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How Rhinoplasty is Performed

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Modifications in the appearance of the nose are performed by altering the underlying skeletal structure of the nose. Depending on the location of the desired physical change, the nasal bones and/or cartilages under the skin may be moved, augmented, or reduced to improve the nasal appearance during the San Francisco rhinoplasty procedure.

Dr. David C. Mabrie uses illustrations to explain how rhinoplasty is performed. He works with men and women from throughout the Bay Area including San Francisco, Oakland and Walnut Creek. Request a consultation online or call us at (415) 689-6634 today.

Featured Cases

Case 338

ABOUT OUR PATIENT   So many people are unhappy with their nasal tip!  It’s either "too round" or "too droopy". This young lady from the Castro Valley was concerned with the latter. She wasn’t thrilled with her nose’s curvature or the way the tip pointed downward. As intent as she was on finding a fix for her issue, she wasn’t comfortable with surgical procedures...

Case 325

ABOUT OUR PATIENT After doing some research about non surgical treatment, this young man from Brazil stopped by my San Francisco office for a consultation. He had a clear vision of what he wanted to improve-his nose. He wanted to remove a small distracting bump and make the tip appear more upturned. Facial dermal filler treatments are ideal for these kinds of aesthetic defects, so I was more than...

Case 312

ABOUT OUR PATIENT For about a year, this 40-something mother of two had thought about getting a treatment for her nose. She started doing research about her options and came across the reviews and photos for my cosmetic surgery practice. Soon after, I was glad to welcome her to my San Francisco office where I gave her an in-depth consultation. DR. MABRIE'S TREATMENT PLAN For this patient, I per...

Case 300

ABOUT OUR PATIENT This African American man in his 20's had a big problem: he had long felt his nose detracted from the rest of his face. While he appreciated its shape in general, he felt it made him look too childlike. During his search for a surgeon experienced in Ethnic Rhinoplasty, my videos caught his eye, so we met in my downtown San Francisco office, where I consulted with him about non...

Case 280

Background: This woman, from Modesto, was now in her 50's and wanted to rejuvenate her looks. She spent time researching cosmetic surgeons and procedures, and decided to consult with Dr. Mabrie after reviewing his website. They discussed options for giving her a younger and more attractive looking face. She had never received Dermafillers before and was concerned about bruising, as she did not kno...

Case 227

Background: This east bay woman consulted with Dr. Mabrie in his San Francisco office about non-surgical Rhinoplasty. In general she was happy with the overall size and character of her nose, but wondered if some small improvements could be made. Her two main concerns: 1. She didn't want her nose to look "done". 2. She was afraid of needles!   Dr. Mabrie's Assessment: “This ca...

Case 221

Background: This woman was primarily concerned with her profile. She felt the curvature was extreme and made the nose seem large. She found Dr. Mabrie online and consulted about non-surgical treatment. Dr. Mabrie’s Assessment: “This was a very satisfying case. We both agreed that her concerns were slightly different from many of the cases previously seen in my photo gallery. This...

Case 218

ABOUT OUR PATIENT This young lady was already feeling somewhat satisfied with the shaping of her nose, but she knew there was room for improvement. She felt it looked a little round and slightly undefined. Basically, she was looking for a change that was defining but not too drastic. After searching online for a facial plastic surgeon specializing in Non-Surgical Rhinoplasty, she found our before...

Case 210

ABOUT OUR PATIENT This patient initially visited my San Francisco office interested in finding the right kind of filler treatment for bags under her eyes. I noticed her nose was somewhat misshapen and injured as well. She told me it was the result of a Rhinoplasty she had many years ago. There has been a hump reduction during the Rhinoplasty surgery, which had caused the middle cartilaginous port...

Case 208

  Achieve similar results non-surgically! Check out this case: Non-Surgical Rhinoplasty Background: This young San Francisco woman was interested in Rhinoplasty surgery.  She chose Dr. Mabrie because of his experience with preserving ethnic characteristics and maintaining natural results.  She wanted a softer nose, like her mother's, with better symmetry, a smaller tip, and ...

Case 201

  Achieve similar results non-surgically! Check out this case: Non-Surgical Rhinoplasty Background: This woman had long considered Rhinoplasty surgery. Her nasal tip was full and similar in size and shape to the nose of her father. While she liked his nose on him, she wanted something softer and more feminine. After searching several plastic surgery websites of doctors in San Francisc...

Case 198

Background: This young lady was unhappy with her nose. She felt the bridge and tip were too wide. She did some research for non-surgical rhinoplasty and after viewing similar cases by San Francisco facial plastic surgeon, Dr. Mabrie,  made an appointment. Dr. Mabrie's Assesment: This young woman of pacific island decent has requests that are common for patients researching Asian rhinoplasty ...

Case 195

< Achieve similar results non-surgically! Check out this case: Non-Surgical Rhinoplasty Revision  Background: This young woman had a previous Rhinoplasty years ago that had given good results. Years later she started to see a change in those results. She came in to see Dr. Mabrie for a consult with specific goals in mind. 1. Narrow the nasal bridge. 2. Make the tip less round. 3...

Case 169

  Achieve similar results non-surgically! Check out this case: Non-Surgical Rhinoplasty Background: This 24 year old African American woman consulted with Dr. Mabrie about Rhinoplasty in San Francisco to improve the appearance of her nose. She explained that she would like the bridge thinner and tip more detained to match her face. Dr. Mabrie's Assessment: "The nose actually has a ni...

Case 120

Background: This 21 year old Tourism student is of Spanish and Italian ethnic background. She had a history of trauma a few years ago during a water polo incident.  Her concerns were to: 1. Primarily reduce the bump in her nasal dorsum, 2. Resolve her difficulty in breathing, 3. To smooth the lines in her nose, and 4. To maintain the look and character of her nose. Dr Mabrie&...

See All Before & After Photos
See All Before & After Photos

Skin Incisions in Rhinoplasty

To access the nasal bones and cartilages, incisions are made inside the nose. Sometimes incisions are made through the skin on the structure called the collumella, the thin portion of the nose between the nostrils, in the center of the nose, just above the lips. The incision is carefully made in a zig-zag fashion to help camouflage it when it heals. The scar from this incision may be slightly dark temporarily, but in most cases is eventually imperceptible.

Skin Incisions in Rhinoplasty

The blue line shows where the skin incision is typically made. After a few weeks, the incision usually starts to fade. After a few months, the incision is almost inperceptible.

Straightening the Nasal Bone on Frontal View

The type of modification needed depends on the location of the desired change. For deviations or wideness close to the face, the nasal bones must be moved. Controlled precise breaks are created in the nasal bones, which are then repositioned and secured in place usually with a nasal splint worn about one week after surgery.

Reducing Dorsal Convexity (Nasal Hump)

A frequent request of patients is to improve the nasal profile by modifying the bridge (dorsum) of the nose. Many patients of Mediterranean heritage are interested in reducing the hump.

The bridge of the nose is made of both bone and cartilage. To reduce the hump, incisions are made inside the nose. If necessary, pinpoint pricks are made in the skin the help cut the bone. A portion of the bone is then either removed or chiseled. The cartilage is carefully removed, taking care not to over reduce the profile.

Dorsal Augmentation

While San Francisco plastic surgery patients frequently want to reduce the nasal dorsum, there are incidences when there is a need to augment the dorsum. If the dorsum is underdeveloped, the nose may not seem strong enough on profile view. Many African-American and Asian-American patients share an interest in dorsal augmentation, as can be seen in our Balancing Ethnic Features page.

Materials For Augmenting the Profile

There are several materials used to augment a patient's profile, depending on the amount of augmentation needed and patient and surgeon preference. The patient's own cartilage or bone, harvested from the nose, ear or skull may be used. Cadaveric cartilage may be used. Several synthetic, medical grade materials are created for this purpose. Dr. Mabrie prefers to use goretex for augmenting the dorsum.

How Dorsal Augmentation Is Done

If the patient only needs augmentation of the dorsum, and no changes in the tip, the procedure may be done in less than an hour with internal incisions. The implant is trimmed to size and fits snugly under the skin. The risk of infection or mobility is extremely low because of the shape and characteristics of the goretex implant. Goretex is extremely well tolerated by the body and used frequently in heart surgery.

Images from a dorsal augmentation procedure. The implant is modified to fit under the skin and fill in the concave area.

Dr. Mabrie usually performs dorsal augmentation with patients under general anesthesia, although the procedure may be done with only IV sedation. Recovery from dorsal augmentation is rapid, with patients normally feeling comfortable in the public eye within 2-4 days. If there is no work to be done on the nasal tip, all incisions are inside the nose and there is no need for suture removal.

Lifting a Drooping Tip

Many San Francisco nose surgery patients interested in rhinoplasty want to improve their profile view by lifting a drooping nasal tip. When viewed from the side, the ideal angle between the nose and upper lip is about 90 degrees in men (pointing straight ahead.) In women the ideal angle is 110 degrees (pointing slightly upward). A droopy tip may be lifted during rhinoplasty by modifying the nasal cartilages. The cartilage may be sewn together or some of the patient's own cartilage may be used to refine their appearance from a profile view.

Nostril Flare Reduction

This is an in-office procedure that requires local anesthesia only. The procedure will take about half an hour, and you can expect to be "restaurant ready" in 7 to 10 days.

Non-Surgical Rhinoplasty

Non-surgical dermal fillers such as Restylane®, RADIESSE® and JUVÉDERM® Injectable Gel have become increasingly popular for a non-surgical nose job since they allow you to attain your desired changes in less than one hour, without the post procedure down-time necessary from a surgical procedure.

Rhinoplasty with Chin Augmentation

Many patients who request rhinoplasty surgery in San Francisco would also benefit from chin augmentation surgery. Both the nose and chin have a large affect on the appearance of your facial profile. In addition to the sizes of the nose and chin, the relative proportions of the structures to each other is very important. If the chin is proportionately underdeveloped in relation to the rest of the face, it can make a slightly large nose look even bigger. Dr. Mabrie frequently performs chin augmentation and rhinoplasty together. Chin augmentation is a relatively straight-forward procedure and only adds about an hour to the length of the case.

San Francisco Facial Plastic Surgeon David C. Mabrie M.D., F.A.C.S.

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The Surgeon

Dr. David Mabrie offers:

  • Double board certification
  • Excellent training & experience
  • Specialization in the face and neck
  • A trainer's skill in injectable filler techniques
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Mabrie Facial Cosmetic: David C. Mabrie, MD
166 Geary Street
13th Floor

San Francisco, CA 94108
Phone: (415) 445-9513
Monday–Friday 8:30 a.m.–6 p.m.