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Atlanta Facial Plastic surgeon

Important factors in facial aesthetics include symmetry and harmony between the facial features.  For some, an overly large, wide, long, or crooked nose may detract from their appearance and affect self-confidence.  For this reason, rhinoplasty (or nose surgery) has been and remains among the most popular procedures to which patients turn to enhance their appearance.  Rhinoplasty typically lands in the top 5 most popular plastic surgery procedures year after year, and on average, 220,000 Americans undergo rhinoplasty annually.

At Aviva Plastic Surgery, we believe that looking your best should not compromise the features that make you unique.  A facial plastic surgeon and rhinoplasty expert, Dr. Fishman is among the few plastic surgeons in the United States to offer both traditional and preservation rhinoplasty – a modern approach to nose surgery that offers less invasive techniques, faster recovery, and more natural-looking results. Learn how either the traditional nose job or preservation rhinoplasty can help you feel more confident.

Best Rhinoplasty Plastic Surgeon in Atlanta, GA

What is Preservation Rhinoplasty?

Like traditional rhinoplasty, preservation nose surgery is a highly personalized treatment designed to improve the overall shape and size of the nose while ultimately improving overall facial aesthetics. However, the methodology and technique behind traditional and preservation rhinoplasty differ.

Piezo Ultrasonic Rhinoplasty

Traditional Rhinoplasty

Traditional rhinoplasty relies on reducing undesirable volume of the nose by removing excess cartilage and/ or bone.  Excess cartilage is typically resected with scissors or a scalpel, while excess bone is typically “filed down” with rasps. These reductive techniques can disrupt critical connections between the structures of the nose, leading to less support and even some degree of nose collapse over time.  While it is a very effective solution to reshaping the nose, traditional rhinoplasty can have complications—such as prolonged swelling and undesirable scarring—which can negatively impact the shape of the nose.

Preservation Rhinoplasty

Preservation rhinoplasty offers patients a less invasive approach to nose jobs. Relying on reshaping tissues more than removing it. Instead of filing down the dorsal hump like during traditional rhinoplasty, this conservative approach uses incisions into the nasal bone to lower the entire bridge as a single unit. During preservation rhinoplasty, our facial plastic surgeon, selectively removes a thin strip of bone and cartilage from under the bridge of the nose, thus keeping intact important connections between the structures of the nose.  In practicing preservation rhinoplasty techniques preserves more of the cartilage and bone, leading to less swelling and a more natural-appearing nose contour.  

Candidates for Preservation Nose Surgery

For the best results, preservation rhinoplasty is recommended for the following individuals:

  • First-time or primary rhinoplasty patients
  • Patients with dorsal humps (or bridge bumps)
  • Patients with crooked noses
  • Patients without a history of septal or nose trauma

While preservation rhinoplasty can be an excellent option for some individuals, not all patients may enjoy the same results.

Benefits of Preservation Rhinoplasty

Preservation rhinoplasty has some significant benefits that help hesitant patients feel more comfortable with the rhinoplasty. These include:

While rhinoplasty is consistently among the top requested plastic surgeries, its initial recovery can last up to two weeks, with swelling taking several months to resolve completely. Because preservation rhinoplasty preserves the patient’s original nasal anatomy, it reduces how much swelling or bruising patients experience during recovery and shortens the recovery process. 

Preservation rhinoplasty techniques help Dr. Fishman preserve the natural support structures of the nose, which are important both for nose aesthetics and function, specifically breathing.  Nasal preservation techniques can even enhance airflow by widening the internal air passage.

Preserving the nasal bridge can yield more natural-looking results with greater longevity. When too much tissue is removed, the nose can become structurally unsound and lose its support over time. Aesthetically, this can leave patients with an “operated” and unnatural appearance post-surgery, including a poorly supported nasal bridge and potentially misshapen tip. Medically, changes in the shape of nasal passages required by more invasive surgery put airflow passages at risk. In contrast, preservation rhinoplasty removes excess tissue from the base of the nasal bridge, lowering the entire bridge as a single piece, thus allowing the nose to retain its structural integrity.

Preservation rhinoplasty Atlanta nose surgery

Recovery after surgery–especially after facial surgery–is understandably a common and significant concern for most men and women pondering aesthetic treatments.  Facial Plastic Surgeon Dr. Inessa Fishman and the Aviva team strive to ensure both great treatment outcomes and a smooth recovery for our patients.  Thorough preparation and appropriate expectations for recovery are important to lessen anxiety and help with post-surgery recovery.

This 19-year-old Caucasian woman is recovering well 1 week after preservation rhinoplasty to treat her dorsal bump (or bump at the nose bridge) and refine her nasal tip.  Her thin skin shows minimal swelling, and her bruising is a faint yellow tinge under the eyes.  The nasal tip is a bit over-rotated due to swelling, and will settle over the next few weeks.  While she is comfortable returning to work and social obligations, her final results will appear in a few months as her nasal appearance refines.

Preservation rhinoplasty Atlanta piezo expert surgeon

Preservation rhinoplasty and piezo rhinoplasty techniques result in less swelling both in the tissues around and within the nose.  This 37-year-old Persian woman is recovering well 10 days after preservation rhinoplasty, revision septoplasty, and cadaver cartilage graft to support her nasal tip and treat a dorsal hump after nasal trauma.  Her bruising is limited to a slight yellow tinge at the cheeks, and swelling is minimal at the face and nose. 

Preservation rhinoplasty provides long-lasting stability to the nose support and appearance.  Dr. Fishman uses a combination of preservation and traditional rhinoplasty techniques to provide her patients with natural, elegant appearing rhinoplasty results.

I went to Dr. Fishman for a rhinoplasty. She was a 10/10 experience. She is incredibly talented and gives you photos of what you will look like after surgery. They say there is no such thing as perfection but she is as close as it gets! 5 stars!

Candidates for Traditional Rhinoplasty

Patients with:

  • large noses looking to significantly reduce the nose size
  • problems related to a previous rhinoplasty
  • significant septal deviation or septal scarring

Benefits of Traditional Rhinoplasty

Rhinoplasty finds its place in the top five plastic surgery procedures year after year for good reason. When carried out by an expert surgeon like Dr. Fishman, rhinoplasty can treat multiple structural and aesthetic concerns. With traditional rhinoplasty, Dr. Fishman can:

  • reduce the overall size of the nose
  • address breathing problems
  • improve the angle between the nose and the upper lip
  • remove bumps and bends within the nose
  • straighten a crooked nose
  • narrow flaring nostrils 
  • narrow the “bulb” of “ball-like” appearance of the tip of the nose
  • change the shape of the nose bridge

I am so, deeply happy about both my results and my experience. I have always been curious about a "liquid nose job" and due to the doctor's experience with rhinoplasty as well as fillers, I knew she would be an expert.

While rhinoplasty has long been a popular procedure for decades, the treatment has at times drawn criticism for erasing ethnic features in favor of a more Caucasian nose appearance.  In recent years, ethnic rhinoplasty has become a popular approach to creating personalized, natural-looking results that are inclusive of diverse patient backgrounds.  Dr. Fishman uses both traditional and preservation rhinoplasty techniques to get best results in ethnic rhinoplasty.

Ethnic rhinoplasty is tailored to help patients retain and even emphasize their ethnic heritage while adding balance and harmony to their appearance.  Correctly performing this procedure involves not only in-depth anatomical knowledge of the nose, but also an understanding and appreciation for different standards of beauty found across different cultures and ethnicities.

Dr. Fishman brings unique experience and international training to the rhinoplasty treatment development process.  She has traveled across the globe to train with renowned rhinoplasty surgeons in Turkey and Russia, attend specialized surgical conferences, and learn about the different standards of beauty unique to different parts of the world.  Dr. Fishman’s aesthetic sense and training offer unparalleled ethnic rhinoplasty expertise to her patients.

Ethnic Rhinoplasty: Rhinoplasty Can Align with Your Heritage

Preservation piezo rhinoplasty Atlanta nose surgery

This 31-year-old woman wanted to improve the dorsal bump (or excessive fulness along the bridge of her nose) as well as the drooping nose tip.  She is recovering well 1 month after preservation rhinoplasty, and while she still has several months of healing ahead, the features of her new nasal shape are already becoming apparent.  

This patient’s nose surgery was done via a closed approach, which keeps the incisions and scars hidden inside the nostrils.  The preservation rhinoplasty approach allowed Dr. Fishman to keep the natural stability within the patient’s nose bones and cartilage, preventing the risk of unsightly scarring and visible deformities in the future.  Dr. Fishman used the patient’s own septal cartilage to support her nasal tip, putting it into a more aesthetic position and preventing it from the common age-related drooping which occurs both in noses previously treated with surgery and not treated at all.

Before + After Rhinoplasty

Piezo ultrasonic rhinoplasty

Piezo or Ultrasonic Rhinoplasty

A cutting-edge advance in the world of rhinoplasty, the piezo or ultrasonic rhinoplasty technique allows for greater precision and a significantly shorter recovery after nose surgery.  Piezo rhinoplasty uses the piezotome instrument, a small handpiece with different cutting and shaping tips which uses tiny, ultrasonic wave movements allowing Dr. Fishman to create very precise cuts in the nasal bone with significantly reduced trauma, swelling, and bruising.

Traditional rhinoplasty relies of cutting chisels (called osteotomes) and hammers to create cuts or incisions in the bone, to narrow or reshape the bony parts of the nose.  These instruments, used for centuries, can create pronounced bleeding, bruising, and swelling.  Likewise, the bony incisions created with chisels can create fragmented, imprecise bone cuts.  Piezo or ultrasonic rhinoplasty helps improve this, allowing Dr. Fishman to carry out the most advanced preservation rhinoplasty techniques while providing you with natural, long-lasting results and a shortened, minimal post-surgery recovery.  When it comes to permanently altering a part of your anatomy, trust your face to an expert; to learn more about piezo rhinoplasty with Dr. Fishman, contact us to schedule your consultation.

Rhinoplasty Frequently Asked Questions (FAQs)

Rhinoplasty recovery typically is not too painful. Most patients manage the pain with a combination of over-the-counter pain medications. We also provide our patients with a prescription-strength pain medication to use as needed. 

We do not work with any insurance providers in our practice. Some patients will submit out-of-network claims with their insurance providers if they are having issues with breathing, snoring, or other related issues. In these cases, insurance will cover the septoplasty portion of their procedure. The cosmetic rhinoplasty portion of the procedure is an out of pocket cost.

Yes, it is okay to have a rhinoplasty if you have a history of keloids. We will closely monitor your incisions while healing for any signs of keloidal development. Dr. Fishman can also inject the scars with an anti-inflammatory and anti-scarring medication to help keep a keloid from developing or worsening. 

Out-of-town patients should plan to stay in town for at least a week following a rhinoplasty procedure. We like to see you back in the office one day post-operatively as well as an additional 1-3 times during your first week. At one week, Dr. Fishman will look at how things are healing and typically most patients are good to travel back home. If Dr. Fishman would like you to stay in town for longer to continue to monitor your healing if there are any issues, she will let you know. 

Following a rhinoplasty procedure, there will be a dressing of brown paper tape over your nose and under eye area. This is to help reduce the amount of swelling and bruising post-procedure. This is removed on day 7 post-procedure. Swelling is common following any facial procedure and usually peaks around post-op day 3. The majority of this swelling is resolved around 1-2 weeks following rhinoplasty, but it may take up to a year to see the final results of your rhinoplasty procedure. 

A “closed” rhinoplasty is one in which the incisions are completely on the inside of the nostrils. An “open” rhinoplasty includes an incision along the columella or bottom portion of the nose that is in between the nostrils. Dr. Fishman performs the majority of her rhinoplasties using the “closed” approach, but may used an “open” approach if a patient has had rhinoplasty surgery before or if she needs better access to the upper structures of the nose. 

Patients should sleep with their heads elevated for 2 weeks following rhinoplasty surgery. After this, we recommend you avoid sleeping on your side for another four weeks. You may use a neck travel pillow to keep yourself from rolling onto your side and compressing your nose.

Avoid blowing your nose at all for at least 14 days following surgery. After this, blow through both sides at once. We do not want you compressing one side. If you need to sneeze, do your best to sneeze through your mouth. 

Most patients return back to school or work around day 7 or 8 following rhinoplasty surgery, once the surgical dressing has been removed. We typically say that patients will be “restaurant ready” around 3 weeks following surgery. For big events such as birthdays, graduations, and other celebrations we recommend being at least 2-3 months out from surgery. 

We recommended wearing lightweight glasses on the nose as long as the protective post-rhinoplasty dressings remain in place, usually for 1 week after your surgery.  After this, we recommend suspending glasses and sunglasses from the forehead or the cheeks for ~6-8 weeks; excessive pressure on the nose can change is contour during the early healing phases.

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