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Most rhinoplasty is performed under general anesthesia

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Incisions are typically made inside the nostrils (closed rhinoplasty) or may include an additional incision across the strip of tissue between the nostril (open rhinoplasty).

Swelling / bruising icon


Swelling can gradually decrease over the following weeks and months.

A rhinoplasty is a common plastic surgical procedure to reshape or reconstruct the nose. Several concerns are often addressed during a rhinoplasty. These concerns will vary depending on the individual’s goals and specific nasal characteristics.

A good candidate for rhinoplasty is an individual who has realistic expectations, good overall health, and specific concerns about the appearance or functionality of their nose.


Here’s a overview of what typically happens on the day of a rhinoplasty:

Pre-operative preparations: A special preoperative cleansing soap, called hibiclens may be recommended to use the night before surgery. Hibiclens is an antimicrobial skin cleanser and may reduce the risk of infections. The patient should not eat or drink anything after midnight the night prior to surgery. In the morning, the patient should arrive at the surgical facility between one to two hours prior to the procedure. This time will allow for changing into a surgical gown, and meeting with the anesthesia provider, and some final paperwork. A final preoperative discussion with the surgeon also takes place.

Anesthesia administration: Once you are prepared for the procedure, the patient will walk to the procedure room. A calming medication may be administered to help you relax. Most rhinoplasty is performed under general anesthesia, which means that patients do not remember or feel anything. Dr. Domanski will also inject local anesthetic medication into the nose. This local anesthetic medication reduces the amount of pain after the surgery. Some patients report feeling no discomfort till the next day.

Incisions and access: The surgeon will then make the necessary incisions to access the nasal structures. The specific technique used will depend on the surgical plan and the goals discussed during the pre-operative consultations. Incisions are typically made inside the nostrils (closed rhinoplasty) or may include an additional incision across the columella (the strip of tissue between the nostrils) for open rhinoplasty.

Reshaping the nose: The surgeon will then proceed with reshaping the nose according to the predetermined surgical plan. This can involve removing excess bone or cartilage, repositioning or reshaping the nasal bones, refining the nasal tip, or addressing other concerns identified during the consultation.

Closing the incisions: After the desired changes are made, the surgeon will close the incisions using sutures. If the incisions were made inside the nostrils, there will be no visible external scarring. In open rhinoplasty, the small incision on the columella is usually well-concealed and will fade over time.

Nasal packing or splints: In some cases, nasal packing or splints may be placed inside the nose to support the new nasal structure and help control bleeding. These will typically be removed within a few days after the surgery.

Recovery and post-operative care: After the procedure, the patient will be taken to a recovery area where they will be monitored as the anesthesia wears off. Some swelling, discomfort, and bruising is normal after rhinoplasty. Pain medication and cold compresses may be provided to manage any discomfort.

What is the difference between an open and a closed rhinoplasty?

The main difference between an open rhinoplasty and a closed rhinoplasty lies in the location and extent of the incisions made during the procedure. These incisions determine the access the surgeon has to the nasal structures and the visibility of the surgical site.

Most surgeons perform “open” rhinoplasties using an incision at the columella (outside lower middle part of the nose). The nasal skin is then pulled upward to reach the nasal cartilage and bone. This makes for some dramatic videos and pictures. Afterwards the nose is often quite swollen.

Open Rhinoplasty:

Incisions: In an open rhinoplasty, an additional incision is made across the columella, which is the strip of tissue between the nostrils. This creates a small, well-concealed scar that is typically not noticeable after healing.

Visibility and Access: The advantage of an open rhinoplasty is that it provides a direct, unobstructed view of the nasal structures. By lifting the skin and soft tissues of the nose, the surgeon can easily access and manipulate the nasal cartilage and bone. This increased visibility allows for precise adjustments and complex reshaping.

Suitability: Open rhinoplasty is often preferred in more complex cases that require significant reshaping or reconstruction of the nasal structures. It is also useful when addressing specific concerns such as nasal tip refinement, major asymmetries, or revision rhinoplasty.

Closed Rhinoplasty:

Incisions: In a closed rhinoplasty, all incisions are made inside the nostrils, which means there are no visible external scars. The surgeon accesses the nasal structures through these internal incisions.

Visibility and Access: The access and visibility in closed rhinoplasty are more limited compared to open rhinoplasty. The surgeon works through the nostrils and manipulates the nasal structures indirectly, relying on tactile feedback and surgical instruments. This technique requires a high level of skill and experience.

Suitability: Closed rhinoplasty is commonly chosen for cases that involve less extensive modifications to the nasal structures. It can be suitable for addressing concerns such as nasal hump reduction, minor tip adjustments, or refinement of the nasal bridge. Closed rhinoplasty is often associated with less swelling and a shorter recovery time compared to open rhinoplasty.

Dr. Domanski prefers “closed” rhinoplasties.

Closed rhinoplasties:

  • have less swelling
  • reduce postoperative risk of twisting
  • do not leave an external scar

Many surgeons do not perform closed rhinoplasties because closed rhinoplasties require more skill.

Dr. Domanski completed a five year ear-nose-throat residency and a three year plastic surgery residency. He is board certified in both ENT and Plastic Surgery. Dr. Domanski prefers closed rhinoplasties.

A rhinoplasty procedure often includes removing the dorsal hump, nasal bone realignment, cartilage grafting and nasal tip refinement. During the procedure, the patient is under anesthesia and should not remember or feel anything.

At the end of the procedure, a nasal splint is often applied to maintain the nasal shape.


People want to have a nose that fits their face. Sometimes it’s a dorsal hump. Sometimes it’s a plunging nasal tip. Cyrano de Bergerac said, “A great nose may be an index of a great soul.”

A rhinoplasty is a common plastic surgical procedure to reshape or reconstruct the nose. Several concerns are often addressed during a rhinoplasty. These concerns will vary depending on the individual’s goals and specific nasal characteristics.

Nose size: Many people seek a rhinoplasty to reduce or increase the size of their nose. This can involve refining the overall proportions of the nose to better fit the person’s facial features. Sometimes patients will request for a dorsal hump to be brought down. This can be done through a technique known as rasping. Other patients may desire the dorsum of the nose to be made stronger. This can be accomplished through cartilage grafting.

Nasal symmetry: An asymmetrical nose can be a common concern. Rhinoplasty can help address any imbalances in the nasal structure, including deviations or twists. Improvement of nasal symmetry will have to take into account the soft tissue, or skin of the nose, as well as its underlying cartilaginous and boney structure.

Nasal bridge: Some individuals may have a nasal hump or a bridge that is too flat. Rhinoplasty can address these issues by removing or augmenting the bone and cartilage to achieve a smoother profile.

Nasal tip: A bulbous or drooping nasal tip is another common concern. Rhinoplasty can refine the shape and projection of the nasal tip to create a more defined and balanced appearance. Techniques used include adding cartilage using cartilage grafts. Cartilage from the nasal tip may be reduced using a procedure known as a lower lateral cephalic trim. The nasal tip may also be refined by using a suture technique, such as inter-domal or intra-domal sutures. These tip suture techniques can produce a more refined nasal tip.

Nostril shape and size: The shape and size of the nostrils can also be addressed during rhinoplasty. This may involve narrowing or reshaping the nostrils to improve overall facial harmony. Cartilage grafts, or skin reduction techniques may be chosen. One cartilage graft technique is called a composite graft. A com composite post graft contains both skin and cartilage. A common location to obtain a composite graft is the ear. A composite graft has the advantage of reconstructing both nasal lining as well as structure. Another technique is called Weir reduction, or alar wedge excision. A weir reduction can be used to narrow the nasal base.

Breathing difficulties: Rhinoplasty can also address functional issues related to the nasal passages, such as a deviated septum or nasal valve collapse. These structural abnormalities can be corrected to improve airflow and alleviate breathing difficulties though techniques such as an alar batten graft. An alar batten graft is used to reconstruct the external nasal valve. A turbinate reduction can be used to improve the internal nasal valve.


Rhinoplasty is about enhancing what a patient already has. Rhinoplasty patients are those that say:

“I like this about my nose.”
“I don’t like this about my nose.”
“I would like my nose to look like this.”

Frequent concerns that rhinoplasty patients have are:

“I want my nose to look natural.”
“I don’t want my nose to be too swollen afterwards.”

A good candidate for rhinoplasty is an individual who has realistic expectations, good overall health, and specific concerns about the appearance or functionality of their nose. Here are some characteristics that typically make someone a suitable candidate for a rhinoplasty:

Concerns about nose appearance: The individual should have specific concerns about the size, shape, symmetry, or proportions of their nose. They may be unhappy with a prominent nasal hump, a drooping or bulbous tip, or overall facial imbalance due to the nose.

Fully developed facial growth: Rhinoplasty is typically recommended for individuals whose facial growth is complete. For most people, this means reaching the age of 15 or 16 for females and 17 or 18 for males. This ensures that the nose has stopped growing and provides a stable foundation for the procedure.

Realistic expectations: A good candidate understands the limitations and potential outcomes of rhinoplasty. They have realistic expectations about the procedure and understand that the results will enhance their nose’s appearance rather than achieving perfection or radically transforming their entire face.

Good physical and mental health: The candidate should be in overall good health, without any significant medical conditions that may increase the risks associated with surgery. They should also have a stable mental and emotional state, as the decision to undergo rhinoplasty should be made without any external pressure or unrealistic motivations.

Non-smoker: Smoking can negatively impact the healing process and increase the risk of complications. Ideally, a candidate should be a non-smoker or be willing to quit smoking for a period before and after the surgery.

Good communication and understanding: A good candidate is open and honest about their concerns, goals, and expectations. They should be able to effectively communicate with their plastic surgeon, providing a clear understanding of their desired results.

Realization of the recovery process: Rhinoplasty requires a recovery period, during which swelling and bruising are common. A good candidate is willing to follow post-operative instructions, including proper care, rest, and avoiding certain activities to ensure optimal healing.


Before and after results of our procedures.

Before Image After Image


Immediate post-operative period: After the surgery, a patient is taken to a recovery area where they are monitored until the effects of anesthesia wear off. The patient may feel groggy or disoriented during this time. Some discomfort, swelling, and bruising are normal, and pain medication will be prescribed to help manage any discomfort.

Post-operative instructions: The surgeon will provide detailed post-operative instructions, including information on wound care, activity restrictions, medication usage, and follow-up appointments.

Discharge: Once a patient has sufficiently recovered from the anesthesia, they will be discharged to go home. It’s important for a responsible adult to drive the patient, as the effects of anesthesia can impair one’s ability to drive safely.

Nasal packing and splints: Depending on the surgeon’s preference and the extent of the surgery, nasal packing or splints may be placed inside the nose to provide support, help control bleeding, and aid in healing. These are usually removed within a few days after the surgery.

Swelling and bruising: Swelling and bruising are common after rhinoplasty and may be more pronounced in the first week following the surgery. Swelling can gradually decrease over the following weeks and months, but it may take several months for the final results to be fully evident. Cold compresses and keeping one’s head elevated can help reduce swelling.

Nasal congestion and breathing: A patient may experience nasal congestion and difficulty breathing through the nose in the initial stages of recovery. This is often due to swelling and the presence of nasal packing or splints. Breathing usually improves as the swelling subsides and the nasal passages heal. Dr. Domanski frequently uses a nasal splint to help the nose heal. Dr. Domanski tries to avoid the use of internal splints because the discomfort internal splints can cause patients.

Activity restrictions: It’s important to avoid strenuous activities, heavy lifting, and activities that could accidentally impact or injure the nose during the early stages of recovery. We recommend that patients do not drive while taking narcotic pain medication.

Follow-up appointments: You will have several follow-up appointments with your surgeon to monitor your healing progress, remove any sutures, and assess the final outcomes of the surgery. Appointments are generally at one week, one month, and three months after the rhinoplasty.

Patience for final results: It’s essential to have realistic expectations and understand that the final results of rhinoplasty may take time to fully manifest. As the swelling subsides and the tissues settle, a patient will begin to see the improved shape and contour of their nose. The complete healing process can take up to a year or longer, but most noticeable swelling typically resolves within a few months.

In summary, after a rhinoplasty, patients go home the same day. The nasal splint is removed by the first postoperative visit. Some bruising around the eyes is to be expected. We often say that with makeup, patients can go to their second most favorite restaurant in about a week.
Normal activities are resumed gradually. Activities that may risk injuring the nose (soccer) should be resumed after 6 weeks.

Why us?

With over 70 plastic surgeons in the area, patients choose Dr. Domanski because they trust him. We believe you will not find a more honest surgeon than Dr. Domanski.

“Be Yourself,
Everyone Else Is Taken.”

– Oscar Wilde



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