Rhinoplasty is one of the oldest plastic surgeries. The first nasal reconstructions were probably done about 3000 years ago in India. Today rhinoplasty is one of the most requested plastic surgery procedures in the US. A change in the shape of the nose can often have a dramatic effect on your overall appearance. Correction of a deviated septum can result in an improvement of your breathing as well.

The nose is a complex three-dimensional structure. Skin, cartilage, bone, and an inner lining are all packed into a very small space. If breast surgery or liposuction are like sculpture, rhinoplasty is like miniature model making. This is a surgery of millimeters. So it is critical to have an honest discussion with your surgeon about the specific things you would like to change about your nose. Small modifications in surgery can affect the size, width, and length of your nose, the shape of the tip, the shape of the nostrils, the angle it makes with the lips, whether the nose is straight or crooked, and on and on. A clear pre-operative plan informed by a detailed analysis of your facial proportions is critical. For example, the nose is significantly influenced by the chin. A nose that appears “too large” may be improved tremendously by a chin implant that adds balance to the face.

Techniques of rhinoplasty

One aspect of rhinoplasty that patients often research is the question of “open” vs “closed” techniques.

  • – Open techniques involve a small and well-hidden incision at the base of the nose that provide complete access to all the internal structures of the nose, allowing precise control over the bone, cartilage, lining, ligaments and sk
  • – Closed techniques on the other hand, require an incision inside the nose, and while this allows certain areas to be directly seen and worked on, the surgeon is “blind” in other areas of the nose, relying only on feel to perform the procedure.

In cases that involve significant nasal reshaping, Dr. Nagarkar prefers an open technique because this allows better control and more predictable results, and the resulting scar is quite inconspicuous.

Dr. Purushottam Nagarkar, University of Texas Southwestern Medical Center, Dallas, Plano and Frisco
Dr. Nagarkar on the rhinoplasty:

Many plastic surgeons think of the rhinoplasty as the most difficult procedure in plastic surgery. Rhinoplasties are my favorite example of a core principle of plastic surgery (and woodworking) – measure twice, cut once. It is always simpler to get something right the first time than it is to fix a problem after the fact. This is why I have an in-depth discussion on your goals for the surgery, and then perform a comprehensive facial examination and detailed photographic facial analysis. There is no single “ideal” nose – any surgery must take into account how your nose and the rest of your face complement each other to achieve an elegant, natural, and beautiful result.

Who is a good candidate for a rhinoplasty:

Most patients who are in generally good health can be appropriate candidates for a rhinoplasty. However, perhaps the most important aspect is that patients have realistic and clear expectations on their goals for a rhinoplasty.

How to prepare for surgery:

If you are a smoker, you must completely stop smoking and refrain from any nicotine-containing smoking cessation aids (such as patches or gums) for 6 weeks before and after surgery. This is critical: smokers who undergo facial plastic surgery can have significant wound complications.

You should discuss with Dr. Nagarkar which medications and supplements you need to stop taking before surgery, and which ones you can continue. In general, blood-thinning medications such as Aspirin must be stopped for a week before surgery. It is very important to provide complete information to prevent any post-operative problems. You will get detailed written instructions for pre- and post-operative care. In addition, you will receive any postoperative prescriptions you might need so that you can have them filled by your pharmacy in advance.

What to expect on the day of surgery:

Rhinoplasties can require between 2 and 5 hours, depending on the complexity of the surgery. You should plan on having nothing to eat or drink after midnight the night before surgery. Generally, you will be able to go home immediately after surgery unless you had a face lift or other major procedure performed at the same time. You will need to have someone drive you to and from the surgery, and to help around the house for a few days while you get your energy back.

What to expect after surgery:


Your surgery is designed and performed to achieve the best possible result on the operating table. However, you will have swelling in the first 24 to 48 hours after surgery, which will resolve slowly over the course of 6 months or more. Major changes in your nose (for example, removal of a large hump) will be obvious even with the swelling. However, subtle changes made to your nose may not be apparent at first. As the swelling resolves, your final result will become visible.

The first few days

  • It is very important for the first several days after surgery that you keep your head elevated to prevent swelling. You should avoid anything that causes your heart rate to become elevated or your blood pressure to increase – so no strenuous activity. This is important, as an increased heart rate or blood pressure increases the risk of bleeding.
  • You will feel as if you have a stuffy nose and you will want to blow your nose. Don’t blow your nose! Blowing your nose increases the pressure inside your nostrils and can cause bleeding. The sensation of stuffiness is from post-surgical swelling and will resolve on its own.
  • Dr. Nagarkar will call you the day after you go home to check in with you and to answer any questions you might have.


Narcotic pain medications are usually not needed at all. Anti-inflammatory over the counter medications like Advil or Tylenol are generally adequate.

Incision care

After your rhinoplasty, you will have a splint on your nose (just like in the movies). You should leave this in place until Dr. Nagarkar sees you in the office, a week after surgery.


You can return to your regular diet after surgery, but for the first day or two, stick with lighter meals. Anesthesia can sometimes make your digestive system a bit sensitive, and having a double cheeseburger the evening after surgery is not recommended.


You should be able to return to work after your splint is removed in the office. Bruising will be resolved around 2 weeks after surgery, and you will be able to wear makeup around the same time.


You will be able to go back to non-strenuous activities such as walking, using a computer, writing, and so on, immediately after surgery.


Aerobic exercise such as yoga, running, cycling, barre, etc., must be stopped for 3 weeks to allow the skin to heal and prevent bleeding complications. You should not lift anything over 10 lbs for the first 3 weeks.


You can resume driving once you are no longer taking narcotic medications, and when you feel that you are in full control of your car.

Follow-up visits

You will see Dr. Nagarkar in the office usually around 7 days after surgery to remove your splint and sutures, and to ensure that you are healing appropriately. We will see you again at the 2-3 week mark for a brief checkup, and then again around 3 months, 6 months and 1 year after surgery.

To meet Dr. Nagarkar in person, schedule your consultation or call us.