Nose Reshaping (Rhinoplasty)

Rhinoplasty Surgery in Los Angeles

Most of Dr. Vladimir  Grigoryants’ Los Angeles practice is dedicated to cosmetic and functional rhinoplasty. Dr. Grigoryants performs rhinoplasty procedures every day.  He is one of the busiest rhinoplasty surgeons in Los Angeles and United States. Dr. Grigoryants offers the latest rhinoplasty procedures to produce the best possible result and achieve a  natural balance between the nose and the rest of the face.  Dr. Grigoryants has improved many of the closed rhinoplasty techniques to make rhinoplasty results as predictable and consistent as possible. In addition to cosmetic reshaping, Dr. Grigoryants opens the nasal airways to treat any pre-existing nasal airway obstruction or to prevent nasal airway obstruction after surgery. Dr. Grigoryants is one of few rhinoplasty surgeons in Los Angeles who specializes in scarless nose reshaping known as endonasal rhinoplasty (or closed rhinoplasty). In this procedure, incisions are placed inside the nose. Therefore, no scars will be present across the bottom portion of the nose.

His work as a rhinoplasty expert has spread not only in Los Angeles but also throughout the world by word of mouth. Many of Dr. Grigoryants patients come from different parts of the world. Many celebrities and athletes have turned to Dr. Grigoryants for rhinoplasty.

Dr. Grigoryants was chosen to be the rhinoplasty surgeon on Real Housewives of Beverly Hills (season 3) and was featured as a plastic a Los Angeles plastic surgery specialist on HLN (CNN).

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What is the process once I have decided to have rhinoplasty?

You would first meet with Dr. Grigoryants for an initial consultation. Dr. Grigoryants believes that for each patient the rhinoplasty procedure needs to be individualized as every person has a different nose. During your consultation, Dr. Grigoryants will evaluate your nose and facial features and together with you will decide what nose reshaping changes to produce. The doctor will discuss your goals with you and examine your nose. He will also show you in the mirror by covering, lifting, and narrowing parts of your nose which result to anitcipate. Dr. Grigoryants will meet with you again for a preoperative visit 2-3 weeks prior to surgery to review the rhinoplasty procedure and give you preoperative and postoperative instructions.

To schedule your rhinoplasty consultation with Dr. Grigoryants, call us at 1(818)396-5551

For patients from other states or other countries, initial rhinoplasty consultation can be done over the phone or email. You would need to email your face pictures (front, side, and bottom views) to Dr. Grigoryants at . Dr.Grigoryants will review your pictures and then talk to you over the phone or via email. Our practice is located in Southern California in Glendale and surrounded by Los Angeles, Beverly Hills, Pasadena, and other cities of the Los Angeles county.

Why closed rhinoplasty?

Dr. Grigoryants prefers closed rhinoplasty as it allows to reshape the nose without a visible scar across the columella. Dorsal hump and tip reshaping is done through incisions placed inside the nose. Dr. Grigoryants has improved the closed rhinoplasty techniques which allow him to perform reshaping of the tip, and dorsum and perform functional nasal airway surgery all under direct vision. Furthermore, since the nasal skin is not lifted (as in open rhinoplasty), Dr. Grigoryants finds that closed rhinoplasty results are more predictable and consistent. Healing is easier after closed rhinoplasty than after open rhinoplasty.

In open rhinoplasty, a cut is made across the columella, and the skin of the nose is lifted. The columella scar healing is not always predictable. In many patients, especially patients with thicker skin such as ethnic patients ( e.g. Middle Eastern, Mediterranean, Hispanic, etc.), the columella scar results in a visible notch and thickening of the skin in front of the scar. We see this frequently in patients who come to us for revision rhinoplasty. Revision surgery after open rhinoplasty tends to be more difficult than after closed rhinoplasty. In many patients who underwent previous open rhinoplasty, Dr. Grigoryants will frequently perform revisions using closed techniques. However, in some patients with very scarred tips after several previous surgeries, he would perform open rhinoplasty.

The goals of rhinoplasty

In general, the goals of rhinoplasty are to produce a nose that appears natural, and in better balance with the rest of the face as well as to maintain or improve nasal airways. For each patient, the specific goals will be discussed as to the degree of nasal narrowing, lifting of the tip (if at all), achieving a straight vs. sloped profile (and how sloped), columella position, any possible nostril narrowing, etc.

Will computer imaging be used?

Although Dr. Grigoryants does use computer imaging and Photoshop to show what can be done with the nose, he finds that this method of predicting the surgical outcome is not reliable. Many patients have come to our practice from elsewhere complaining that their surgical results look nothing like their preoperative imaging. Surgical outcome depends on the surgeon’s skill and experience, the patient’s skin/bone/cartilage thickness, and the forces of postoperative healing. Photoshop does not take into account any of these. It is more important to see the surgeon’s actual results, and as many as possible, to decide what the surgeon may be able to do for you. We believe that a surgeon’s rhinoplasty volume and consistently good surgical results are the two most important factors for achieving a successful outcome.

Patient 1: This patient exemplifies how rhinoplasty techniques need to be customized for each person. Closed rhinoplasty was performed to produce very subtle changes including slight lifting of the tip and minor dorsal hump reduction. This resulted in a natural shape of the nose. Incisions were placed inside the nose (endonasal rhinoplasty), leaving no visible scarring. More drastic nasal reshaping ( which works for many patients) would not be appropriate for this patient.

Where will my surgery be performed?

To assure the highest safety for his patients, Dr. Grigoryants performs surgery in multispecialty accredited surgical centers. These state-of-the-art facilities provide not only the safest possible environment but also caring and friendly staff. Your anesthesia will be performed by experienced anesthesiologists (doctors).

How long does rhinoplasty surgery last?

This procedure lasts anywhere from 1 – 2.5 hours. Revision rhinoplasty may last longer.

What happens after surgery?

Patients go home the same day after surgery. The next day Dr. Grigoryants will examine you and remove your dressing. The splint on your nose will be removed in 5-6 days after surgery.

Will nasal packing be used?

Dr. Grigoryants does not use nasal packing to avoid any unnecessary discomfort or pain.

When will I see the final result after rhinoplasty?

The nose will look better already as the most noticeable facial swelling will resolve in 10 days to two weeks. Swelling in the upper part of the nose goes away faster. Swelling in the lower half of the nose and tip takes longer to resolve. Typically, swelling will be 80-90% resolved by 12 months, around 90% by 18-24 months, and nearly all by three years after rhinoplasty. Although it is stated in other sources that the final result will be seen in one year, it is almost never true as mid-nasal area and the tip continues to shrink for at least two years after surgery. Patients with thick skin tend to have more pronounced swelling.

Patient 2: This patient underwent closed rhinoplasty to reshape the nose and open nasal airways. The resolution of swelling is evident as the tip appears well refined. It takes 1-2 years after surgery to achieve this type of shape. Visit our rhinoplasty Before and After photo gallery to view front and side views of this patient.

What about pain and bruising after rhinoplasty?

Most of our patients report no pain or only mild discomfort following nose reshaping surgery. Therefore, most patients do not take any pain medications (even though those will be provided for you). Some patients may have bruises which usually resolve within 7-10 days.

When can I start wearing glasses following rhinoplasty?

If reshaping of the bones is performed, then patients can usually resume wearing glasses in about 3- 4 weeks after surgery. However, if only tip reshaping is done, then glasses can be worn in 5-6 days after rhinoplasty.

Does medical insurance cover rhinoplasty?

Cosmetic rhinoplasty is not covered by insurance. Patients who have breathing problems through the nose may be eligible for insurance coverage for the medical or breathing improvement part of surgery. Coverage depends on the type of insurance.

What is done to open nasal airways?

Dr. Grigoryants opens nasal airways in almost every patient presenting for rhinoplasty, especially in patients complaining of nasal airway obstruction. The following important steps are typically taken to open nasal airways:

  1. Septoplasty. Most people have some degree of septal deviation. Significant septal deviation needs to be corrected surgically.
  2. Turbinate Reduction. Many patients have enlarged inferior turbinates. The turbinates are long structures on each side of the nose consisting of a bone (concha) covered with soft tissue that can enlarge and shrink. These turbinates enlarge and shrink throughout the day especially when lying down, in people with nasal allergies, or when ill with a cold. Enlarged turbinates frequently cause nasal airway obstruction. During surgery, the inferior turbinates are reduced in size. Aggressive reduction or removal of the turbinates is avoided to prevent the so-called empty nose syndrome (chronic dryness and inability to feel nasal airflow).
  3. Spreader grafts – Many patients with nasal airway obstruction have a narrow internal nasal valve and spreader grafts are used to reconstruct the internal nasal valve. Spreader grafts are strips of the patient’s own cartilage that are placed on each side of the septum ( between the septum and the side wall). The cartilage for spreader grafts is usually obtained from the patient’s septum. Spreader grafts are very important to prevent midnasal collapse (also known as an internal valve collapse or inverted V deformity) in rhinoplasty.

Furthermore, in nearly all cases when dorsal hump reduction is performed, the spreader grafts must be used to preserve the smooth dorsal aesthetic lines ( smooth lines on each side of the bridge of the nose, from the forehead to the tip)  and prevent midnasal collapse. See the patient below.

Can nose reshaping be combined with other procedures?

Yes. Many patients combine rhinoplasty with other plastic surgery procedures such as breast augmentation, liposuction, tummy tuck, eyelid surgery, brow lift, or labiaplasty (labia reduction).

In this patient rhinoplasty and ear reshaping (otoplasty was performed at the same time). The crooked appearance of the nose was improved, deviated septum corrected, the tip narrowed and lifted, the dorsal hump reduced, and the ears reshaped. The patient’s nose and ears appear natural and in a better balance with the rest of the face.

What if I have thick nasal skin?

Patients with thick nasal skin represent a challenging group of rhinoplasty patients. Thick nasal skin limits how much smaller the size of the tip can be made. Dr. Grigoryants introduced some of his own techniques to improve rhinoplasty outcomes in this group of patients. His techniques were published in Aesthetic Plastic Surgery Journal, June, 2013.

Does Dr. Grigoryants perform ethnic rhinoplasty or Middle Eastern rhinoplasty?

Patients come to Dr. Grigoryants for rhinoplasty from various parts of the world and different ethnic backgrounds. Therefore, Dr. Grigoryants has a very diverse mix of rhinoplasty patients. Many patients are ethnic / Middle Eastern including Armenian, Iranian, Pakistani, Indian, Afghan, African American, and others.

Patient 3: Closed rhinoplasty was performed on this Middle Eastern patient. The drooping tip was raised, the dorsal hump removed, and the nostrils narrowed and shortened. Visit our rhinoplasty photo gallery to view additional views of this patient.

Postoperative Instructions

The following instructions are given to Dr. Grigoryants’ patients after rhinoplasty. These instructions may be modified for each patient depending on what was performed during surgery.

First day after surgery:  Keep your upper back elevated 30-40 degrees.  Apply a cold compress (cloth soaked in cold water or crushed ice in a glove placed over a cloth) during the first 24 hours. Avoid applying anything frozen directly on the skin.  Start taking antibiotics (prescribed by Dr. Grigoryants) the same evening and prescribed pain and nausea medications as needed (read instruction labels on the medications).

Facial swelling tends to get worse during the first 3 days after surgery and improves by the fifth day after surgery.  Call Dr. Grigoryants’ office to schedule your postoperative appointment 5-7 after surgery.

Starting day 3 : Start cleaning the bottom of the nose gently using cotton balls or facial tissue soaked in warm water.  Apply Vaseline on the rims of the nostrils once a day. Do not put Q-tips inside the nose.

Day 5-7:  Dr. Grigoryants will remove your splints and sutures if your nostrils were narrowed.  Having the nostrils lubricated with vaseline prior to the appointment will make suture removal less uncomfortable.  Dr. Grigoryants does not use nasal packing.

– Irrigate the nose with saline spray (also known as Ocean spray).  Apply Vaseline inside the nose at night for two weeks using a corner of an open paper napkin rolled into a cylindrical shape (Q-tips are too stiff and may cause injury).  Sutures and dry secretions/dry blood will come out. Breathing will improve.

– Tape your nose only at night.  Although taping will not affect the final result, it will help minimize  swelling that develops overnight during the early postoperative period.

– Avoid alcohol and blood thinners (aspirin, Motrin, Advil, Excedrin, naproxen, ibuprofen, vitamin E, fish oil, omega 3 fatty acids, herbal supplements ) for 2 weeks after surgery.

– Showers, makeup, and facial creams can be restarted.

Nose blowing: Can be started gently 2 weeks after surgery.

Driving:  You may drive when facial swelling is not impairing vision and you are no longer taking pain medications.

Exercises:  Avoid bending for 2 weeks after surgery.  Exercises can be resumed 1 month after surgery.

Swimming:  Swimming with a submerged head in the water can be started 2 months after surgery.

Sun exposure: You may be in the sun but avoid prolonged exposure. Use a hat to protect your nose.

Pore strips:  May be resumed 3 months after surgery.

Unpleasant smell in the nose: This may occur in some patients after rhinoplasty and will go away over time.

Stiff upper lip and smile:  Usually resolves by 2-3 months after surgery.

Flying on airplanes:  You may fly 7 days after surgery. Dr. Grigoryants will review special in-flight care instructions with you.

Does Dr. Grigoryants perform revision rhinoplasty?

Revision rhinoplasty is frequently performed by Dr. Grigoryants and his revision rhinoplasty patients come from various parts of the world. Dr. Grigoryants will carefully assess who would benefit from revision rhinoplasty and wether closed or open rhinoplasty techniques would be used.

An example below illustrates a patient who underwent open rhinoplasty elsewhere. She presented to us complaining of a crooked nose, residual dorsal hump, hanging columella. The patient also requested to preserve ethnic nasal features and not make the tip too narrow. Open revision rhinoplasty was performed. The results at 19 months after surgery are shown below.