Rhinoplasty

Although the nose is situated at the center of the face, an attractive nose is not one that draws attention to itself. Rather, the viewer’s attention should always be drawn to the most attractive facial feature: the eyes. A nose may be considered unattractive when it becomes the focus of attention and detracts from other pleasant features. To achieve the best rhinoplasty—or best nose job—results, Montreal, Quebec, surgeon Dr. Mark Samaha reshapes the nose by modifying or softening its appearance to bring it into harmony with the remaining facial features.

Choose a Rhinoplasty Specialist

Rhinoplasty is arguably the most complex and technically challenging aesthetic surgical procedure. It requires intimate knowledge of not only external aesthetics but also the internal anatomy of the nose. The surgeon is required to execute the necessary refinements while predicting the healing process and how the final outcome will materialize several months later. Every rhinoplasty procedure demands that the entirety of the surgeon’s technical skills, knowledge, and experience be applied in order to achieve a pleasing, natural-looking, and long-lasting result. Therefore, it’s important to choose your rhinoplasty surgeon carefully to obtain the best results.

Dr. Samaha, a rhinoplasty surgeon in Montreal, specializes in Otolaryngology – Head and Neck surgery. His expertise in facial plastic surgery and his extensive experience in all types of nasal surgery – functional, aesthetic, and reconstructive – makes rhinoplasty a procedure of particular interest to him. He is considered an expert in rhinoplasty, having performed more than 2500  aesthetic rhinoplasties and 3000 nasal surgeries for breathing and functional problems.

Dr. Samaha teaches rhinoplasty all over the world at courses, conferences, and surgical missions aimed at teaching other doctors.

Dr. Samaha teaching rhinoplasty at a course he gives on facial plastic surgery.

Most patients consulting Dr. Samaha for rhinoplasty surgery are referred by friends or family members who have had surgery, or other plastic surgeons who feel that the patient’s case is very complex, requiring more advanced techniques. He is considered by many to be among the most experienced rhinoplasty surgeons in Montreal, having performed over 2500 rhinoplasty procedures.

Dr. Mark Samaha

Meet Dr. Mark Samaha

A double board-certified otolaryngologist whose practice focuses exclusively on facial plastic surgery, Dr. Samaha is highly qualified in facial aesthetics. Learn more about our physician and how he's carefully refined his skills to sculpt your beautiful face.

Meet Dr. Samaha Doctor credentials

Anatomy of the Nose

The nose is composed of many different components that fit together to give it its shape. It is bone in its upper 1/3 and cartilage in the bottom 2/3. There are several different cartilages that give shape to the nose, particularly the tip. Finally, there is a septum, which is a wall composed of bone and cartilage that divides the nose into left and right. When deviated, this septum can cause breathing difficulty or an esthetic issue with a deviated nose.

The anatomy of the nose is complex, and each component is important to the final outcome of surgery. This is one of the reasons that rhinoplasty is a complex procedure that requires much expertise.

The nose is not only an esthetic structure in the face, as it also performs a function: breathing. In this way, it is different than other areas of the face or body where esthetic surgery is performed. The surgeon needs to possess expertise not only in fashioning and sculpting the esthetics of the nose, but also in maintaining or occasionally repairing the nose’s breathing ability.

The bone and cartilage skeleton of the nose is covered by thin layers of muscle and skin. This envelope, often overlooked by novice surgeons, is very important to the appearance of the nose and plays an important role in the planning and outcome of surgery. For example, patients with thin skin will require different planning and consideration than patients with thicker skin. The expected result is also different for patients of different skin types and thicknesses.

A picture containing map, text, drawingDescription automatically generated

Side view of the structure of the nose.

A picture containing drawingDescription automatically generated

Front view of the structure of the nose.

Is Surgical or Non-Surgical Rhinoplasty Right for Me?

Rhinoplasty surgery may not be an option for some patients. They may not be ready emotionally, they may not be ready financially, or they may not be a good candidate for surgery. In such instances, another option is available: non-surgical rhinoplasty.

What is Non-Surgical Rhinoplasty?

Non-surgical rhinoplasty is modifying the shape of the nose using dermal fillers (Restylane, Juvéderm, and others), without surgery. This treatment option is performed in the office by Dr. Samaha and is similar to other injectable treatments.

How Is Non-Surgical Rhinoplasty Performed?

It is a simple procedure. The skin of the nose is cleaned and disinfected. Dr. Samaha injects dermal fillers into key areas of the nose to achieve the desired. He fills in hollows and balances asymmetries to change the appearance of the nose. The process takes 5-10 minutes. A follow-up appointment is usually scheduled, and any necessary touch-ups are performed at that time.

Candidates for Non-Surgical Rhinoplasty  

Patients who do not wish to have surgery due to budgetary concerns may opt for a non-surgical rhinoplasty. Other candidates include patients who have had rhinoplasty surgery with a poor result and do not wish to undergo another surgery. A non-surgical rhinoplasty can address their concerns without additional surgery.

Some patients who are not candidates for surgery due to a medical condition may also benefit from non-surgical rhinoplasty.

Advantages of Non-Surgical Rhinoplasty

  • It provides an option for patients who do not wish to have surgery or who are thinking about surgery but have not yet reached a decision.
  • Since the dermal fillers used are not permanent, non-surgical rhinoplasty provides the patient with an opportunity to have a preview of the result and get used to it before committing to surgery. For patients who wish to have surgery but feel unsure or concerned about the result, this is a great option. If the patient is not satisfied with the result the product can either be dissolved (this is very rare) or left to disappear on its own within a year or so, at which time the nose will revert to its original shape.
  • Touch-ups are easy and consist of adding a small amount of dermal filler to certain areas of the nose. The result can therefore be easily adjusted until the desired result is achieved.
  • The cost of non-surgical rhinoplasty is, of course, much less than rhinoplasty surgery.

How Long Does Non-Surgical Rhinoplasty Last?

Depending on the dermal filler used, the injection technique, and the individual variation among different people, the result can last 12-18 months.

Limitations of Non-Surgical Rhinoplasty

  • The main limitation of non-surgical rhinoplasty is that it is not permanent. Of course, that is an advantage as well for certain patients who are uncertain, since it does not commit the patient to a permanent result.
  • Although most imperfections can be camouflaged and corrected, a few cannot. For example, flared nostrils cannot be improved with non-surgical rhinoplasty and will require surgery for correction.

Open Rhinoplasty

In the open approach, incisions are made on the skin of the columella (the partition between the nostrils) and inside the nose. The skin is then peeled off the nasal cartilage, the structure of the nose is modified, the skin is replaced, and the incision is finally sutured to leave a small scar.

Closed Rhinoplasty

The closed approach, also known as an “endonasal” approach, means that the necessary changes are performed by placing small incisions inside the nose only, without an external scar. The changes to the nasal cartilages and bones are then made by inserting the instruments in a way that Dr. Samaha compares to a “mouse under the rug.”

Dr. Samaha performing a closed rhinoplasty in the operating room with his team.

Dr. Samaha performing a closed rhinoplasty in the operating room with his team.

Open Rhinoplasty vs. Closed

Dr. Samaha favors the closed approach because the surgery itself is shorter and both swelling and bruising are usually minimal after surgery as compared with the open approach. He has honed his expertise thanks to extensive experience and is, therefore, able to effect the necessary changes to achieve his patients’ goals using this less invasive approach.

Revision Rhinoplasty

When a rhinoplasty is not successful and does not meet the patient’s expectations, revision rhinoplasty is an option. The goal of the procedure is to correct the esthetic imperfections and possible breathing issues that resulted from the previous procedure.

Revision rhinoplasty is quite different than primary (first time) rhinoplasty because of the changes that have previously been done on the nose and the scarring from the previous rhinoplasty procedures. In addition, the patient who has now been disappointed by the unsuccessful procedure is understandably more concerned about the success of the revision surgery.

Revision rhinoplasty therefore requires a higher level of expertise and lots of experience performing nasal surgery. Advanced techniques need to be used to perform the necessary corrections. In addition, the surgeon needs to have experience in correcting breathing difficulties as these frequently need to be addressed in revision rhinoplasty.

In skillful and experienced hands, revision rhinoplasty can be very successful, yielding excellent results and relieving the patient of the complex of having a poor result. Dr. Samaha’s vast experience and specialized expertise in rhinoplasty allows him to perform revision rhinoplasty with reliable results. It is very gratifying for him to help his patients recover their natural appearance and their confidence and self-esteem.

Rhinoplasty Without Nasal Packing

Upon leaving, patients do not have any “packing” or gauze in the nose. Instead, Dr. Samaha places a small piece of cotton dressing the size of a fingernail on either side at the tip of the nose, to be removed that evening or the next morning by the patient or a family member.

This absence of nasal packing makes a significant difference in the rhinoplasty recovery process. When patients report pain, pressure, headaches, and discomfort after traditional rhinoplasty surgery, it is usually related to the presence of the packing, not the surgery itself. In addition,

removing this packing a few days after surgery is reported as extremely unpleasant and painful by patients who have had the misfortune of being subjected to this experience. Therefore, the absence of packing after surgery makes the recovery much more easily tolerated and, for the large majority of his patients, painless.

There is a plastic splint dressing on the outside of the nose to minimize swelling and support the nose, allowing it to heal in the desired shape.

How Long Is the Recovery From a Nose Job?

Recovery time is usually about 7 to 10 days. The plastic splint is removed at the first postoperative visit, 1 week after surgery, after which patients are usually comfortable returning to work. The appearance of the nose at this point is not the final result. Nevertheless, the patient can expect their nose to look better than it did before the surgery.

The short recovery period of 7 days is the result Dr. Samaha’s Maximum Result Minimum Recovery™ approach. This approach consists of several measures and techniques, developed by Dr. Samaha over 20 years of research and experience, to minimize swelling and bruising and allow patients to return to daily activities sooner. These include the use of a minimally invasive anesthesia, a closed rhinoplasty technique with minimal tissue trauma and inflammation, and no scarring, and a very specific sequence and timing of the steps during the surgery. Indeed, the order in which Dr. Samaha works on the tip, bridge, nostrils, and other parts of the nose makes a significant difference in the comfort of the patient during the surgery while also shortening the recovery period. Learn more about Dr. Samaha’s Maximum Result Minimum Recovery™.

The swelling from the surgery will gradually decrease over the next few months to reveal fine details and refinements achieved by the rhinoplasty procedure. An appointment is scheduled 6 months after surgery, and at this time the long-term result is assessed, and photos are taken. However, the nose continues to heal and “settle” for about 18 months before the result is final, though this may vary depending on skin type and thickness.

MAXIMUM RESULT MINIMUM RECOVERY™

Dr. Samaha has developed techniques and methods to minimize swelling and bruising after surgery for his patients to shorten their recovery. This has culminated in his Maximum Result Minimum Recovery system.

Learn More

How Much Does Rhinoplasty Cost in Montreal?

The cost of rhinoplasty depends on several factors.

  • Complexity. The procedure can vary widely from the simple removal of a hump to a complicated revision rhinoplasty requiring reconstruction and repair. The more complicated the surgery the more the procedure is likely to cost.
  • The patient’s anatomy. Some anatomic features (crooked nose, thin skin, etc.) require more work and time to correct. This will be reflected in the cost.
  • The surgeon’s expertise and experience. A surgeon who performs only a few rhinoplasties a month and who doesn’t specialize in facial procedures may charge less than a surgeon who is a true expert in nasal or facial surgery and performs significantly more rhinoplasties every month.

Surgery is a significant expense and finances are a major consideration for most people. It is therefore understandable that many patients consider cost as a major factor in their decision about surgery.

However, surgery on the face – or any surgery – is not the time for bargain hunting, and it is very risky to select a surgeon or clinic based on cost. One question to ask one’s self: “Do I want the cheapest I can get for my face?”

Making the best choice should depend on which surgeon understands the patient’s wishes, shares the same vision, and will be able to safely achieve the desired result. If the patient cannot afford this surgeon’s fees, it is best to wait until such a time as her/his finances permit, rather than choosing a surgeon who is not a good fit for the patient, but who has lower fees.

Over the years, Dr. Samaha has seen many patients who consulted him for revision rhinoplasty after a disappointing result of a previous “bargain” rhinoplasty. Of course, any savings on the initial rhinoplasty, even if they were significant, are now overshadowed by the remorse of a poor result. The patient is now faced with a fee for a revision surgery, which is usually higher given the increased complexity of such a procedure. The end result is the remorse and disappointment of having gone through an unsuccessful surgery, having to undergo two surgeries, and paying twice.

As with any surgery, especially rhinoplasty, the first time is the best opportunity to “get it right”. Price shopping to select a surgeon or clinic based on cost alone is therefore very risky.

Am I a Good Candidate for Rhinoplasty?

Most patients with concerns about their nasal appearance are good candidates for rhinoplasty and would benefit from obtaining a great improvement from surgery. The elements that make a good candidate for rhinoplasty are:

  • An obvious esthetic imperfection that is amenable to correction. The more obvious the imperfection, the more significant will the improvement be, and the more satisfied the patient is likely to be.
  • Having realistic expectations. It is important for the surgeon to inform and show the patient what can be done with rhinoplasty and to help the patient visualize the potential final result. Having realistic expectations will lead to higher satisfaction after surgery. Similarly, having unrealistic expectations of a perfect nose or a certain celebrity’s nose will often lead to disappointment.
  • Understanding the goal of surgery. The goal of rhinoplasty or any esthetic surgery should be to enhance one’s self-confidence and self-esteem. If the goal is to impress or please someone else or undergo surgery in response to criticism by others, surgery is unlikely to lead to a positive outcome.
  • Carefully considering one’s decision. Generally, patients who have thought about surgery for some time have had time to identify which areas they wish to improve and define their goals. Time also helps the decision to “mature” in one’s mind. This usually leads to higher satisfaction after surgery. In contrast, making an impulsive decision about surgery is often met with regret after it is all done.
  • Good physical health. Of course, being healthy and physically fit for surgery is essential.

Combining Rhinoplasty With Other Surgeries

In addition to a rhinoplasty surgery, reshaping the chin (with a chin implant) can provide additional improvement to the overall facial aesthetics for some patients. This is particularly true of the profile in certain patients where a slight augmentation of the chin will harmonize the alignment and provide a significantly more balanced facial profile.

Buccal fat removal, a procedure which creates better definition in the cheeks for patients with full or heavy cheeks, has become increasingly popular and is frequently requested in conjunction with rhinoplasty. It complements rhinoplasty in helping better define and sculpt the cheeks to enhance the middle part of the face and further enhance the new nose.

Newsletter Sign-Up

Call our friendly staff now for expert help.

Call our friendly staff now for expert help.

Caring team members are here to take your call from 8 a.m. to 5 p.m.

CALL: (514) 731-2525

Frequently Asked Questions

Is rhinoplasty painful?

The overwhelming majority of our patients report no pain after surgery. Pain medication is prescribed to use as needed after surgery. However, our patients do not usually take it. The main reason is that Dr. Samaha does not place any packing after surgery, as mentioned earlier. Other reasons have to do with the surgical techniques used, and anti-inflammatory medications Dr. Samaha prescribes.

What are the activity restrictions after rhinoplasty?

The main restriction is the avoidance of strenuous activity, which includes vigorous exercise and heavy lifting, for 1 week. Other actions that increase the pressure in the nose are also to be avoided. These include nose-blowing and bending forward. Otherwise, patients may carry out usual activities.

How long does the bruising last after rhinoplasty?

Most of Dr. Samaha’s rhinoplasty patients experience minimal bruising that is usually 90% resolved by the first follow-up visit at 1 week. Most rhinoplasty surgeries are associated with some bruising under the eyes. This does not apply to patients who are having only modifications to the tip of the nose. The degree of bruising depends upon surgical technique and the patient’s own tendency to bruise. Dr. Samaha uses advanced, minimally invasive techniques to minimize bruising and swelling after surgery. Patients who have a natural tendency to bruise easily will experience slightly more bruising under the eyes after rhinoplasty surgery.

Does Dr. Samaha use nasal implants in rhinoplasty surgery?

Although foreign materials are routinely used in surgery for various parts of the body, the implantation of foreign material in the nose is associated with an increased risk of infection, rejection of the material, and scarring, even several years after surgery. For this reason, Dr. Samaha strictly avoids use of any foreign materials in the nose. Occasionally, adding tissue to support certain areas of the nose or modify its appearance is required. In these instances, Dr. Samaha will use some of the patient’s own tissue, which is very safe.

Would you like to learn more about rhinoplasty and how it can help you? Request your consultation with Dr. Samaha online, or call us at (514) 731-2525 to make your appointment.

Back to Top