Rhinoplasty Results and What to Expect

What this site publishes, and what it does not

This page carries no before and after gallery. The doctors' pages carry operative pairs, supplied by the doctor who operated: the first frame before the operation and the second at the end of it, which is a photograph of surgery rather than of a result.

A photograph implies a promise. One person's result records one person's anatomy, skin thickness and healing. Placing it beside your search implies you would get it, and nobody can know that.

Galleries are among the easiest things in this industry to fake. Images can be bought, taken from another surgeon, mirrored, retouched, or shot in lighting chosen to flatter. A reader cannot tell, which is exactly why they work.

That applies to the pairs on this site as much as to anyone else's, which is why each one carries what it is and when it was taken. How to read a before and after photograph sets out the test, and the rest of this page is about applying it to the images a surgeon shows you in a consultation.

How to read a surgeon's own photographs

The value of a photograph is in its conditions, not its content. Ask about the conditions, and ask what is missing.

• Lighting, background, distance and lens should match across the pair. Changing any of them changes the apparent shape of a nose.
• Angles should match too, and ask to see the nose from the front, both sides, both obliques and from below. A missing angle is rarely the flattering one.
• Ask whether anything was retouched, including skin smoothing and the automatic correction a phone applies without being asked.
• Ask how many operations the set was chosen from. Twenty images picked from two thousand operations would describe the picking, not the surgery.
• Ask to see the results that disappointed, and the revisions. A surgeon who has operated for years has both.
• Ask how long after surgery each image was taken, and ask for cases that started where you are: your skin thickness, your concern, your anatomy.

What three dimensional measurement shows about swelling

Swelling does not peak on the day of surgery. Three dimensional photography in 18 primary open rhinoplasty patients put maximum nasal volume at 7 to 14 days, about when the splint comes off.

Those figures describe 40 patients after one type of operation, not every nose. They also describe an average curve, and an average curve is not a week by week experience.

Swelling comes and goes. Looking better one week and fuller the next is ordinary, and it is the main reason an early photograph misleads the person in it.

The tip is the slowest area. In thick skin, tip definition keeps refining for 18 months or more.

When a result can fairly be judged

The American Society of Plastic Surgeons puts the appearance of the final shape at a year or more after surgery. Three points on the way there are worth naming.

1. Day 6 to 8Splint and any sutures removed. The nose looks swollen at this stage, and this is not the result.
2. Month 2 to 6The greater part of the swelling has resolved. Changes become gradual rather than week to week. The tip remains the slowest area to refine.
3. Month 12 to 18The result is generally considered settled. Thick skin and revision cases can continue to change beyond this.

Judging a nose before that is largely judging swelling, which is why revision surgery is not usually considered until at least 12 months after the previous operation.

What a gallery cannot tell you

A before and after set is a claim about outcomes, made by the person who produced them. Read it as one: ask how many cases the set was chosen from, and ask to see a result in the same lighting and at the same angle as the photograph you were shown.