Rhinoplasty (nose surgery) follows five core steps: an in-depth consultation and surgical plan, anesthesia, an open or closed incision approach, reshaping of the bone and cartilage, and closing with a protective splint. The full procedure typically takes 1.5 to 3 hours, and most patients go home the same day. Below is what actually happens at each stage, explained in plain terms.
Step 1: Consultation and Surgical Planning
Before any surgery is scheduled, your surgeon evaluates your nasal anatomy, breathing function, skin thickness, and facial proportions. This is also where your goals get translated into a concrete surgical plan — whether that means refining the tip, reducing a dorsal hump, narrowing the bridge, or correcting a functional issue like a deviated septum. Many surgeons use computer imaging to preview possible results and confirm expectations are realistic before moving forward. If you haven’t had this conversation yet, our rhinoplasty FAQ page covers the questions patients ask most often at this stage.
Step 2: Anesthesia
Rhinoplasty is performed under either general anesthesia or IV sedation with local anesthesia, depending on the complexity of the case and surgeon preference. An anesthesiologist monitors you throughout. This step exists purely for comfort and safety — you won’t feel or remember the procedure itself.
Step 3: The Surgical Approach — Open vs. Closed
Surgeons use one of two techniques to access the underlying nasal structure:
- Closed rhinoplasty: All incisions are made inside the nostrils, leaving no visible external scarring. This approach suits many straightforward reshaping cases.
- Open rhinoplasty: A small incision is added across the columella (the strip of tissue between the nostrils), allowing the skin to be lifted for a direct view of the cartilage and bone. This is often preferred for more complex reshaping, revision cases, or significant tip work.
Neither approach is universally “better” — the right choice depends on what your specific anatomy and goals require.
Step 4: Reshaping the Bone and Cartilage
This is the core of the procedure. Depending on the goals, your surgeon may:
- Remove or reduce a bony or cartilaginous dorsal hump
- Narrow the nasal bones (osteotomy) to refine the bridge
- Reshape or reposition tip cartilage to adjust projection and rotation
- Add cartilage grafts (often from the septum, ear, or rib) to build structure, common in revision or ethnic rhinoplasty
- Straighten a deviated septum to improve airflow
Every adjustment here is planned around preserving — or improving — how you breathe, not just how the nose looks.
Step 5: Closing and Splinting
Once reshaping is complete, incisions are closed with fine sutures. A rigid external splint is placed over the nose to protect and stabilize its new shape while initial healing occurs, and internal splints or soft packing may be used if septal work was performed. The external splint typically stays on for about a week.
What Happens After Surgery
Most swelling and bruising subside significantly within two to three weeks, though the nose continues to refine subtly for up to a year as deeper swelling resolves. Most patients return to desk work within one to two weeks. We cover the full timeline in more detail in our recovery guide, and you can browse real results in our before-and-after gallery.
Frequently Asked Questions
How long does the rhinoplasty procedure itself take?
Most rhinoplasty surgeries take between 1.5 and 3 hours, depending on complexity. Revision cases or those requiring cartilage grafting can take longer.
Is rhinoplasty done under general anesthesia?
Most rhinoplasties are performed under general anesthesia, though some surgeons use IV sedation with local anesthesia for select cases.
What’s the difference between open and closed rhinoplasty?
Closed rhinoplasty uses incisions hidden inside the nostrils with no external scar. Open rhinoplasty adds a small incision across the columella for direct visibility, typically used for more complex reshaping.
Will I be awake during the procedure?
No. Rhinoplasty is performed under anesthesia, so you will not be awake or feel the procedure.
Ready to Take the Next Step?
Every nose — and every set of goals — is different, which is why the steps above are a general framework rather than a fixed script. The best way to understand what your rhinoplasty would actually involve is a one-on-one consultation. Dr. Mark Markarian is a Harvard-trained, board-certified plastic surgeon based in Wellesley, MA, with a particular focus on rhinoplasty, including ethnic rhinoplasty. Visit our rhinoplasty page to learn more, or book a virtual consultation to start the conversation.
This article is for general educational purposes and isn’t a substitute for personalized medical advice. Individual results and recommendations vary by patient.
