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Overview of Rhinoplasty Surgery in Washington

Ariel N. Rad, M.D., Ph.D. is experienced in rhinoplasty, septoplasty and non-surgical nose job techniques. Dr. Rad trained with world-renowned rhinoplasty surgeons and his rhinoplasty experience as Director of Aesthetic Plastic Surgery and Assistant Professor at Johns Hopkins attracts regional, national and international patients who seek world-class results without the down time. Particularly in Washington DC, limiting down time for nose surgery is often as important as the result itself and Dr. Rad is one of the few Washington and northern Virginia rhinoplasty surgeons offering the “closed” approach, a scarless and minimally invasive technique to achieve natural results with a fraction of the recovery time. Although Dr. Rad is skilled in the “open” approach patients seek his expertise in the scarless approach. In Washington DC Dr. Rad’s experience with nose surgery strikes the perfect balance of nuanced and refined results without excessive recovery.

Am I a Good Candidate for Rhinoplasty Surgery?

If you are healthy, have breathing obstruction and/or desire an improvement in the appearance of your nose, regardless of whether you’ve had nasal surgery or procedures in the past, then you may be a good candidate for rhinoplasty, also known as nose job surgery. Dr. Rad focuses his rhinoplasty techniques on improving both aesthetic shape and airflow while minimizing tissue trauma, swelling and recovery. Self-confidence and breathing can be significant improved.

Functional goals:  

  • correct a deviated septum (to improve breathing)
  • open collapsed nostrils (“external valve” problems)
  • open collapsed internal airways (“internal valve” problems)
  • enhance airflow through the nasal passages
  • improve comfort during nasal breathing

Aesthetic goals:

  • refine and define a bulbous or ball shaped tip
  • reduce a large dorsal hump
  • elevate or rotate a drooping tip
  • narrow a widened nose
  • shorten a long nose
  • improve projection (not to increase length) of the nasal tip
  • lift a hanging columella (the column of tissue between nostrils on the underside of the nose)
  • reduce nostril retraction
  • restore symmetry
  • straighten deviation

How Does Dr. Rad Approach Rhinoplasty Surgery?


Rhinoplasty is a delicate procedure requiring skill and experience to restore proportion, and Dr. Rad is one of the few plastic surgeons offering the “closed” scarless nose job. Very few surgeons can perform scarless rhinoplasty due to the nuance and skill required. However, the advantages of scarless techniques are many: aside from achieving equally excellent results, Dr. Rad’s closed technique involves no visible scar across the base of the nose, minimal invasiveness, limited swelling and short recovery (7 days).
 
For your comfort and safety, light general anesthesia is administered by a Board-certified anesthesiologist in a hospital operating room and a breathing tube protects your airway. Dr. Rad makes incisions hidden inside the nostrils, not across the base of your nose as in the “open approach,” then he creates a precise tunnel through which a dorsal hump can be reduced and straightened.  Dr. Rad then borrows cartilage from the septum (thus straightening a deviated septum, called septoplasty) and uses it as graft material to make refinements in nasal shape. When extra cartilage is required, the ear or rib are good sources. Dr. Rad places cartilage grafts in key areas to enhance and refine shape and also to improve airflow. Dr. Rad narrows the nasal bones and nasal base when necessary. Splints are placed inside and outside the nose for approximately 1 week, after which time patients can return to work and most activities with little restriction.

The goals of closed rhinoplasty are to target only surgeons who have a special focus on rhinoplasty, and who have exceptional spatial artistry and nuance, are able to master the “closed” scarless method for nose surgery. Therefore, most open rhinoplasty surgeons, while able to achieve excellent results, tend to stick to the methods they are accustomed to performing.  Correcting inexperienced work is more challenging (but not impossible), so choose the right surgeon the first time. Dr. Rad is considered an expert having been an invited lecturer at the “Mastering Endonasal Rhinoplasty” symposium December 2018 where Dr. Rad lectured to surgeons from 12 countries worldwide on scarless techniques.

Learn The Nuance Of The Washington Rhinoplasty


Rhinoplasty

Dr. Rad’s approach is unique for each patient, and it combines sophisticated, state-of-the-art techniques to achieve natural and long lasting results.

WHAT RESULTS CAN I EXPECT?

Your vision for your results will emerge through detailed consultation with Dr. Rad, meticulous examination of your anatomy, and careful pre-surgical planning. While Dr. Rad’s surgical approach is unique for each patient, the goal of naturalness remains constant.

Actual Washington Rhinoplasty Patient of Dr. Rad’s
See More Top Rhinoplasty Results

Sherber+Rad cannot guarantee specific results.
Individual results may vary.

Q+A

WHAT IS A RHINOPLASTY?

Rhinoplasty (“nose job”) surgery aims to improve external nasal appearance and to improve nasal breathing. Particularly in Washington DC, limiting down time is often as important as the result itself. Therefore, Dr. Rad performs minimally invasive rhinoplasty with the “closed” (endonasal) approach. The “closed” approach offers multiple advantages: no visible scars, minimally invasive approach, results are as good if not better than via the “open” approach, and recovery time is a fraction of the recovery time with the open approach.

AM I A GOOD CANDIDATE FOR A RHINOPLASTY?

If you have breathing obstruction and/or desire an improvement in the appearance of your nose, then you may be a good candidate for rhinoplasty. Rhinoplasty surgery focuses on improving aesthetic shape and improving airflow through the nostrils. As a consequence, self-confidence and breathing can be significant improved.

CAN RHINOPLASTY IMPROVE MY BREATHING?

About 80% of people have a deviated septum which blocks breathing, leads to sinus blockages or infections, and impairs sleep which can lead to fatigue, lack of concentration and poor work performance. Rhinoplasty can significantly improve airflow through nasal passages which can improve sleep and restfulness. Even in the absence of a deviated septum, Dr. Rad employs techniques (such as the use of “spreader grafts”) designed to open the airways further. Opening the airways does not cause the nose to appear wider. Improved breathing by 20-30% is common even when the primary goal is to improve shape.

WHICH RHINOPLASTY PROCEDURES ARE SUITABLE FOR ME?

The 3 approaches to rhinoplasty are: Non-surgical: using filler, Dr. Rad can make modest aesthetic improvements such as filling in the bridge of the nose or defining tip shape. Advantages: in-office procedure is cost-effective and involves no down-time. Disadvantages: improvements disappear after 6-12 months, and only small improvements can be made. Surgical, “closed” or endonasal approach: using incisions hidden within the nostrils permanent improvements can be made to shape and nasal breathing. Advantages: hidden scars and minimal disruption of tissues lead to minimal discomfort, minimal swelling and congestion, and short recovery (~5-7 days). Disadvantages: none. This technique is state-of-the-art and is Dr. Rad’s preferred approach (read below for more detail). Surgical, “open” approach: using a visible incision across the base of the nose, permanent improvements can be made to shape and nasal breathing. Advantages: improved surgeon visibility of underlying structures – however this is not a true advantage to the patient and is unnecessary to achieve the common goals of rhinoplasty. Disadvantages: aggressive dissection and invasiveness leads to greater discomfort, swelling and congestion, and longer recovery times (~4 weeks).

WHAT IS A NON-SURGICAL RHINOPLASTY?

Non-surgical rhinoplasty is an in-office procedure whereby Dr. Rad injects dermal filler in precise areas of the nose to improve nasal shape and proportion. It is ideal for patients who have volume deficiency in specific areas. The ideal candidate for non-surgical rhinoplasty are those who have a dorsal hump or downward curving shape of the nose and for whom the radix (upper bridge at eye level) is concave. Dr. Rad carefully studies and measures nasal proportions, and he also pays attention to patients’ ethnicities, in order to optimize nasal shape. With topical numbing medicine pain is minimal, no recovery time is necessary, and results are immediate. The results last 6-12 months depending on the filler used and the amount of volume placed. Dr. Rad uses hylauronic acid-based fillers such as Juvèderm, Voluma, Vollure or Radiesse depending on patient characteristics and desired goals.

WHAT ARE THE DIFFERENCES BETWEEN OPEN AND CLOSED RHINOPLASTY?

The open and closed approaches refer only to how the internal structures are accessed. Both are equally effective in allowing the surgeon to achieve patients’ goals. However, there are big differences in scar and recovery. The “closed” approach requires exceptional nuance and skill. Dr. Rad employs the “closed” approach because results are excellent and recovery is minimal. This is in contrast to the “open” approach which involves a visible scar, significant swelling and recovery due to unnecessary invasiveness. In Washington DC, minimizing down time is often as important as the result, and Dr. Rad performs the “closed” approach to achieve natural, balanced results with a fraction of the recovery time. The external scar from open rhinoplasty, while usually not terrible, is still often visible, may require makeup to cover, and may be disconcerting to patients. Additionally, the significant swelling, and thus the recovery time, associated with the open approach is much greater than swelling and recovery after a closed approach. The difference can be 3 to 4 fold. Particularly in Washington, recovery time and social downtime can be as important as the result itself. This is where the closed approach shines: the two greatest advantages of closed rhinoplasty are (1) the limited invasiveness and therefore a quicker recovery for the patient, and (2) the ability to “fine tune” the result. Limiting invasiveness is also advantageous to achieving better results: Dr. Rad can control the external shape better if the nasal skin is disturbed less. Whereas the focus in the open approach is the underlying bone and cartilage, the emphasis in the closed approach is the external shape. After all, what we see on the outside is what matters! The fact that all the incisions are inside the nose does not mean that the surgery is “blind.” Almost every step is still executed very precisely and under direct vision, but the planning and technique are unique. In fact, avoiding unnecessary dissection of the nasal skin is an advantage because Dr. Rad can better assess shape, symmetry and proportion, while avoiding excessive swelling, bruising, pain, numbness, visible scar and extended recovery time as are typical of the open approach.

WHAT ARE OTHER DIFFERENCES BETWEEN OPEN AND CLOSED RHINOPLASTY?

Another disadvantage to the open technique is the surgery takes longer to perform. In some cases, open rhinoplasties can add an hour or more to surgery time. Open rhinoplasty also causes numbness to the nasal tip which can last up to a year and is caused by the nasal skin being peeled back to expose the underlying cartilages, a maneuver not necessary to achieve beautiful external shape. With more invasiveness and dissection, additional scarring results from unnecessary dissection and separation of the natural tissue boundaries. Scar forms in response to such traumatic disruption and this causes thickening of the tissue envelope which may distort the overall nasal shape. In contrast, the “closed” approach minimizes tissue disruption which reduces scar tissue formation, distortion, swelling and recovery time: all desirable outcomes. Another major disadvantage of the open approach is the visible scar at the base of the nose. The scar often becomes pink and may thicken, making it difficult to hide even with makeup. Furthermore, cutting part of the blood supply to the tip can potentially cause the skin not to have enough blood flow and tissue healing problems.

SO WHY DOESN’T EVERY SURGEON PERFORM CLOSED RHINOPLASTY?

Most surgeons are trained in open rhinoplasty because frankly it’s easier to perform technically, logically and visually. Therefore, surgeons-in-training are usually exposed first to the open method. Only surgeons who have a special focus on rhinoplasty, and who have exceptional spatial and nuance, are able to master the closed method. Therefore, most open rhinoplasty surgeons, while able to achieve excellent results, tend to stick to the methods they are accustomed to performing. However, the advantages of closed over open rhinoplasty are many and very worthwhile to the patient. Unfortunately, these advantages are often suppressed or “down played” to patients by open rhinoplasty surgeons. As a proponent of the closed technique, Dr. Rad’s goal is to educate patients as to what he is able to achieve and, with this information, patients are able to make the appropriate decision for their goals.

IF I’VE HAD A RHINOPLASTY BEFORE AND I NEED FURTHER IMPROVEMENT, AM I ABLE TO UNDERGO RHINOPLASTY AGAIN?

Primary (1st time) and revision (2nd, 3rd or more) rhinoplasty patients are well suited to achieving excellent results with the closed approach. Many surgeons who advocate the open approach argue that it is more effective than the close approach when the anatomy is distorted and the tissues are scarred. The reality is the reverse: the more difficult the anatomy, the more the closed approach shines because minimizing invasiveness helps to minimize further distortion from scar tissue. In this scenario, less is more.

HOW DO I CHOOSE A RHINOPLASTY SURGEON IN WASHINGTON DC?

Particularly in rhinoplasty, surgery can’t be reversed and correcting inexperienced work is more challenging (but not impossible), so choose right the first time. When vetting a plastic surgeon, use this check list: S/he should be certified by the American Board of Plastic Surgery. S/he should have trained at premier institutions. S/he should have at least 5 years of experience performing rhinoplasty regularly. S/he should have extensive before/after photos to show during your consultation. Keep in mind that the number of photos displayed publicly is not indicative of the surgeon’s volume. Dr. Rad’s rhinoplasty page shows representative cases because the vast majority of his patients prefer not to have their photos displayed on the internet. Within a private consultation, Dr. Rad will show many before/after cases. S/he should spend time discussing the procedure/benefits/expectations, answering your questions and addressing concerns. Surgery is significant undertaking with many details to review, and your consultation should be unhurried. S/he should offer a “morphologic simulation” of your surgical result: by using advanced “morphing” software, Dr. Rad provides patients with a digital simulation of what your nose might look like after surgery. Attention to detail is crucial. Note how the surgeon addresses the details of your surgery and pre-operative and post-operative care. Also pay attention to the cleanliness of the office, friendliness and competence of office staff, presentation of information of the website, and other clues to how attentive to detail the surgeon is. Cost: Consider the quality you’re “buying.” Cheaper is not better.

WHAT IS SEPTOPLASTY?

The septum is a flat piece of cartilage that is the barrier between your twin nasal passages. Sometimes the septum is bowed to one side (called “deviated septum”), causing airway obstruction. A septoplasty is a surgical procedure Dr. Rad performs to (1) straighten the septum to provide better airflow in patients who are suffering from a deviated septum, and (2) obtain cartilage grafts which Dr. Rad uses to reshape the nose for cosmetic improvement. Dr. Rad performs rhinoplasty and septoplasty together. If you’ve already had a septoplasty in the past and now want cosmetic improvements to the shape of your nose, then Dr. Rad may need to borrow cartilage from other areas (the inner “bowl” of the ear, or a rib) to obtain enough cartilage for grafts.

SHOULD OTHER PROCEDURES BE CONSIDERED WITH RHINOPLASTY?

If you have concerns for improving other areas of the face then Dr. Rad will advise you. While rhinoplasty can improve the appearance of the nose itself, facial balance and proportion are crucial to consider. Dr. Rad will evaluate your facial architecture to determine if you would benefit from enhancement or refinement of other areas of your facial skeleton. The most popular adjunct to rhinoplasty is chin augmentation (genioplasty) for a receded or diminutive chin. When the chin is too small the nose often looks disproportionately large and patients and surgeons alike may conclude erroneously that reducing the nose further is the solution. Quite the contrary: chin augmentation endeavors to improve projection, shape and size of the chin so that the nose does not appear disproportionately large. Facial width is also important to consider: some patients benefit from enhancement of the cheekbones either through facial fat grafting or malar (cheek) implant augmentation, whereas others may benefit from slimming of “chipmunk” cheeks via buccal fat pad removal. Patients in later years may combine face lift or neck lift surgery with rhinoplasty. The bottom line is that combining surgeries is generally safe and requires careful assessment of your facial architecture and your goals. The range of breast and body procedures are also well tolerated when combined with rhinoplasty. Overall combining procedures is generally safe, cost-effective and involve one recovery period, making it a popular approach.

HOW ARE COMPLICATIONS AVOIDED?

Rhinoplasty surgery in skilled hands is very safe. Dr. Rad takes every precaution to minimize risk through careful pre-surgery preparation and exceptional post-surgery care. Rather than performing surgery in a small office surgicenter which cannot handle potential, albeit rare, complications from anesthesia (such as airway obstruction), Dr. Rad performs surgery at hospitals in DC and northern Virginia wherein Dr. Rad works only with Board certified anesthesiologists and experienced staff. This assures the lowest risk of complications.

HOW LONG CAN I EXPECT MY RHINOPLASTY RESULT TO LAST?

In the right hands surgical results last a lifetime.

Consultation with Dr. Rad

What Will My Consultation with Dr. Rad be Like?

Dr. Rad spends time with his patients, and you can expect to receive his undivided attention for 40 minutes.  Your consultation will not be rushed, and your questions will be answered fully. Dr. Rad’s primary concerns are for your safety and to achieve the optimal results possible. During your rhinoplasty consultation Dr. Rad may use morphing software to create a realistic “after” photo of your result. This is applicable for dorsal hump reductions, tip and bridge narrowing, tip rotation or length changes or radix (bridge of nose) augmentation. Oftentimes patients benefit from chin augmentation which can also be simulated.

If you have a history of nasal trauma and deviation, Dr. Rad recommends bringing old photographs taken prior to the traumatic event. Photos are helpful to compare your natural facial anatomy and to facilitate discussion of how to restore normal nasal architecture.  Some patients require “medical clearance” from their primary care physicians (PCP) and possibly from specialists. Additional medical tests and blood work may be needed for patients with certain medical concerns, although this is not routine for those who are in good health.

What are Dr. Rad’s patients saying?

“We consulted with three plastic surgeons before choosing Dr. Rad for my 17-year-old son’s rhinoplasty and chin implant in March 2017. From the first meeting, we felt confident that Dr. Rad is a skilled, experienced and talented surgeon who pays attention to every detail. He is also a super guy – warm, caring, attentive and welcoming. Everything went smoothly and we are extremely happy with the results. We are very pleased with the whole experience and recommend him without hesitation.“

A.B. in Washington, DC | October 3, 2018

About your Washington surgeon

Dr. Rad’s credentials, results and patient reviews speak for themselves. Princeton (magna cum laude) and Duke University educated, Dr. Rad is a Johns Hopkins trained board certified plastic surgeon and Assistant Professor of plastic surgery there. Dr. Rad has performed thousands of aesthetic facial surgeries and he specializes in minimally invasive, scarless approaches featuring minimal downtime. He is ranked in the top 3 plastic surgeons in DC, has the highest patient ratings across all doctor review websites and has been an invited expert in international conferences teaching his techniques to surgeons from around the world. Dr. Rad’s patients seek to look refreshed and rested with natural results, minimal scars and the least downtime. He has innovated scarless techniques due to his patients’ needs for discretion and hidden evidence of surgery. Dr. Rad has membership with the American Society of Plastic Surgeons, the American Society for Aesthetic Plastic Surgery, and he is certified by the American Board of Plastic Surgery. Through rigorous written and oral examinations, these national societies have vetted Dr. Rad’s education, training, professional qualifications, surgical competence, and ethical conduct as having met the highest standards in the world.

Meet Dr. Rad

What is the cost of rhinoplasty surgery in DC?

The cost of rhinoplasty in Dr. Rad’s DC practice ranges from $800 – $2,400 for non-surgical rhinoplasty, and from $6,500 for tip rhinoplasty to $9,500 for primary surgical rhinoplasty, and up to $16,000 for complex surgery, corrective work and/or additional procedures such as rib graft. Total cost depends on many factors: your unique anatomy, your goals and preferences, complexity of surgery, first-time or corrective work required, in-office (non-surgical) or hospital-based operating facility (surgical), and the training, experience and skill of your surgeon. Johns Hopkins trained, and Assistant Professor and former Director of aesthetic surgery there, Dr. Rad is a board certified plastic surgeon with over a decade of experience. He is an aesthetic surgery expert, having lectured to plastic surgeons from around the world on scarless surgical techniques and microsurgery. He is ranked in the top 3 plastic surgeons in DC, and he has the highest patient ratings across all doctor review websites.

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Sherber+Rad1101 15th St. NW, Suite 100, Washington, D.C. 20005