Rhinoplasty reshapes the bone and cartilage of the nose to change its bridge, tip or symmetry, and with septoplasty it also improves breathing. In a study of 4,978 patients, 0.7 percent had a major complication. At Biruni Hospital in Istanbul, our plastic surgery team plans open or closed rhinoplasty from your photographs, with a stay of seven to ten days and video follow-up for a year.
About This Department
Plastic Surgery
The nose sits at the center of the face and carries the airway. Good rhinoplasty changes its shape without costing a breath.
Rhinoplasty reshapes the bone and cartilage of the nose to change its size, profile, tip or symmetry, and when combined with septoplasty it also straightens the inner wall that divides the airway. In a prospective study of 4,978 patients, 0.7 percent had a major complication within 30 days, hematoma and infection being the most frequent (Layliev and colleagues, Aesthetic Surgery Journal, 2017). Around one patient in ten asks for a revision in the years after, a figure that rises after earlier nasal surgery or injury. In a multicenter study of septorhinoplasty, patient-rated satisfaction with the nose rose from 32.3 to 69.8 out of 100. Swelling settles over a year, and the final shape needs that long to show. This page explains the types of rhinoplasty, who is suited, planning, open and closed techniques, cartilage grafts, breathing, risks, the operation day, recovery, revision, and how patients from abroad arrange rhinoplasty at Biruni Hospital in Istanbul.
0.7
Percent of 4,978 rhinoplasty patients with a major complication within 30 days
9.8
Percent revision rate after cosmetic rhinoplasty in a series of 369 consecutive patients
69.8
Average satisfaction score out of 100 after septorhinoplasty, up from 32.3 before surgery
Free
Review of your photos and goals by our plastic surgery team
Rhinoplasty changes the framework of the nose, the nasal bones in the upper third and the cartilages in the lower two thirds. The skin then settles over the new framework. Reduction removes a hump or narrows the bridge, augmentation builds up a low bridge or a weak tip, and refinement changes the tip, nostrils or angle between the nose and the lip.
Septorhinoplasty combines the cosmetic change with straightening of the septum, the inner wall of cartilage and bone that divides the two airways. Many patients need both, because a crooked outer nose and a bent septum tend to go together.
Rhinoplasty changes more than looks. It changes the airway, and every step of the plan has to protect breathing.
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Variations
Preservation rhinoplasty lowers a hump by letting the bony and cartilaginous bridge settle downward, keeping its natural surface. Ethnic rhinoplasty respects features typical of the patient's background. Revision rhinoplasty corrects a previous operation.
Who is suited
Good reasons for rhinoplasty
Concern
What surgery can do
Limit
Dorsal hump
Lower or smooth the bridge
Skin thickness affects the new line
Wide or bulbous tip
Narrow and define the tip
Thick skin limits definition
Crooked nose after injury
Straighten bone and septum
Some asymmetry may remain
Drooping tip
Lift and support the tip
Overrotation looks unnatural
Blocked breathing
Straighten septum, open valves
Allergy needs separate treatment
Age and health
Growth of the nose ends around 15 to 16 in girls and 17 to 18 in boys, and cosmetic rhinoplasty waits until then. Nonsmokers heal best, and smokers stop at least four weeks before surgery and after it. Blood thinners, aspirin, fish oil and some herbal supplements are paused on the surgeon's advice.
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Clear motivation
The best candidates can point to a specific feature that bothers them and want the change for their own sake. Pleasing a partner or copying a photograph of someone else makes a poor reason.
Surgery refines the nose a patient has. It does not transplant another person's nose onto a different face.
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Medical conditions
Uncontrolled high blood pressure, bleeding disorders and active skin disease on the nose delay surgery until treated.
Consultation and planning
What we assess
Assessment before rhinoplasty
Step
Purpose
Detail
Face and nose analysis
Proportion with forehead, lips and chin
Standard photographs from six angles
Inside of the nose
Septum, turbinates, nasal valves
Examination with a speculum or endoscope
Skin thickness
Predicts how much definition shows
Thick skin hides fine detail
Breathing history
Blockage, snoring, allergies
Questionnaire and examination
Imaging when needed
Bone and septum after injury
CT scan of the sinuses
A chin that sits back makes the nose look bigger. In some faces, a small chin implant or filler balances the profile better than a larger nasal reduction.
Photo morphing lets the surgeon and patient agree on direction and degree before surgery. It shows a goal and not a promise, since skin and healing differ from one patient to the next.
Expectations and the mirror
Some worries about the nose come from the mind more than the nose.
A Belgian study of 226 people seeking rhinoplasty found that 33 percent showed at least moderate symptoms of body dysmorphic disorder, a condition in which a person becomes preoccupied with a slight or imagined flaw, and the severity of those symptoms bore no relation to how the nose looked to independent observers (Picavet and colleagues, Plastic and Reconstructive Surgery, 2011). A later multicenter German study found similar rates and showed that these patients gained less from surgery, even when the operation went well (Hohenberger and colleagues, Laryngoscope, 2024). We therefore ask every patient a short set of screening questions, and when the answers suggest the worry runs deeper than the nose, we recommend a talk with a psychologist first, because an operation cannot fix a distress that the mirror did not cause.
Saying no is part of the job.
Open and closed rhinoplasty
Both approaches reshape the same structures. They differ in how the surgeon reaches them.
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Open rhinoplasty
A small incision across the columella, the strip of skin between the nostrils, lets the skin be lifted so the cartilages lie in full view. It suits complex tips, grafts, crooked noses and revisions, and the scar fades to a fine line that few people ever notice once the first months have passed.
Open surgery gives the surgeon a direct view. Closed surgery leaves no outside scar and causes a little less tip swelling.
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Closed rhinoplasty
All incisions lie inside the nostrils. It suits hump reduction and modest tip changes where grafting needs are small.
Open and closed approaches compared
Feature
Open
Closed
Visible scar
Fine line under the tip
None
View of cartilages
Direct
Limited
Tip swelling
Longer
Shorter
Best suited to
Complex tips, grafts, revision
Hump, minor tip work
Cartilage grafts
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Why grafts
Strong support keeps the nose stable as scar tissue contracts over the years. Grafts straighten, lengthen, support the tip and keep the nasal valves open for breathing.
Septal cartilage from inside the nose serves as the first choice. When too little remains, from injury or earlier surgery, cartilage comes from the ear or a rib.
Graft sources
Source
Advantage
Drawback
Septum
Straight, same operative field
Limited amount
Ear
Curved, useful for tip and nostrils
Soft, small scar behind the ear
Own rib
Plenty, strong
Chest scar, warping risk, pain
Donor rib, irradiated
No second site
Some resorption over time
Common grafts and their role
Graft
Position
Role
Spreader grafts
Along the bridge
Open the internal valve, straighten
Columellar strut
Between tip cartilages
Support tip projection
Alar rim grafts
Nostril edge
Prevent collapse and notching
Breathing and the septum
A bent septum, enlarged turbinates or a weak nasal valve block airflow and cause snoring, mouth breathing and a dry throat at night. Septoplasty and turbinate reduction treat these in the same operation, and insurance in some countries covers that functional part.
Results for breathing
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Functional gains
In 259 patients across German centers, the functional rhinoplasty outcome score improved from 54.4 to 32.8, lower scores meaning fewer complaints, alongside the rise in satisfaction with appearance (Hohenberger and colleagues, 2024).
Why the tip decides
Surgeons debate the bridge. Patients notice the tip.
The tip carries the most delicate cartilages, the thinnest support and the greatest variation in skin between people, so it shows small errors that a hump never would. A series of 369 consecutive cosmetic rhinoplasties linked failure to address the tip at the first operation to more dissatisfaction, along with earlier nasal surgery, facial fracture and complications (Neaman and colleagues, Aesthetic Surgery Journal, 2013). A plan that treats the tip together with the bridge gives a nose that looks balanced from every angle.
Balance beats size.
Risks
Bruising and swelling around the eyes in the first two weeks, fading from purple to yellow.
Nosebleeds for a few days, light and self-limiting in nearly all patients.
Numbness of the tip and upper lip, returning over weeks to months.
Among 4,978 rhinoplasty patients, the major complication rate reached 0.58 percent for rhinoplasty alone and rose to 2.09 percent when two other body areas were operated in the same session. Patients aged 40 and over carried about twice the risk (Layliev and colleagues, 2017).
Uncommon complications
Complication
How often
Management
Hematoma, blood collection
0.2 percent in the large series
Drainage
Infection
0.2 percent
Antibiotics
Septal perforation
Rare
Observation or repair
Irregularity or asymmetry
Part of the revision rate
Revision after a year
Worse breathing
Uncommon with structural support
Graft or revision
Common questions
Will people notice that I had surgery?
A well-planned rhinoplasty looks as if the nose has always been that shape. Visible bruising fades within two weeks, and after that friends usually see a fresher face rather than a new nose. Residual tip swelling shows only to the patient for some months.
Combining procedures
Procedures often combined with rhinoplasty
Procedure
Why
Consideration
Septoplasty
Breathing
Standard part of septorhinoplasty
Chin augmentation
Profile balance
Implant or filler
Eyelid surgery
Tired eyes
Adds operating time and risk
Each added area raises the complication rate, so we keep combined sessions short and limited to what the face needs.
The operation day
Operation day timeline
Step
Timing
Note
Fasting
Six hours before
Clear water up to two hours before
Anesthesia review
Morning
General anesthesia in nearly all cases
Surgery
Two to four hours
Longer for revisions and rib grafts
Recovery room
One to two hours
Head raised, cold compresses
Discharge
Same evening or next morning
Written instructions
At the end of surgery, a splint on the outside holds the new shape, and soft silicone splints inside the nose support the septum. We do not use tight packing, which lets patients breathe through small channels from the first day.
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Pain
Discomfort peaks on the first two nights and responds to paracetamol and mild painkillers. The feeling of a blocked nose bothers patients more than pain.
Medicines after surgery
Medicine
Purpose
Duration
Painkillers
Comfort
Three to five days
Antibiotic
Prevention when grafts are used
Five to seven days
Saline spray
Keep the lining moist
Several weeks
Sleep with the head raised on two pillows for the first week.
Before you leave
We check the dressing, explain splint care, and give a direct number for questions at any hour.
Recovery week by week
Healing follows a predictable pattern, though the final result takes a year.
Timeline
Recovery after rhinoplasty
Time
What happens
Activity
Day 7
Splint and internal splints removed
Public outings possible with light makeup
Week 2
Bruising fades
Return to desk work
Weeks 4 to 6
Bones stable
Gym, swimming, glasses resting on the nose
Month 3
Most swelling gone
Contact sports with care
Month 12
Final shape
Assessment for any revision
Protecting the result
Avoid blowing the nose hard, bending with the head down and direct sun on the bruised skin during the first weeks.
Patience with swelling
The nose keeps changing for a year.
Swelling leaves the bridge first and the tip last, and thick-skinned noses hold it longest. Patients who judge the result at one month often feel disappointed and then pleased at six. Morning swelling that fades by evening belongs to normal healing.
Photographs help. We take them at each visit.
Revision rhinoplasty
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When revision makes sense
A second operation corrects a residual hump, a pinched or drooping tip, asymmetry or blocked breathing. We wait at least 12 months after the first surgery, until swelling has settled and scar tissue has softened.
Revision in a series of 369 patients
Measure
Rate
Linked factors
Complication
7.9 percent
Previous nasal surgery or fracture
Dissatisfaction
15.4 percent
Tip left untreated
Revision
9.8 percent
Complications, incomplete correction
What revision involves
Revision compared with primary rhinoplasty
Feature
Primary
Revision
Approach
Open or closed
Open in nearly all
Graft need
Septum often enough
Ear or rib often needed
Operating time
Two to three hours
Three to five hours
Revision surgery demands more experience and time than a first operation. Scar tissue, missing cartilage and thinned skin all make the work harder, and expectations must be realistic.
For patients from abroad
Plan for seven to ten days in Istanbul. The splint comes off on day seven, and the flight home follows that visit.
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What to send
Photographs from the front, both sides, three-quarter views and from below, a short description of what you want to change, notes from any earlier nasal surgery, and a list of medicines.
After you return
After you return home, follow-up continues by video at one, three, six and twelve months, using photographs you send. A local doctor can check the nose if needed, and we share the operative report with them.
Your stay in Istanbul
Day
Step
Note
Day 1
Consultation, tests, photographs
Final plan agreed
Day 2
Surgery
One night in hospital if needed
Days 3 to 6
Rest at the hotel
Check visit on day 3
Day 7
Splint removal
Cleared for travel
One coordinator from the international patients office handles arrangements from the first message through discharge and answers the same WhatsApp number after you return. The office works in English, Arabic, French, Russian, Serbian, Romanian and Spanish and books interpreters for other languages, and it arranges the visa invitation letter, airport transfers, daily transport and accommodation near the hospital. Halal, vegetarian and diabetic meals, a prayer room on site, and a female physician on request wherever the rota allows.
Cost
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What drives the price
Primary or revision surgery, the need for ear or rib cartilage, added septoplasty or chin work, and the number of nights in hospital.
We quote after reviewing your photographs, and the quote states what it includes before you travel.
What a quote for rhinoplasty covers
Item
Included
Priced separately
Surgery
Surgeon, anesthesia, operating room
Rib cartilage when needed
Hospital
Stay, medicines on discharge
Extra nights
Follow-up
Splint removal, video visits for a year
Revision surgery
Rhinoplasty is priced as one package, and revision surgery is quoted separately.
Compare quotes for the same approach, grafts and follow-up, and ask who performs the operation and who sees you after it.
References
Layliev J, Gupta V, Kaoutzanis C, et al. Incidence and preoperative risk factors for major complications in aesthetic rhinoplasty. Analysis of 4978 patients. Aesthet Surg J. 2017;37(7):757-767.
Neaman KC, Boettcher AK, Do VH, et al. Cosmetic rhinoplasty. Revision rates revisited. Aesthet Surg J. 2013;33(1):31-37.
Picavet VA, Prokopakis EP, Gabriëls L, Jorissen M, Hellings PW. High prevalence of body dysmorphic disorder symptoms in patients seeking rhinoplasty. Plast Reconstr Surg. 2011;128(2):509-517.
Hohenberger R, Endres P, Salzmann I, et al. Quality of life and screening on body dysmorphic disorder, depression, anxiety in septorhinoplasty. Laryngoscope. 2024;134(5):2187-2193.
Editor's note
Written by the Biruni Hospital medical editorial team. Reviewed by Prof. Dr. Atilla ARINCI, Plastic, Reconstructive and Aesthetic Surgery.
