Ramin A. Behmand, MD, FACSDiplomate, American Board of Plastic Surgery Bay Area Rhinoplasty Specialist

Primary Rhinoplasty

Rhinoplasty specialist, Dr. Ramin A. Behmand, is recognized nationally and internationally for his attentive and artistic approach to nose reshaping surgery. Adjustments can be made to reduce the width of the nose, elongate or shorten the length of the nose, reshape the tip and nasal bridge, correct internal nasal deformities due to injury, modify the shape or position of the nostrils and help improve breathing problems. Rhinoplasty surgery is tailored to meet the individual needs of each patient which is why no two patients will have the same exact results. So long as you are healthy and have realistic expectations to improve your nose, you may be a candidate for nasal reshaping surgery. Age may also be a consideration if you have not completed puberty. While exceptions exist, often long term results are more predictable when surgery is performed after the completion of nasal growth seen during puberty, which is around age 15 or 16 for girls and 17 or 18 for boys.

Nose Anatomy

Rhinoplasty Consultation

During your consultation with Dr. Behmand, you will have the opportunity to review all of your questions and concerns. It is important to discuss your complete medical history during this time, whether you feel it to be pertinent or not. This includes general medical history, prior nasal surgeries and injuries, history of allergies and breathing difficulties, medications that you are taking, past injuries and history of any breathing difficulties. After a full evaluation, Dr. Behmand will discuss with you a surgical plan tailored to you for improving the function and and/or appearance of your nose. This is also a good time for you to review with Dr. Behmand any photos you may have of noses which you like and would be helpful in guiding your conversation during the consultation.

After meeting with Dr. Behmand, you will meet with his Patient Care Coordinator to review financial details including surgical costs, facility and anesthesiologist fees and your insurance policies when applicable. Health insurance does not cover the cost of cosmetic nose surgery. If part of the procedure is being recommended to help correct breathing difficulties, that portion of the procedure alone may be covered by your insurance. Please contact our office to schedule your consultation.

Preparing for Rhinoplasty Surgery

Beginning up to two weeks before surgery, you will have certain restrictions including but not limited to: avoiding certain medications including vitamins and supplements, minimizing intake of alcoholic beverages and not smoking. It is important to arrange a responsible driver to take you to and from the surgery center on the day of your procedure and to have someone stay with you for the first 24 hours afterwards. Please see the “Frequently Asked Questions” section for more information on how to prepare for your recovery at home.

The Rhinoplasty Surgery

Dr. Behmand’s rhinoplasty procedures are performed under general anesthesia at our private surgery center in Walnut Creek, California. As rhinoplasty surgery is considered an outpatient procedure, an overnight stay is generally not required. You will meet once more with Dr. Behmand, at the surgery center, before your procedure to review any last minute questions. Once in the operating room, after you are comfortable and asleep, Dr. Behmand will begin sculpting the cartilages and nasal bones. The majority of patients have an “open” rhinoplasty in which all the incisions are placed inside the nose with the exception of a small, stair-step incision between the nostrils. This area at the base of the nose, also called the columella, allows direct access to the cartilages and bones inside the nose. The “open” approach provides better visualization of the nose structures which need to be altered and therefore improves the degree of precision and success in reshaping them. The “closed” rhinoplasty approach has virtually all the same incisions as the open approach, with the exception of the small stair-step incision on the columella. The closed technique has the advantage of less long term swelling after nose surgery, but is inferior in the degree of visibility of the nose structures that are being reshaped. Despite this disadvantage, some patients are uniquely suited to the use of the closed approach based on the thickness of their skin, cartilage quality and the area of the nose requiring the greatest degree of refinement. During your consultation, Dr. Behmand will discuss with you the techniques which are best suited to achieving your aesthetic goals.

At the conclusion of your rhinoplasty procedure, an external support splint (small nose cast) is applied which maintains the shape of your new nose in the early days after surgery. Internal nose splints are also placed to better stabilize and support the shape of your nose. It is important for you to keep these splints protected and dry until your first post-operative appointment with Dr. Behmand, approximately 7-10 days later.

After Rhinoplasty Surgery

Other than feeling drowsy, most patients feel pretty well after surgery and can usually leave the surgery center to go home a couple of hours later. Common side effects are swelling, bruising, occasional headaches and sometimes nausea. You may apply an ice pack to your lower forehead and upper nose area for the first 24 to 36 hours following surgery. Applying ice after this time frame is not necessary, and in fact may slow down the resolution of your facial swelling. Once you arrive home or wherever it is you plan on staying to recover, you will begin using the pain medicine prescribed at your pre-op appointment. It is important to stay hydrated by drinking plenty of water and to also eat something (even if it’s something small, such as crackers or toast) each time you take your pain medication. Doing so significantly reduces nausea related to the use of the narcotic pain medication. For the first week after surgery, you will need to keep your head in an elevated position, even when sleeping. You may do so by using a few pillows or a wedge to support your head and neck at about 45 degrees of elevation. If you have access to a recliner, some patients find it very comfortable to rest and stay somewhat elevated in one. Staying elevated will help you have less swelling of the face and bruising around your eyes, which usually peaks after two or three days. It is important to keep the splint on your nose dry. A splint that gets wet will fall off, adversely affecting the results of the operation. Avoid hot, steamy showers or baths as this the steam will also loosen the nose splint prematurely. All sutures used during surgery are self-dissolving and do not need to be removed.

Rhinoplasty Cost

The cost of rhinoplasty is determined and affected by the extent of work being considered and is generally higher for secondary, reconstructive or revision rhinoplasty. After your evaluation with Dr. Behmand, you will be provided with a quote for the cost of the surgery, but the usual and customary range for initial rhinoplasty surgery is between $12,000 – $20,000.