • The next phase of the surgical experience involves planning the rhinoplasty procedure to suit your specific, individual needs. (There is no assembly line mentality among elite rhinoplasty specialists, and no cookie-cutter surgical solutions. Your surgery is planned around you.) You will learn how your surgery will be performed to achieve your specific desired outcome.

Your Preparation Leading Up to Surgery.

  • Your surgeon will advise you how to prepare for surgery day to ensure an optimal outcome and short recovery period. You will learn how your recovery is expected to go, depending upon the type of surgery you undergo and your overall health, age, etc. (Don’t worry, recovery discomfort occurs in only the first 4 days or so, in the vast majority of cases–and it’s typically pain free or minimally painful.
  • After that, you’ll generally just watch as the swelling abates and stick to your follow-up schedule.) Your preparation instructions help ensure that you have the proper amenities (frozen peas are only the beginning) on hand before surgery day and that your health is optimal. With proper preparation guided by your surgeon, you can arrive home after surgery and rest–allowing your healing to begin.

Surgery Day.

  • Your surgeon will perform your procedure using meticulous care and efficiency, proceeding according to plan. This ensures delicate tissues are minimally disturbed as your nose is expertly reshaped and strengthened, speeding healing. In the very rare event of complications, during or after surgery, your surgeon has well-honed strategies to successfully manage the situation, to ensure the expected and planned best result.
  • In fact, choosing a real rhinoplasty specialist to perform your surgery, with superb technique and surgical judgment, is your best assurance that your surgery will go smoothly to produce consistently excellent outcomes.

Early Recovery Period. 

  • When you awake in the recovery room, your healing has already begun. Your friend will escort you, and your freshly operated nose home. Your rhinoplasty specialist will check on you regularly, including an office visit the next day. In a few days, your stitches (if not disolvable) are removed along with your splint. At this point, we see a lot of smiles, because even at this early point, you will have an idea of your final outcome. You and your surgeon will view and discuss your result, which will look better and better as the days progress.

Follow up.

Your surgeon will closely follow your progress and ensure your healing is going as planned. You have complete access to your rhinoplasty surgeon throughout your recovery. Any and all necessary follow up visits are included. Your rhinoplasty experience should be well worth it, as you look back on the journey and your outcome. This is the case for the vast majority of patients who choose a top rhinoplasty surgeon.

That’s the beauty of selecting a rhinoplasty specialist to perform your surgery. You get much more than a “nose job.” A top surgeon is a dedicated professional who will be with you throughout your rhinoplasty experience.

The following is a breakdown of useful information you can use during each of the abovementioned stages of the rhinoplasty process.

Questions to Ask During Your Rhinoplasty Consultation

1) How Much Experience Do You Have?

The rhinoplasty consultation helps your surgeon learn more about you, but it’s also an opportunity for you to learn more about your surgeon. One of the best ways to learn about a surgeon is to ask them about their experience performing rhinoplasties. Ask them how many they have performed, how often they perform them and how specialized they are.

The answer to this question will vary depending on the surgeon. Look for a surgeon with several years of experience. A good surgeon will be open and straightforward with you about his or her past work.

2) How Will You Perform the Procedure?

Another good question to ask during your rhinoplasty consultation is how your surgeon plans to perform the procedure. Every patient is different, so every rhinoplasty needs a tailored approach. Your surgeon should be willing to take the time to explain his or her plan in detail.

Rhinoplasties vary depending on your condition, but most of them involve similar steps. For an open rhinoplasty, the surgeon makes an incision across the columella, which is the small piece of tissue that separates the nostrils. Then, he or she will reshape the nose according to the patient’s needs. Finally, the nose will be closed and recovery will begin.

3) What Are the Risks?

As with any surgical operation, rhinoplasties come with certain risks. During your rhinoplasty consultation, you should ask your surgeon about the risks of the rhinoplasty procedure so that you can make an informed decision about your health.

Many of the risks of a rhinoplasty are no different from the risks of other surgeries: infection, bleeding, scarring, pain and swelling. Other risks may include difficulty breathing through the nose and an uneven appearance to the nose.

4) What Can I Do to Obtain the Best Results?

It may sometimes feel like you have no control over the outcome of your surgery, but that isn’t the case. There are several steps you can take to improve your chances of a positive outcome. During your rhinoplasty consultation, be sure to ask your surgeon for a detailed list of ways to care for your nose both before and after the operation.

Surgeons typically provide a list of instructions for pre- and postoperative nose care. Preoperative considerations include, for example, avoiding alcohol, smoking, and certain medications. Postoperative care, on the other hand, involves steps to reduce pain and swelling and to prevent complications, such as icing, taking pain medication and avoiding strenuous physical activity.

5) How Long Will It Be Until I See My Final Result?

Perhaps the most pressing question on your mind as your prepare for a rhinoplasty is how long you will have to wait before seeing your final result. Feel free to ask your surgeon about this during your rhinoplasty consultation. He or she can give you an estimate as well as an overview of the recovery process.

The recovery process of a rhinoplasty procedure can vary depending on the patient, but most people are able to return to work within a few days of their operation. The majority of the swelling is usually gone after three or four months. It can, however, take up to a year before the swelling is completely gone and the final result is set.

6) What Do I Do If I Am Not Satisfied With My Results?

Although it isn’t likely, some patients may not obtain their desired result after their rhinoplasty. Your surgeon should be able to provide recourse. During your rhinoplasty consultation, ask your surgeon about what steps may follow an unsuccessful operation. This way, you can begin your treatment with a plan B in mind, even if it’s unlikely that you will need to use it.

Revision surgery is a common step for patients unsatisfied with how their first rhinoplasty turned out. Talk with your surgeon to learn more about what you can do if you are not satisfied with your results.

Preparing for the Procedure

It may seem like you have little control over the course of your rhinoplasty, but there are in fact many steps you can take to facilitate a positive outcome. Some of the most important rhinoplasty procedure steps are done before the operation even starts.

After you’ve researched different surgeons and decided who is right for you, the next rhinoplasty procedure step is a pre-operative consultation. During this meeting, your surgeon will perform a physical examination, evaluate your medical history and provide instructions for you to follow in the time leading up to your rhinoplasty. These instructions typically include items like avoiding certain medications and modifying your diet and/or lifestyle to help your body respond well to the surgery; drinking alcohol and smoking, for example, can impede your body’s ability to recover.

Another important rhinoplasty procedure step is making arrangements for your recovery. You should plan to have a responsible companion with you for the first 24 hours after the operation. You may also want to inform your employer about the operation – especially if you have a physically demanding job – as there will be certain restrictions on your physical ability while you recover.

All of the above are steps that you alone can take to improve your chances of a fast and comfortable recovery, but remember that it’s a team effort. Like you, your surgical team will be working to make your operation a resounding success. Their focus will be on organizing personnel and materials, not only to make sure the goal and methods of the operation are clear to all those involved but also to make sure your post-operative time in the surgical facility is as comfortable as possible.

Open Rhinoplasty: Step-by-Step Procedure Breakdown

Once you and your surgical team have made all the necessary preparations and your pre-arranged date arrives, the open rhinoplasty can begin. Although surgeries vary depending on a given patient’s condition and anatomical make-up, they always involve the following three rhinoplasty procedure steps.

1) Incision

The defining feature of an open rhinoplasty is an incision across the columella. So, once you’re safely treated with anesthesia, your surgeon will begin the operation by making this incision, which, in conjunction with other incisions inside the nose, allows the surgeon greater visibility, precision and control compared to a closed rhinoplasty.

2) Reshaping the Nose

Once your surgeon has made the necessary incisions, the next rhinoplasty procedure step will be to reshape the nose. Given that preoperative appearance and postoperative goals vary widely among patients, this step will depend on the details of your case.

Changing the nose’s shape may require the addition or removal of bone and cartilage. Your surgeon may also open your septum if it’s deviated, which can improve your ability to breathe. It’s best to talk with your surgeon to find out exactly how they plan to approach your open rhinoplasty.

3) Closing the Incision

Once your nose has been reshaped as planned, your surgeon will place splints to keep the changes in place and then use stitches to close the incisions. Although an open rhinoplasty involves an external incision, you can expect the scar to be barely, if at all, visible once fully healed.


You will likely be in some pain when you wake up from anesthesia. This is completely normal and you will be given pain medication to help yourself feel more comfortable. On the day of surgery, your surgeon will send you home with some post-operative care instructions to help your recovery go as quickly and comfortably as possible. Instructions may include resting often and with your head elevated, regularly applying cold compresses to your face and being as gentle as possible with your nose.

After about a week, you’ll return to your surgeon for a post-operative consultation, during which they will remove the splints and dressings on your nose. It’s typically at this point that most patients report a significant reduction in swelling, bruising and overall pain. Most patients return to work around this time as well. You should, nonetheless, be cautious about all activity involving your nose and carefully follow your surgeon’s advice.

Most of the effects of the surgery are gone within two or three weeks, although mild swelling can persist for up to a year. Despite the sometimes lengthy persistence of swelling, however, the vast majority of open rhinoplasty patients are satisfied with their results.

Rhinoplasty Procedure Steps with Cohen Winters

Learning about your rhinoplasty procedure steps in advance helps eliminate confusion and apprehension about the operation. This is just a brief overview of the process, however, so you should talk with a qualified surgeon to better understand the details of your case.

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Dr. Winters

About Dr. Winters

Dr. Winters specializes in primary, revision, reconstructive, functional and teenage rhinoplasty surgeries. Dr. Winters is a fellow of the American College of Surgeons and maintains active memberships in the American Society of Plastic Surgeons, the American Society for Reconstructive Microsurgery and others.