The size and shape of the nose can have a great impact on how a person looks and feels about themselves. Since the nose is a defining characteristic of the face, even small alterations can improve the entire appearance. For this reason, many people (about 500,000 each year) decide to undergo a rhinoplasty, or nose job.  Dr. Matthew Bridges M.D. FACS, a Richmond facial plastic surgeon, was trained initially as an Otolaryngologist (Ear, Nose, and Throat) Surgeon. He underwent extensive training in fixing functional problems with the nose, such as difficulty breathing and sinusitis, as well as aesthetic surgery of the nose. Additionally, he completed a very exclusive fellowship in facial plastic surgery with a world renowned facial plastic and rhinoplasty surgeon for the highest level of training in rhinoplasty.  He is therefore fellowship trained and double board certified.   There is truly no higher level of training than this.  Dr. Bridges is Richmond's top rhinoplasty surgeon.  He frequently sees patients from out of town who seek his expertise.     

Richmond rhinoplasty specialist Dr. Bridges performs rhinoplasty with 2 important factors in mind at all times:

1.  Structure – One of the reasons rhinoplasty is difficult is the extreme variability in the anatomy of the nose from patient to patient.  However, everyone, regardless of ethnicity, gender, or size, has the same basic cartilage in the nose.  The person with a “bulbous” tip has the same inherent cartilage structure as the person with a naturally refined tip.   The difference is the shape of the cartilage.  Therefore, better, more structurally sound and natural results can be achieved by maintaining structure and reshaping the cartilage.  Older techniques involve significant reduction/removal of cartilage that can cause problems in the future. Certainly, there are times when some trimming of cartilage is necessary to achieve the aesthetic goals, but Dr. Bridges feels that in general cartilage structure should be maintained as much as possible.
2. Function – The nose is a functional organ that directs air through the skull and into the lungs.  It helps humidify and warm the air to aid in oxygen exchange.  This functional aspect must be kept in mind during rhinoplasty.  Although frequently the goal of surgery is simply cosmetic change of the nose, the functional aspect of the nose cannot be overlooked.  Some maneuvers used to reduce an overly large nose can cause breathing obstruction unless preventative steps are taken in the surgery.  A slight septal deviation that did not cause a breathing obstruction prior to surgery may be an issue after other areas of the nose are reshaped or reduced.  Therefore, a septoplasty should be done in this case.  Dr. Bridges always makes sure that the nose will work well and look beautiful.  

Many surgeons prefer the open rhinoplasty approach during nose surgery because they can gain a better view and better access to the inside of the nose. The incision using this approach is made on the skin between the nostrils or under. Once the incision is made, the skin is moved back to allow access to the internal structures. The incisions consistently heal very well, leaving barely visible scars.   Click here and scroll to "base view" for an example of a healed open rhinoplasty scar. 

The trade-off of the improved visibility during surgery afforded by the open approach is that this technique is more invasive and requires more dissection, leading to more prolonged swelling after surgery.   The internet is full of patients worrying about nose swelling many months after open rhinoplasty.  It is true that it can take 1 year or longer for swelling to resolve after open rhinoplasty.  This is somewhat unique to the open approach, in that with the closed, or endonasal, approach, the swelling fades much faster.  For this and many other reasons, Dr. Bridges now performs exclusively closed rhinoplasty.  This is an evolution of technique over his years of surgical practice.

The closed rhinoplasty technique is performed through incisions made on the inside of the nose only.  The name is a misnomer, in that incisions are made, but only hidden inside the nose.  Separate small incisions are made to access different parts of the nose, such as the tip and bridge.  A more accurate way to refer to this technique is "endonasal rhinoplasty."  Dr. Bridges performs exclusively endonasal, or closed rhinoplasty.   Click here to see an example of a closed rhinoplasty result.  Dr. Bridges is skilled in advanced closed, or "scarless" rhinoplasty techniques.  Closed rhinoplasty is a surgical art form that requires the highest level of understanding of nasal form, function, and aesthetics.  Only with years of practice can this surgical approach be mastered.  Most surgeons perform only open rhinoplasty because the closed approach can be intimidating.  Most surgical training programs teach only the open approach, which has made the closed approach somewhat of a dying art.  Being a master of his craft, and always seeking the best results for patients, Dr. Bridges has honed his techniques over many years to be able to offer this rhinoplasty approach to Richmond nosejob patients.  

Dr. Bridges transitioned to performing exclusively closed rhinoplasty around 2016.  The main reason for the switch is the ability to see the changes made to the shape of the nose on the operating table in real time much more accurately with the closed approach.  See here for an example of the what Dr. Bridges sees on the table with this technique.  From a patient's perspective, the recovery process is much easier with the closed approach, with results seen much earlier than with the open approach.  
 

Rhinoplasty is usually performed under general anesthesia and is always performed in an accredited surgical facility. It is considered an outpatient procedure. After surgery, patients will wear an external splint for about 1 week.  Patients may experience bruising and swelling around the nose and eyes.   Bruising usually subsides over the first few weeks.  If bruising is prominent, Dr. Bridges provides Sciton BBL laser treatments to break up the bruises.   Swelling decreases rapidly over the first 3-4 weeks, then slowly over many months. It can take up to a full year for the nose to gain its final contour and softness.  This is more true of the open approach, as previously described above.  Dr. Bridges does not use nasal packing.  Occasionally, small plastic tubes may be placed in the nose if extensive septal work has been done. 

Yes, and this fear is always elevated when surgery involves the face. However, more than 350,000 people in the U.S. undergo rhinoplasty each year making it one of the most common cosmetic surgeries. One way to help calm your fears is to make sure you find a reputable and skilled surgeon that has extensive experience with nose surgery.  Rhinoplasty is one of the main focuses of Dr. Bridges' practice.  He is the Richmond Rhinoplasty Expert.

Some rhinoplasty patients will benefit from osteotomies, or bone cuts during surgery. This allows maneuvers such as narrowing the width of the nose or correcting an asymmetrical nose. This is a common practice and heals within just a few weeks following surgery.   

Nasal packing is the insertion of gauze and/or cotton packs into the nasal cavity after surgery. These are used to control bleeding, but are not necessary most of the time.  Dr. Bridges almost never uses packing in the nose for rhinoplasty.  He occasionally places soft silicone tubes if extensive septal work is required. 

Noses that are too large or too wide, or have a specific deformity may only be able to be enhanced through nose surgery. However, the look of some noses may be able to be enhanced using an injectable filler.   “Injection rhinoplasty” may be an option before resorting to surgery. This is an in-office procedure that can help to soften and camouflage a bump, alter the tip of the nose, and smooth out irregularities.   

The cost of rhinoplasty varies depending on what needs to be done in surgery. Sometimes, insurance will cover parts of the procedure, such as septoplasty, if they are performed for functional reasons. The out-of-pocket cost can range about $4000-$10,000+, depending on the complexity of the surgery, whether insurance is involved, and whether there has been previous surgery performed.  Facility fees and anesthesia charges add additional cost.