Rhinoplasty is the science & art of Aesthetic Nasal Surgery, which remains the most popular cosmetic surgery across all cultures, races, sexes and ages.  The history of nasal surgery dates back thousands of years to ancient India where the skillful and compassionate surgeon, Sushruta, devised “cutting edge techniques” using forehead tissue as a “flap” to reconstruct women’s noses that had been cut off as a sign and punishment for adultery! We have fortunately come a long way since those cruel and inhumane times.  However some of the techniques used and described by those pioneering ancient reconstructive surgeons are still valid and used today for reconstruction of the nose after trauma, cancer or dog bite injuries.  In fact slight modifications of these ancient techniques gave rise to the Para-median Forehead Flap, which is the cornerstone of all significant nasal reconstruction.

The history of Plastic Surgery and its milestones are tightly interwoven with the history and progress in Rhinoplasty.  In the 16th century, the Italian surgeon, Gasparo Tagliacozzi, who is considered by most as one of the forefathers of Plastic Surgery, devised a clever “flap” using skin from the arm of a patient to reconstruct the nose by attaching the arm to the nose for a period of time until the arm skin developed its own blood supply from the nose.  Although by today’s standards, such a procedure seems gross and primitive, this concept of a “distal flap” is one of the cornerstones of modern reconstructive techniques for very large total nasal defects using methods such as a “Radial Forearm Flap.”

The father of modern Plastic Surgery, John Orlando Roe, who was an Otolaryngologist (ENT) from Rochester, New York, is accurately given credit for performing the first endonasal or “closed” Rhinoplasty and for being the father of aesthetic Rhinoplasty.  Later on Jacques Joseph, from Berlin, used this technique to help a young man who was so embarrassed by his overly large nose that he had avoided appearing in public. 

During the “taboo period” of plastic surgery when the field was seen as superfluous and was not taken seriously by most surgeons, cosmetic surgery and Rhinoplasty where merely available to the select few of wealth and advantage.  However, today more than ever before in history, cosmetic surgery is in the spotlight.  It has gained wide acceptance as a valid field of medicine and the rewards of self-improvement, and increased self-confidence, and wellbeing are available for the first time to the general public. 

This new “birth” of cosmetic surgery has also resulted in a “flooding” of the market by devices, procedures, and promises that are not always grounded in science and medicine but more so in “marketing” and “hype.”  Plastic Surgery is being “sold” today in an alarming rate to the public, in the media and in cosmetic surgeons’ offices. 

Fortunately, the field of Rhinoplasty and aesthetic surgery of the nose has by enlarge been shielded from such hype and exposure;  (with the few exceptions of the doctors offering “no-downtime-rhinoplasty” by injecting fillers like Radiesse into the nasal bridge in order to create a straighter profile).  Overall, Rhinoplasty has evolved properly and stepwise over the last several hundred years into the safe, effective and impressive surgery that it is today when performed by the true “Rhinoplastic surgeon.”

Rhinoplasty is widely considered by all kinds of surgeons to be the most difficult of all surgeries.   Hence, the Rhinoplastic Surgeon is considered to be the most meticulous, skilled and exquisite of all plastic surgeons. Aesthetic surgery of the nose is a three dimensional operation of millimeters.  The successful Rhinoplasty requires skill, artistry and a complete understand of the nose, its architecture, as well as its functional physiology.

Facial Plastic Surgeons who by training are specialists of the nose are inherently better equipped to deal with these issues.  The five to six years of surgical training focusing specifically on the face and nose results in unparalleled skill and expertise. 

Dr. Naderi, belongs to an even more sought after and specialized group of Facial Plastic Surgeons with specific training and expertise in Revision Rhinoplasty or Secondary Rhinoplasty.  Dr. Naderi spends a large portion of his time correcting the work done by other plastic surgeons.  Some of his patients may have had 2 to 6 unsatisfactory surgeries before being referred to him for help.  He has authored chapters on this topic in major medical text books used by other surgeons around the world. Dr. Naderi has held a position at Indiana University School of Medicine as a Clinical Assistant Professor of Facial Plastic Surgery where he has taught many surgical residents the proper techniques of Rhinoplasty for both aesthetic and functional purposes.   Furthermore, Virginia Plastic Surgeons quite often refer their “tough noses” to Dr. Naderi, favoring his expertise and skills.  

As the centerpiece of the face, the nose can draw significant attention to itself.  Given all the intricacies of Rhinoplasty and Revision Rhinoplasty and the skill and experience required, you can rest assured with Dr. Naderi’s unrivalled expertise in the greater Washington D.C. and Northern Virginia area. 

Dr. Naderi takes the time to go over all of your options with the aid of the cutting edge “digital computer imaging” to show you what you may look like after surgery.  He confidently encourages all his patients to seek several other surgeon’s opinions so they can feel totally comfortable with their ultimate decision to undergo Rhinoplasty or Revision Rhinoplasty as well as with their choice of surgeon.

before		after

Your Rhinoplasty experience from A-Z

Q) What is Rhinoplasty?
A) Rhinoplasty is the Aesthetic or Cosmetic Surgery of the nose

Q) Who is a good candidate for Rhinoplasty?
A) Anyone over 16 years of age who is in good medical health and able to undergo surgery and anesthesia.  The ideal patient will have a good realistic expectation regarding the benefits and limitations of Rhinoplasty.

Q) What does the patient need to do prior to the initial consultation?
A) Dr. Naderi encourages his patients to seek several other consultations so they can have a better idea of the different recommendations as well as to be able to gather a list of appropriate questions to ask him during their consultation.  This way, each patient gets the most out of their meeting with Dr. Naderi.

Q) Is it absolutely necessary to have seen other plastic surgeons prior to the consultation with Dr. Naderi?
A) No.  You can meet with Dr. Naderi and then if you so choose, you can return for a 2nd or even a 3rd consultation.  Dr. Naderi takes as much time as necessary, each and every consultation in order to make sure all of his patient’s questions are answered with absolutely no pressure or “sales pitch!”

Q) What are the costs of the consultation?
A) Every cosmetic Rhinoplasty consultation is complimentary (free).  If there is a functional issue such as breathing difficulties, and you decide to use your insurance company for coverage of the “functional” portion of the surgery then your insurance will have to be billed for the initial consultation.  Some patients choose to not use their insurance even for the “functional” portion of the surgery such as the septoplasty and in these cases the entire consultation is again complimentary.

Q) How much time do I need for the initial consultation?
A) We would like you to arrive 15 minutes early to fill out HIPPA compliant medical information paperwork.  After that, you may spend 45 minutes to an hour or more with the doctor until all of your questions have been answered.

Q) Can I see before and after pictures?
A) Absolutely.  Dr. Naderi will show you lots of his “before and after” patient photographs

Q) Do you “morph” or “image” my own picture to show me what I may look like after Rhinoplasty?
A) Definitely.  Digital morphing or imaging is an integral part of your consultation.  Dr. Naderi uses the cutting edge United Imaging Marketwise software.  It is very important for you to be able to visualize yourself with your new changes and be able to make comments or voice your concerns BEFORE undergoing surgery.

Q) How much does Rhinoplasty cost?
A) It depends.  Dr. Naderi will see and examine you and give you a printed quote, which we will honor for up to 4 months.   The cost varies depending on your anatomy and the extent of work necessary.  Just like one nose does not fit all, so to one price does not apply to everyone.  Dr. Naderi will tailor a specific operation for your individual needs.  As a general rule, his costs are somewhat higher than other plastic surgeons in the area due to his level of expertise and focus on Rhinoplasty.  

Q) Are there financing options?
A) Yes.  After receiving your quote, we will go over all of your choices with you and guide you through the financing process for cosmetic surgery if you choose this option.

Q) Do I need labs or tests prior to surgery?
A) Dr. Naderi is first and foremost a physician and then an artist and surgeon so he is very conservative in his approach to patient care.  After thoroughly reviewing your medical history, he will check a quick lab test to make sure you do not have any bleeding tendencies.  Select patients will also need a recent EKG.  Occasionally, we may ask for a brief letter from your primary care doctor confirming your “clearance” for surgery.

Q) Where will the operation be performed?
A) Dr. Naderi has privileges at the top medical centers in Northern Virginia.  INOVA Fairfax Hospital, INOVA Fairoaks Hospital, INOVA Loudoun Hospital, INOVA Mt. Vernon Hospital, and INOVA ambulatory surgery center at Countryside are all top accredited facilities with Board Certified Anesthesiologists.  INOVA hospitals’ nursing staff were recently given the nations top honor – MAGNET AWARD.

Q) How long does the surgery take?
A) Depends on the extent of work necessary.  This may be from 30 minutes to 3 hours or more until the best possible result is achieved.  The ‘average case’ takes between 1 ½  to 2 hours total.

Q) What do I have to do before surgery?
A) Homework!  Make sure this is what you want to do and Dr. Naderi is the Rhinoplastic Surgeon who you want to trust yourself to.  Once you are sure of these choices then relax and we will take you through step by step.

Q) Does Dr. Naderi use Open or Closed Rhinoplasty technique?
A) Dr. Naderi is a true Rhinoplastic Surgeon and therefore he is highly experienced in all techniques of Rhinoplasty.  He utilizes the External approach also known as the “open” approach when intricate and detailed “tip grafts” are needed.  Dr. Naderi uses the Endonasal or “closed” approach on about 70% of his patients and he is able to achieve excellent results without the extra edema, numbness and healing time that the external or “open” approach necessitates.   Each patient’s nose if different and hence an individual plan will be tailored to best suit each patient’s needs.

Q) What is the difference between the open (external) and closed (endonasal) approaches?
A) The majority of incisions are inside the nose and hidden.  With an external approach, a very small incision is made on the columella (the skin dividing each nostril on the base).  This allows excellent exposure of the tip for intricate tip grafting.  When closed meticulously, this incision heals with no grossly visible scar. 
Some plastic surgeons are only trained in this technique and “open” all of their noses.  Dr. Naderi believes that minimal changes dictate minimal dissection and therefore the endonasal approach is a fantastic technique and a fading art  amongst plastic surgeons when only moderate modifications are needed.

Q) Is Rhinoplasty painful?
A) Rhinoplasty is surprisingly not very painful at all.  You will have some throbbing of your nose the first night but 95 out of 100 patients do not take any narcotic pain medicine beyond the first night.

Q) What happens after surgery?
A) Most patients go home the same day.  Dr. Naderi insists on seeing all of his patients the next day in the office to make sure they are clear on post-op care.  Post op care is very simple and entails cleaning the nostrils with hydrogen peroxide soaks Q-tips followed by application of antibiotic ointment to the nostrils with a Q-tip.  Ice-cold wash-cloths  to the upper face are encouraged for the first 48 hours and help minimize bruising and swelling.   You will be seen back on post-op day 3 – 5 if an open approach was taken to remove the very fine sutures under the nose.  If a closed approach was taken then this appointment is not necessary.  Then on post-op day 7 the small external splint will be removed and you will be able to see the initial results.

Q) Does my nose get “packed?”
A) Packing can be uncomfortable and hence Dr. Naderi avoids packing the nose unless absolutely necessary. 

Q) Do I have any limitations before &/or after surgery?
A) We do not want you to take Aspirin, Blood Thinners, Herbal supplements such as Fish oil, Flaxid oil, high dose Vitamin E and some other medications which can increase your chance of bleeding.  You will be given a complete list of these medications as well as thorough pre and post op instructions several weeks prior to your surgery. 
You will have to refrain from heavy exercise or lifting for about 2 weeks.  You will have to avoid wearing heavy glasses on your nose for up to 3 weeks.  There are special clips that allow you to wear glasses without pressure on your nose. 

Q) How much bruising and swelling can I expect afterwards?
A) Each person reacts differently.  Some will have hardly any bruising or swelling and some will have a significant amount.  Following Dr. Naderi’s instructions and advice will ensure your best possible outcome.

Q) Do I have to wait a whole year to see my results?
A) No!  You will start to enjoy your new nose from the moment the splint is removed.  You will have swelling and tightness which will improve day by day.  After the bruising has cleared, most people will not be able to tell you have had surgery due to the beautiful yet natural results Dr. Naderi is able to achieve.  However, with time, as the edema resolves, you will see your nose come into its own and you will like your nose more and more everyday.  This healing process typically takes a year to complete but 70-90% of the healing takes place in the first 3 months.  Also “closed techniques” allow quicker healing times and less edema.

Q) What if after a year has gone by I would like slight changes to my nose?
A) Dr. Naderi wants all of his patients to be completely satisfies and happy.  If during the healing process, certain little irregularities have arisen, then he will address these though a minor revision free of surgeon’s charge.  He stands by his work and his patients.  Anesthesia and Hospital fees would have to be covered by the patient.   These situations are rare and you and your loved ones can rest assured that he will see you back frequently until everything has healed and you are completely satisfied with your nose.

Q) What do I do if I am from out of town?
A) Dr. Naderi has patients who come to him from all over the world.  Our office staff will coordinate things for you and make sure your experience is as stress free and enjoyable as possible. 

Q) What is the “down time?”
A) Many people go back to work or school 2 or 3 days later while still having their small splint on the nose.  However most patient who do not wish to draw attention to themselves will take one week to recover and will take this time off from work until their splint is removed on post-op day #7.  After that, women can use makeup to camouflage any remaining bruises and will return to their work or school.  Men usually come up with an ingenious excuse for the bruises and return to work or school confidently.  However, Dr. Naderi wants you to refrain from heavy activity for 2-3 weeks.

Q) Any words of wisdom?
A) Yes.  Although deciding to undergo Rhinoplasty and choosing your Facial Plastic Surgeon can be stressful, we want you to do your homework, relax and enjoy the process.  Not everyone has the luxury of undergoing elective cosmetic surgery so you should enjoy the process as much as possible and let us guide you step by step.