A nose that belongs to the face

Rhinoplasty is an outpatient procedure. The skin of the nose is lifted from its supporting framework. Dr. Kao then removes, adds or reshapes cartilage as the correction requires, and redrapes the skin over the new structure.

His attention extends beyond the bridge and length. He considers the shape of the nostrils and how they relate to the tip, and corrects notched or flared nostrils where needed. Breathing is evaluated at the same time. When a deviated septum restricts airflow, a septoplasty can be performed in the same operation.

Swelling resolves slowly, especially at the tip. The practice states that minor swelling can last up to a year. Results vary from patient to patient.

Recovery Expect bruising, swelling and some congestion. Rest with the head elevated for several days. Packing is removed after four to seven days and splints after about seven. Dr. Kao may tape the nose for a week or two after that, depending on tip swelling. Most patients return to work within two weeks and resume exercise after three to four weeks, once cleared. Avoid direct sun on the nose for several months. If the nasal bones were moved, glasses may need special support for several weeks. Patients may recover at KO'AN Recovery Center, across the street from the surgical facility.

Ethnic rhinoplasty often asks for something different from a reduction. Asian patients may want more bridge definition, stronger tip support or refined nostrils. African American patients often have thicker skin, softer cartilage, a lower bridge and wider nostrils. In both cases, removing tissue alone rarely gives a refined result.

Dr. Kao builds a stable framework first, so the skin can settle over it. Bridge height is set by the forehead, cheekbones, lips and chin. Nostrils are judged against facial width and expression before any narrowing is considered.

The goal is a nose that looks like it has always belonged to the patient. Small changes carry large effects here, so the plan is conservative.

Revision begins with understanding what was done before and what the patient now wants to change. Earlier reduction-focused surgery can leave a tip that droops, nostrils that weaken or a bridge that looks pinched. Breathing can suffer too.

In many revisions the goal is to restore balance. That may mean softening an overbuilt bridge, rebuilding tip support, correcting asymmetry or replacing an unnatural structure with a better-proportioned one. The emphasis is on rebuilding structure.

Scar tissue from prior surgery can lengthen healing. Revision results take longer to settle and vary between patients.

The chin and nose define the profile together. A recessed chin can make the nose look larger than it is. The nose itself is unchanged. A stronger chin can make it look more in proportion.

Dr. Kao offers three techniques. Injectable filler gives a temporary result in the office and lets a patient preview a new profile. Fat transfer uses the patient's own fat, harvested by liposuction, for a longer-lasting change. A silicone implant gives a permanent structural result.

Chin augmentation is sometimes combined with rhinoplasty. It is also paired with the Ponytail Lift™ and neck procedures. Results vary.

Recovery Filler: mild swelling or bruising for several days, with normal activity soon after. Fat transfer: swelling at the chin and soreness at the donor site, with strenuous activity limited for about a week or longer. Implant: swelling, bruising and tightness, a short soft-food diet if the incision is inside the mouth, and light activity within about a week.