Rhinoplasty
in NYC

Rhinoplasty is the surgical term for a nose job, and it is a procedure through which a patient can alter the look and structure of their nose. Patients who are self-conscious about the size, width, or shape of their nose seek Dr. Westreich’s professional expertise to correct a wide range of unwanted nasal characteristics. For example, our NYC rhinoplasty can:

• Straighten a crooked nose
• Re-define a bulbous or rounded nasal tip
• Narrow the size of nostrils that appear wide and flared
• Reduce a high profile or Dorsal Hump

The surgery also has important implications for patients who suffer from a deviated septum that affects their ability to breathe normally and comfortably. Your nose is an important feature of your face and has the ability to greatly alter your overall appearance. Dr. Westreich performs each procedure to meet your needs and aesthetic goals. Together, you and Dr. Westreich will construct a nose that best suits your face, gender, and ethnic identity.

Average Cost of Rhinoplasty

Costs associated with rhinoplasty often include:

• Medical tests
• Surgeon’s fees
• Anesthesia fees
• Prescriptions for medication

These costs can vary based on geographic location. In NYC, a self-pay rhinoplasty can range from $10,000-$15,000. Cosmetic rhinoplasty does not address functional problems, such as a deviated septum, so is not covered by insurance. If medically indicated, insurance can cover certain parts of your surgery and reduce the overall cost of surgery. Before you commit to surgery, you should consult your health insurance provider to discuss possible coverage and out of pocket insurance expenses.

"I came in for a consultation for my nose sometime in February of 2019 and Dr. Westreich was able to provide me with an image of the expected outcome and answer any of the questions that I could think of. Following through with this procedure was the best decision I have made because I am very happy with my nose now and feel much more confident."

- Nick P.

"I absolutely love the results of my rhinoplasty/septoplasty and am so thankful that Dr. Westreich was the one to do it. He's very detailed, devoted and wants to make sure you are fully satisfied with the results. The staff is also super sweet and will make sure you feel comfortable. Highly recommend Dr. Westreich for anyone searching for a truly talented plastic surgeon!!"

- Riley B.

While our nose job is not based on ethnicity alone, patients can look at these categories and gain some insight into what their nose may require based on their individual genetic background. At a consultation, your specific anatomy and desires will be taken into account throughout the decision making process. Your ethnicity may provide hints as to what you may need, but Dr. Westreich treats these as general guides and not predetermined answers. That way, patients can avoid ‘cookie-cutter’ noses and get the outcome that best suits them.

In general:

• Caucasian noses

  Reduction techniques are more common in this group. Noses tend to require less grafting, as the cartilage is typically strong. Profile-plasty without tip work is common. Tip-plasty is recommended for position changes (lifting or dropping a tip) or more substantial narrowing in that region. Septoplasty and nasal valve surgery is very important for breathing restoration or retention.

• Asian noses

  Tend to have small and soft cartilage elements, as well as short nasal bones and moderately thick skin. These cases often require grafting in both the bridge and the tip for comprehensive narrowing. Profile grafting alone may be appropriate for some patients of Asian descent. Septal cartilage grafts are limited by size and ear cartilage or silicone is often recommended for bridge augmentation. Septoplasty tends to be less relevant and inferior turbinate surgery is more likely to achieve breathing improvement.

• African American noses

  These are typically very similar to Asian noses in the need for grafting of the bridge and tip. The cartilage tends to be very soft and the skin can be severely thick in certain patients. Turbinate surgery, rather than septal surgery, is also the main functional intervention. Skin thinning is often recommended as part of the surgery and injections are often required post operatively to achieve sufficient thinning and narrowing. Augmentation using septal, ear, or rib cartilage and/or silicone is typically required in order to ‘push through’ the thick skin and allow the nose to look narrow on front view. Alar base or nostril reduction, is also commonly recommended.

• Hispanic or Latino rhinoplasty

  There is a great deal of variation among Hispanic noses. Elements of Caucasian, Asian, and African American nasal anatomy can be seen and the surgery needs to be tailored to the specific patient’s anatomy. Typically tip-plasty with limited cartilage grafting is the most common recommendation. Limited profile polishing for a small bump is commonly suggested. Septal surgery, valve surgery, and turbinate surgery can be suggested as functional strategies.

Patients typically consult Dr. Westreich to modify aspects of their nose that are affecting their self-perception in a negative way. The ideal candidate is someone, male or female, that has reached full physical maturity and that is in good overall health. It is important that the patient is mentally and physically ready to have a nose job, so that the nose has fully developed and that the patient has realistic expectations of the results of surgery.

• At least 14 years of age (if female) or 16 years of age (if male)
• A nasal tip that has droops, hangs, or is bulbous
• A person with unsatisfactory results from a previous rhinoplasty (revision rhinoplasty)
• A patient who has nasal obstruction due to anatomical problems with the nose
• A person with a nose that is congenitally crooked or became crooked because of trauma
• A person who is unhappy with or self-conscious about the appearance of his or her nose
• A person with overlarge nostrils
• A person with a hump on the bridge of the nose

Your rhinoplasty is catered specifically to your needs and to the complexity of the changes to be made to your nose. Dr. Westreich wants you to be fully relaxed at all stages of this potentially life-altering decision, including during surgery. Our rhinoplasty procedure is performed at our state-of-the-art facility and typically takes about two to three hours. It is performed with the administration of either local or general anesthesia, as determined on a patient-by-patient basis. You can sleep comfortably knowing that when you wake up, you will be one step closer to attaining the nose of your dreams.

Swelling and bruising are completely normal and even expected after a rhinoplasty. In the initial phase of your recovery, you may have bruising around the eyes, painful tenderness of the nose, and swelling and puffiness of the face. Cold packs can help reduce the swelling and medications will be provided to control any post-surgical pain.

You will return home after the procedure with a splint on your nose which will remain in place for approximately one week. Most patients report that recovery from rhinoplasty is more uncomfortable than painful.

Dr. Westreich advises all his patients to plan accordingly, as the recovery period is a crucial aspect of a rhinoplasty. You will likely need to take off from work or school to rest for the first week of your recovery, and should refrain from strenuous physical exercise for at least 2-3 weeks after your nose job. Positive results will be seen gradually, and can take a full year before completely visible.

Typically we recommend the following treatments for all postoperative nasal patients:

• Nasal sprays: Both saline nasal spray to keep things moist and decongestant spray (Afrin or Neosynephrine) to help keep the nasal airway open.
• Ointments on incision lines to allow quicker healing and steroid cream to decrease inflammation.
• Arnica and Bromelain caplets to help reduce the bruising amount and decrease duration of bruising.
• Low-dose steroid pills that provide an anti-inflammatory effect, decreasing swelling.
• Ice packs for the eyes and cheeks to help prevent swelling.
• On a practical level, patients should sleep with their head elevated and limit their activity levels for the first 3-5 days as well.

As with any surgery, a rhinoplasty does have associated complications and risks. Such risks include specific risks from the administration of anesthesia, excess bleeding, collapse of nasal structure, scarring and results different from expected. Though present, these risks should not be a deterrent from your decision to undergo a rhinoplasty as they are uncommon across the board.

When performing a rhinoplasty in NYC, a plastic surgeon has to consider the various anatomical features of the individual’s nose. Although we often associate rhinoplasty with the reconstruction of bone and cartilage, the quality and thickness of the skin has a significant impact on surgical technique and outcome.

A rhinoplasty involves lifting the nasal skin in order to access and resculpt the bone and cartilage. When the skin is redraped over the nose, it has to adjust to the newly altered shape. The anatomy of the skin influences how quickly it will contract and conform to the new structure. Thin to moderately thick skin tends to adjust more rapidly and predictably, revealing the framework of the nose earlier on. Very thick skin presents a unique surgical challenge for several reasons:

• Thick skin can obscure the underlying architecture and definition of the nose (the bone and hard tissue).
• Patients with thick skin are more likely to have prolonged swelling and inflammation after surgery.
• Thick skin does not adjust to the new contour as quickly as thinner skin does.

Thicker nasal skin tends to occur more frequently in certain populations, thus thick-skinned rhinoplasty is sometimes referred to as ethnic rhinoplasty.

Rhinoplasty Techniques

To increase chances of improved definition in individuals with thick nasal skin, specific surgical techniques can be employed.

• Grafts on the tip and bridge. To achieve greater definition, Dr. Westreich may opt to use cartilage grafts on the tip and bridge.
• Reduction of fat in the soft tissue cover (envelope). The careful and conservative thinning of the fatty constituent of the soft tissue, particularly at the tip, can increase refinement.
• Appropriate reduction of the overall size of the nose. Because thick skin takes more time to conform to the nose, it is important to take a measured approach when making the nose smaller. If the surgery has produced a significant “gap” between the skin and the nose structure, there is a risk that scar tissue will form. This can result in an amorphous shape, an undesirable outcome.
• Preservation of adequate support. Thick skin requires greater structural support, so it is important to balance reshaping the nose with maintaining architectural integrity. A strong skeletal framework will also increase the chances of a more refined surface contour when the skin is stretched back into place.

There is no “simple” rhinoplasty procedure, however, a thick-skinned rhinoplasty requires a different level of expertise. The surgeon must have a sense of how much tissue should be removed to maximize results.

Nasal Tip-Plasty

Nasal Tip-Plasty involves reshaping the cartilages of the nasal tip. Two paired horseshoe like cartilages make up the tip of the nose. The length, width, and bending contour of those cartilages, as well as their symmetry, determine the look of that region. Some nasal tips will narrow with a small amount of cartilage removal, while other tips will need sutures, grafts, or division techniques in order to drastically change their shape. The nasal tip is a very 3-dimensional structure, which should only be modified in order to achieve significant and necessary changes in nasal tip appearance.

Profile-Plasty

Profile-Plasty involves reducing a bump on the bridge of the nose. Removal of cartilage and bone from the top of the nasal septum and nasal bones can be required for profile reduction. After removal, nasal structures need to be brought together again in the midline with osteotomies. Spreader grafts may also be necessary in patients with weak cartilages. It is important that patients have a nasal tip which will balance well with the new profile, as this area of the nose is not manipulated in profile procedures.

Polish Rhinoplasty

This describes a procedure often used for deviated noses that also have functional blockage. Since all areas of the nose are typically involved in deviation (including bone and cartilage), re-breaking the nose is often required. When crooked structures are moved, it is important to polish and trim them smooth. Camouflage grafts and other structural grafts may also be required to give the nose an even appearance.

Non-surgical rhinoplasty entails injection of hyaluronic acid (HA) filler, which results in a transformation similar to classic rhinoplasty results, albeit temporary. Dermal filler surgery changes the shape of the nose for up to 6 or 8 months, thus this procedure tends to be ideal for individuals who want to make their nose look less angular but aren’t yet interested in a permanent adjustment or cosmetic alteration. Non-surgical rhinoplasty is a great option with less risk potential and a shorter recovery process.

As a double-board certified facial plastic surgeon, Dr. Westreich takes pride in being able to give his patients a new, aesthetically-pleasing nose. When seeking to make such an important change in your physical appearance, it is essential that you look for the best in the field in which to place your trust. The focus of your initial consultation visit will be to familiarize you with Dr. Westreich’s approach and technique, as you work together to achieve the mutual goals of your new nose. Dr. Westreich will happily address any concerns, questions, or comments during this initial visit, and will seek to build a strong, lasting relationship as he has with each of his past patients.

Dr. Westreich’s practice is devoted to cosmetic and reconstructive procedures on the face and neck. Because of his background in Otolaryngology (ENT), he has a special interest in functional nasal preservation and correction. A practice emphasis is on nasal surgery of all varieties and surgery for facial rejuvenation.

Consequently, he is able to offer a wide array of nasal surgery options, including closed approach rhinoplasty (endonasal), open rhinoplasty, revision rhinoplasty, profile- plasty and tip-plasty, deviation correction, and subtle polish procedures.

Dr. Westreich has originated many rhinoplasty and septoplasty techniques, such as Foundation Rhinoplasty and Rhinosculpting which have been published in medical journals and textbooks on facial plastic surgery. He has given courses and lectures at major medical conferences for the American Academy of Facial Plastic Surgery and other medical societies.

Dr. Westreich has previously been recognized as a leader in facial plastic/ENT surgery and was most recently listed in NY Magazine’s Best Doctors for 2014, 2016, 2017, 2018, 2019, and 2020. He is also a former president of the New York Facial Plastic Surgery Society and a member of the American Academy of Facial Plastic and Reconstructive Surgeons, the American Academy of Otolaryngologists, and American College of Surgeons.

• Rhinoplasty Recovery & Post-Op
• Rhinoplasty for Dorsal Hump
• Rhinoplasty for Bulbous Tip
• Managing Swelling After Rhinoplasty
• Rhinoplasty For Thick Skin