The quintessential goal of facial plastic surgery procedures such as rhinoplasty (nose job), facelift, etc., is to achieve a more youthful and/or harmonious appearance. Furthermore, the results must also be gender appropriate and in sync with the rest of the facial features, says leading Los Angeles plastic surgeon Dr. Tarick Smiley.
Over the past several years, rhinoplasty, facelift, and eyelid surgery have been the most commonly requested procedures of both men and women, according to surveys released by the American Society of Plastic Surgeons.
Dr. Smiley believes that the patient’s gender is one of the key variables that determines the ideal correction and surgical approach.
For both men and women, rhinoplasty ranks as one of the most commonly requested procedures. But due to its technically demanding nature, medical literature suggests that it has a higher revision rate compared to other facial plastic surgery procedures.
Aside from residual asymmetry, patients asking for revision rhinoplasty also complain about results that look of out sync with their gender and ethnicity, two key variables that a surgeon should have deep understanding to achieve a satisfying outcome.
Male noses are generally accepted to appear wider, longer, and bigger compared to female noses. For this reason, over-reduction, creation of suptra tip break (which contributes to the slightly upturned, “cutesy” nose), and over-narrowing of the nasal profile can spell disaster for most men.
Other key differences include straighter or more arched nasal bridge and more acute tip in men than women.
Facelift is another popular facial plastic surgery for both men and women. Contrary to popular belief, modern techniques go beyond pulling and tightening the skin that most also include the correction of volume/fat loss that contributes to the aged, gaunt appearance.
A good number of facelift patients also require “volumizers” to correct the hollowed cheeks. But when dealing with men, it is critical not to make the malar (cheekbones) prominent lest it could lead to a more rounded, fuller look that is synonymous with feminine beauty.
Most volumizers today come in the form of dermal fillers or fat transfer, although patients who need more correction (extremely gaunt cheeks) or desire for a more angular appearance might be more suitable for facial implants.
While cheek implants are more popular among female patients, the vast majority of patients requesting for chin and jaw implants are men because a more angular, chiseled face is closely tied to masculine attractiveness.
While there are generally accepted beauty ideals dictated by gender, Dr. Smiley says that facial attractiveness is determined by other key variables such as “right and left” symmetry, averageness, and youthfulness, among others.
On average, nose surgery cost is around $7,000, although it is important to note that the actual price depends on a number of factors including the clinic’s location, amount of correction needed, and surgical venue.
Should the surgery involve complex surgical maneuvers, some patients should expect to pay more (up to $10,000-$12,000), as suggested by experts at the California Surgical Institute.
While most nose surgeries are performed as an outpatient procedure, a few patients may require a hospital stay, which can add up to the cost.
The surgeon’s fee accounts for about half of the nose surgery cost, with one survey suggesting that on average it is around $3,500. In general, patients pay for their doctor’s experience, which has a large influence on the success rate.
Nose surgery, or medically referred to as rhinoplasty, is one of the most complicated procedures in the field of facial plastic surgery, so a prudent patient will not shop around for bargain deals at the expense of his safety and appearance.
Nevertheless, expensive surgeons do not necessarily mean better qualifications or experience.
The general rule of thumb is to find a board-certified facial plastic surgeon who performs nose surgery on a regular basis (ideally every week for more than a decade). His experience, aside from education and training, has a large influence on the results of plastic surgery, which is described as more of an art than a science.
It might be ideal to talk with three or more rhinoplastic doctors to further make an informed decision. A good rapport plays a crucial role in the success of nose surgery or any elective procedure in which the goal is to improve one’s appearance.
While oftentimes the results of nose surgery can be revised, it is highly ideal to get it right the first time because major revisions are more expensive and result in longer recovery and higher risk of complications.
Full recovery from major revisions can take up to two years, especially if the patient has a markedly thick nasal skin, as opposed to the usual 9-12 months healing period after primary surgeries.
However, minor revision surgeries are less invasive, involve shorter recovery, and are usually less expensive than primary rhinoplasties.
Some doctors perform revision nose surgery on their previous patients for free, although the latter should still pay for expenses related to anesthesia, surgical facility, and postop medications.
Also, some surgeons offer insurance programs, which cover the cost of revisions should their patients develop cosmetic-related issues or breathing problems.
How a septoplasty is performed depends on the anatomies and underlying problems. Nevertheless, its goal is to correct the misaligned or deviated septum or the wall separating the two nostrils, thus improving one’s breathing functions and even quality of life.
Dr. Karan Dhir, one of the leading Beverly Hills plastic surgeons, says septoplasty as a stand-alone procedure takes 30-90 minutes to complete, although it could be longer when combined with rhinoplasty in which the “outside” appearance of the nose is improved as well.
Septoplasty and rhinoplasty (or nose job) are commonly performed together if there is also a desire for cosmetic improvement. Also, it gives the surgeon the opportunity to use the nasal cartilage (or “main structure” supporting the nose) instead of getting it from other donor sites such as the bowl of the ear or rib.
As a stand-alone procedure, septoplasty rarely changes the outside appearance of the nose unless there is a very visible deviation prior to surgery.
Most septoplasties use incisions in the nostrils so there is no risk of visible scar. During surgery, doctors will make a cut on one side of the nose to lift the mucous membrane around the deviated septum.
The deviated septum is then straightened and any barrier or protruding nasal bone or cartilage is removed, trimmed, or filed. Once the necessary adjustments are made, the mucous membrane is positioned back.
Most patients will need stitches to support the new contour or hold the septum and membrane in place, although others will only require cotton, soft plastic sheets, or splints to keep them in position.
The success of any type of nose surgery (both reconstructive and cosmetic procedures) is largely determined by the surgeon’s level of skills. Ideally, it is performed by someone who has double board certifications in facial plastic surgery and ENT (ear, nose, and throat).
In most cases, septoplasty results in a straightforward recovery, with pain easily managed by prescribed medications. However, aspirin and aspirin-like products must be avoided for about 1-2 weeks to prevent healing problems, persistent swelling, and bleeding.
Instead of the actual pain, patients often think that nasal stuffiness is the most bothersome symptom, which could take up to six weeks to dissipate. However, controlling the amount of swelling (through head elevation, ice packs, and low-sodium diet) is one way to improve breathing function.
Ice packs have also been shown to control pain, although the general rule of thumb is to use them not more than 20 minutes at a time to avoid cold burns and injuries.
Septoplasty recovery differs from patient to patient, although statistics show that most people feel good 2-3 days postop. However, bruising and swelling can take about a week or two to dissipate, assuming that it is performed as a stand-alone procedure.
But when septoplasty is combined with rhinoplasty, which improves the outside appearance of the nose, a patient should expect more bruising and swelling and longer “social recovery,” as suggested by experts at the California Surgical Institute.
Because septoplasty as a stand-alone procedure uses internal incisions in the nostril (to correct the crooked septum or wall between the nostrils, leading to improved breathing), the pain is easily controlled with narcotic pain medications.
But since prolonged narcotic use can cause constipation and lethargy, two days postop most patients are instructed to switch to Tylenol.
Aside from painkillers, some plastic surgeons also recommend antibiotics for 5-7 days to minimize the risk of infection.
Due to postop swelling, it is not uncommon to experience congestion and difficulty breathing, forcing some patients to breath through their mouth. However, this will improve after about a week or sometimes sooner if they are able to control the amount of swelling.
In the first few days, head elevation can control swelling. The idea is to minimize edema or water retention in the tissues by keeping the surgical site above the heart.
Other ways to control postop swelling include low-sodium diet, cold therapy around the eyes and bridge of the nose (never put ice directly on bare skin to prevent burns and injuries), and low level physical activity to prevent increased heart rate and blood pressure.
Meanwhile, the real challenge for most patients is the social recovery, which is largely determined by how long the bruising and swelling will dissipate. According to statistics, most people will have to wait about a week two before they can go to work or return to their social activities.
While most patients are back on their feet in no time, it remains crucial to avoid strenuous activities and heavy lifting for 4-6 weeks to prevent bleeding, hematoma, and other variables that could jeopardize their healing and result.
But for contact sports, a longer waiting period—at least six months—is ideal to allow the cartilage and other tissue to heal without any interruption.
Aside from low-level physical activity, they should also maintain their blood pressure and heart rhythm in relaxed state to promote quick recovery.
Surveys have shown that a good number of male patients cited stiff job competition as their main reason for getting a plastic surgery procedure. For the past several years, men accounted for 8-9 percent of all surgical enhancements performed in the US.
Los Angeles plastic surgeon Dr. Tarick Smaili explains the most commonly requested plastic surgery for men and the corresponding techniques to preserve their masculine appearance.
- Male breast reduction. This corrects a condition called gynecomastia in which the excess skin, tissue, and fat lead to the appearance of woman-like breasts.
Aside from removing the excess soft tissue, typically the procedure also involves reducing the nipple size to further achieve a more masculine contour. Meanwhile, failure to address an overlarge areola can lead to a disproportionate or “effeminate” appearance.
- Rhinoplasty. More commonly referred to as nose job, it should be able to produce results that respect the patient’s ethnicity, the rest of the facial features, and most importantly, his gender.
According to studies, the ideal angle between the upper lip and nasal tip for men is around 90 degrees, thus creating a straighter profile. For this reason, male rhinoplasty must avoid any procedure that may cause the tip to become more upturned, leading to a feminine look.
Nevertheless, some male rhinoplastic patients can tolerate a minimal droop and still look attractive and “manly” with such feature.
- Facelift. Compared to women, most male patients require less contouring in their jaw line since they tend to ask for subtle improvements.
Male facelifts and forehead lifts also tend to be more conservative because it is crucial to preserve the “heavy” brow look and the strong jaw. An overly tight appearance, meanwhile, can lead to feminine-looking brow, flat cheeks, “distorted” smile, and other telltale signs of surgery.
- Liposuction. In general, men have more fibrous fats and have bigger body-frame than women, so their surgery is more time-consuming, more challenging, and more expensive.
Liposuction only removes the excess “superficial” fat beneath the skin, and not the deeper visceral types that lead to obesity-related health condition. For this reason, men who are complaining about their “beer belly” are rarely considered as good candidates for the procedure.
- Eyelid surgery. There are some subtle nuances involved in male eyelid surgery. For instance, men tend to have thicker and more vascularized skin (increasing the risk of bleeding and more postop bruising), and shorter upper lid platform than women.