A nose job, known medically as rhinoplasty, is a surgical procedure that reshapes the nose for cosmetic or functional reasons. It’s one of the most commonly performed plastic surgeries in the United States, with tens of thousands of cases completed each year. Some people get a nose job to change how their nose looks, while others need one to fix a breathing problem. In many cases, both goals are addressed in a single surgery.
Cosmetic vs. Functional Rhinoplasty
The term “nose job” covers a wide range of procedures, and the specific goals vary from patient to patient. Cosmetic rhinoplasty focuses on appearance: smoothing a bump on the bridge, refining a bulbous or pinched tip, narrowing wide nostrils, correcting asymmetry, or adjusting the overall size and proportion of the nose relative to the rest of the face. The goal is balance. A nose that tilts or leans to one side, or one that seems out of proportion, can be reshaped to sit more naturally with surrounding features.
Functional rhinoplasty addresses structural problems inside the nose that make breathing difficult. The most common issue is a deviated septum, the strip of cartilage between your nostrils that ideally sits straight and vertical. When it’s angled, air can’t flow freely through one or both sides. A septum-straightening procedure on its own is called a septoplasty, and it’s often combined with cosmetic changes in the same surgery. Other functional issues include nasal passages that are too narrow and enlarged turbinates, the small structures inside your nose that warm and filter air. When turbinates swell from allergies, hormonal changes, or chronic sinus infections, they can block airflow on both sides.
Open vs. Closed Techniques
Surgeons use two main approaches, and the choice depends on how much reshaping is needed. In a closed (endonasal) procedure, all incisions are made inside the nostrils. This means no visible scarring, less swelling afterward, and a somewhat shorter recovery. It works well for straightforward changes like reducing a dorsal hump or performing bone work on the upper part of the nose.
An open procedure adds a small incision across the columella, the strip of tissue between the nostrils. This lets the surgeon lift the skin and see the entire cartilage framework directly, which is useful for more complex reshaping, especially of the nasal tip. The trade-off is a tiny scar on the underside of the nose (which typically fades to near-invisible) and slightly more swelling during recovery.
What Happens During Surgery
A nose job takes between one and three hours, depending on complexity. You’ll receive either general anesthesia, meaning you’re fully asleep, or local anesthesia with sedation, where your nose is numbed and you’re deeply relaxed but not fully unconscious. Your surgeon then works through the chosen approach to modify bone, cartilage, or both. This might involve removing a hump, narrowing the bridge, reshaping the tip cartilage, or adjusting the nostrils.
A newer technique called ultrasonic rhinoplasty uses a small titanium device that delivers targeted ultrasonic vibrations to sculpt bone with extreme precision, down to a fraction of a millimeter. Unlike traditional methods that require manually breaking and resetting nasal bones, this approach reshapes bone without cutting through surrounding soft tissue. Blood vessels stay mostly intact, which means significantly less bruising, bleeding, and swelling compared to conventional bone work.
Recovery Week by Week
Swelling peaks two to three days after surgery. Your nose, cheeks, and the area under your eyes will look puffy, and bruising is common, especially if bone work was involved. A splint or brace is placed on the nose to hold everything in position during the first week.
Around day seven, the splint comes off. Most people feel comfortable returning to work or school at this point, though the nose still looks noticeably swollen. Over the next several weeks, swelling gradually decreases, and by month two or three, your nose will look close to its final shape to most people around you. The last traces of swelling, particularly at the tip, can take a full 12 months to fully resolve. That final result at the one-year mark is the true outcome of the surgery.
Preparing for the Procedure
In the weeks before surgery, you’ll need to stop taking aspirin and any medications containing aspirin, as these thin the blood and increase bleeding risk. This includes many common over-the-counter pain relievers and cold medications like Excedrin, Alka-Seltzer, and BC Powder. Your surgeon will provide a complete list. Smoking also needs to stop well before surgery because it restricts blood flow and slows healing.
Risks and Revision Rates
A study of nearly 176,000 patients found an overall revision rate of 3.3% for nose surgery. However, that number varies considerably depending on the type of procedure. Functional surgeries like septoplasty and turbinate reduction had the lowest revision rates, around 2.4% to 2.5%. Cosmetic rhinoplasty had a higher rate at 7.9%, and more complex reconstructive cases, such as those involving cleft repair, reached revision rates of 15% to 17%.
Patients who had already undergone one revision were more likely to need another, with an 11% revision rate for secondary procedures compared to 3.1% for first-time surgeries. Younger patients, women, and those with a history of autoimmune conditions also had slightly elevated revision rates.
Why Revision Surgery Is Harder
When a first nose job doesn’t produce the desired result, or when the nose changes shape over time as it heals, a revision rhinoplasty may be needed. These are considerably more challenging than the original procedure. Internal scarring from the first surgery makes the tissue harder to work with, and the original anatomical landmarks are altered or missing. Most revision procedures require cartilage grafts to rebuild structure. If the septum has already been used as a graft source, surgeons turn to ear cartilage, which is flexible and variable in thickness, or rib cartilage, which provides the most material but carries additional risks including chest pain and a separate incision scar.
Cost and Insurance Coverage
The average surgeon and facility fee for a nose job is roughly $6,000, based on 2022 data from The Aesthetic Society. That figure doesn’t include anesthesia, medical tests, prescriptions, or other associated costs, so the total out-of-pocket price is typically higher. Cosmetic rhinoplasty is considered elective and is not covered by insurance. If the surgery corrects a deviated septum or another structural problem that impairs breathing, the functional portion may be covered, though you’ll need to verify your specific plan’s criteria beforehand.
The Non-Surgical Option
For people who want a minor change without surgery, a liquid rhinoplasty uses injectable dermal fillers to smooth bumps, fill depressions, or refine the nose’s contour. It’s a quick, minimally invasive office procedure. The trade-off is that results are temporary, lasting 12 to 18 months before the filler gradually breaks down and repeat injections are needed. A liquid nose job can camouflage a dorsal hump or improve symmetry, but it can only add volume. It can’t make a nose smaller, narrow the nostrils, or fix internal breathing problems. For patients who combine fillers with a fat transfer to the nose, results can last indefinitely as long as their weight stays stable.