Last updated: 2026-09-02 # Rhinoplasty in Brazil for U.S. Patients [Home](https://www.walterzamarianjr.com/us/) » [Face](https://www.walterzamarianjr.com/us/face/) » Rhinoplasty By [Dr. Walter Zamarian Jr.](https://www.walterzamarianjr.com/us/walter-zamarian/) · Updated: 09/02/2026 **Author and medical reviewer:** [Dr. Walter Zamarian Jr.](https://www.walterzamarianjr.com/us/walter-zamarian/) — Plastic Surgeon **CRM-PR 17.388** · **RQE 15.688** Full Member of the [SBCP](https://sbcp.org.br), [ASPS](https://www.plasticsurgery.org), [AExPI](https://www.aexpi.com.br). Training: [Ivo Pitanguy Institute](https://www.walterzamarianjr.com/us/walter-zamarian/training-mentors/) (Santa Casa do Rio de Janeiro). Operates at: [Hospital do Coração — Unidade Bela Suíça](https://www.walterzamarianjr.com/us/clinic/), Londrina-PR, Brazil. Last medical review: April 21, 2026 **Current practice:** I no longer perform rhinoplasty. This page remains available for educational purposes and does not offer a rhinoplasty consultation or procedure at my practice. Descriptions of my rhinoplasty techniques, protocols and patient outcomes below refer to my former practice. They are retained as historical educational material, not as an offer of surgery or a guarantee of future results. At a glance * **What it is:** structured rhinoplasty — an open technique that rebuilds the nasal architecture with autologous cartilage grafts (septum or rib) rather than just removing tissue, preserving aesthetics and respiratory function * **Techniques used:** spreader grafts, septal extension graft, columellar strut, ultrasonic micro-osteotomies when indicated * **Also treats:** deviated septum, hypertrophied turbinates, and nasal valves in the same surgical time (functional rhinoseptoplasty) * **Surgery duration:** 3 to 5 hours under general anesthesia, with hospital admission * **Recovery:** nasal packing removed in 24-48h · splint removed in 7-14 days · social return in 10-14 days · final result in 12 months (residual tip swelling takes the full year) * **Durability:** structural support is designed for long-term stability, but each result depends on anatomy, healing, skin thickness, postoperative care and whether the case is primary or revision * **Indicated for:** prominent dorsum, drooping tip, crooked nose, asymmetries, trauma sequelae, symptomatic septal deviation, ethnic correction * **Availability:** Dr. Walter Zamarian Jr. no longer performs rhinoplasty; this summary is educational * **Historical surgical setting:** Hospital do Coracao — Unidade Bela Suica, Londrina-PR, Brazil * **Author:** Dr. Walter Zamarian Jr. (CRM-PR 17.388 · RQE 15.688), trained at the Ivo Pitanguy Institute, advanced training with Dean Toriumi (Chicago) and Ali Sajjadian (California) ## What is rhinoplasty? Rhinoplasty is the name given to **plastic surgery of the nose**. The goal is to improve nasal shape, nasal balance and, when indicated, nasal breathing. As a **rhinoplasty specialist in Brazil** with over twenty years of practice, I treated **rhinoplasty in Brazil** as both an aesthetic and functional operation, not as a simple change in appearance. **Structural Rhinoplasty in Brazil** — educational content by **Dr. Walter Zamarian Jr.**, who no longer performs rhinoplasty, in **Londrina, Paraná, Brazil**. This page is an educational resource for U.S. and international patients comparing **rhinoplasty Brazil**, **Brazil rhinoplasty**, **nose job Brazil** or **nose job in Brazil**. It explains structural rhinoplasty, breathing, recovery, risks, travel timing, cost factors and consultation. **CRM-PR 17,388 | RQE 15,688**. **What U.S. patients usually mean by “nose job in Brazil”:** they want to know whether Brazil is a reasonable destination, how to choose a qualified surgeon, how breathing is evaluated, what recovery requires, how much time to stay in Brazil and what cost factors change the final budget. Price matters, but it should not be separated from safety, hospital setting, postoperative follow-up and realistic expectations. **Rhinoplasty in Brazil** — educational content by **Dr. Walter Zamarian Jr.**, who no longer performs rhinoplasty, in **Londrina, Brazil**. Structural rhinoplasty specialist with training in the **USA** (Dr. Dean Toriumi, Dr. Ali Sajjadian). Open approach with **cartilage grafts** when indicated, planned for facial balance, airway assessment and long-term support. **+20 years of experience**, **+8,000 surgeries** (today, by deliberate choice, 3 facelifts per week, ~150 per year). Trained at **Ivo Pitanguy Clinic** (Rio de Janeiro). **CRM-PR 17,388 | RQE 15,688**. Structured rhinoplasty represents a paradigm shift from the old reductive technique that simply removed cartilage and bone to make the nose smaller. In my former rhinoplasty practice at my clinic in Londrina, Brazil, I reconstructed and reinforced the nasal framework using cartilage grafts harvested from the patient's own septum, ear or rib when indicated. These grafts serve as structural support points that can help keep the nose stable over the long term, reducing the late collapse and deformities associated with older methods. Over more than twenty years and eight thousand surgeries, I have seen how careful structural planning can support a natural-looking result, while still respecting the fact that every nose heals differently. My training at the Ivo Pitanguy Clinic in Rio de Janeiro, complemented by advanced rhinoplasty courses in the United States, gave me the technical foundation to offer nose surgery that is simultaneously aesthetic and functional. As a member of SBCP and ASPS, I continually refined my technique with evidence-based advances. The nose occupies the center of the face. It strongly influences facial balance and proportion. When its shape, size or function bothers a patient, that concern can affect confidence, photos and daily comfort. I received patients from Brazil and abroad seeking **nose surgery in Brazil** because they want an individualized assessment that considers both nasal appearance and breathing. When the indication is appropriate and expectations are realistic, improving nasal shape, proportion or function can be meaningful for the patient. This was one of the aspects that motivated me most when I performed rhinoplasty. **Nose plastic surgery** is challenging. Each patient has a different anatomy, and this requires specific planning for each case. There is no one-size-fits-all solution. That’s why I dedicated time in the consultation to understand exactly what needs to be done to your nose. In my former rhinoplasty practice in Londrina, Brazil, I performed **rhinoplasty** comprehensively: reshaping the dorsum, refining the tip, adjusting the nostrils, and when necessary, correcting septal deviation, turbinate hypertrophy, and problems with the internal and external nasal valves. In other words, I took care of both aesthetics and respiratory function in the same surgery. In my former rhinoplasty practice, international patients considering **medical tourism for rhinoplasty in Brazil** received care from the initial virtual consultation through postoperative follow-up. ### What is rhinoplasty for? I performed rhinoplasty to: * Reduce the nose; * Narrow the nose; * Refine the tip; * Lift the tip of the nose; * Straighten the nose; * Enlarge the nose; * Improve asymmetries of the nose; * Breathe better. ### Who should have rhinoplasty? Rhinoplasty should be performed in an accredited surgical facility by a professional with a deep understanding of nasal anatomy and physiology. I am a plastic surgeon and specialized in both the aesthetic and functional aspects of the nose. I underwent specific training in the United States to develop a comprehensive approach without needing to divide the surgery with another professional. When choosing your surgeon, check their qualifications, talk to previous patients, read testimonials, and watch videos about their work. In the consultation, ask any questions you may have. Try to understand their work philosophy and see if the results presented appeal to you. ## What no one tells you about rhinoplasty Here you will find everything about rhinoplasty, with details that I made a point to share, based on over twenty years of experience operating on noses. This is one of the most comprehensive pages in English on the subject. You will learn what you need to know to make your decision with confidence - and much more. If you prefer a summary, I have prepared a video about rhinoplasty right below. **Subscribe to my YouTube channel:** [Subscribe on YouTube](https://www.youtube.com/@drwalterzamarianjr?sub_confirmation=1) ### "I summarized this page for you in this YouTube video:" **Historical context:** Historical video recorded when I performed rhinoplasty. The original spoken words and transcript are retained for educational context; they do not describe my current service availability. ## Natural Rhinoplasty In my rhinoplasty practice, my greatest commitment was to a natural result. In rhinoplasty, the goal is not an operated-looking nose, but a nose that fits the face and preserves the patient's identity. This is the type of result I sought in every rhinoplasty I performed, within the limits of anatomy and healing. ## Specialized in Aesthetic and Functional Rhinoplasty I specialized in the United States with surgeons known internationally for aesthetic and functional rhinoplasty. I was not satisfied with analyzing only the external shape of the nose: breathing also matters. That’s why I assessed the four pillars of nasal breathing during rhinoplasty: septum, turbinates, internal nasal valve, and external nasal valve. ## The Functions of the Nose The nose is not just for appearance. It is responsible for breathing, humidifying and filtering the air, regulating temperature, and smell. All these functions need to be preserved during a rhinoplasty. That’s why I always took into account the septum, the turbinates, and the internal and external nasal valves - structures that directly influence airflow. ### Nasal Septum The nasal septum is a perpendicular structure, like a wall, composed of a cartilaginous part and a bony part (vomer and ethmoid bones). It divides the nose in half, into two nasal cavities. Air flows laminar from each side of the septum. Any deviation can alter this flow and cause enlargement of the turbinates. The recommended surgery to correct this is septoplasty. The good news is that I could combine septoplasty with rhinoplasty in the same surgery -- what we call septorhinoplasty. This way, I took care of both aesthetics and respiratory function at the same time. ### Turbinates The turbinates are curved bony plates, like a lateral elevation of each wall of the nasal cavity, covered with mucosa, that protrude from the inner face of the ethmoid and bulge outward from the nasal cavities. They play an important role in the respiratory system, the immune system, and the sense of smell in humans. There are two types of turbinates: the constant turbinates which include the inferior, middle, and superior turbinates, and the variable turbinates which include the Santorini turbinate and the Zuckerkandl turbinate. The inferior turbinate is the largest of the three, responsible for humidifying, temperature regulation, and filtering the air that enters through our nose. Additionally, the inferior turbinate has the greatest impact on resistance to airflow in the nose, potentially accounting for up to two-thirds of that resistance. The middle turbinate is the intermediate one, which protects the sinuses from direct contact with the airflow. Finally, the superior turbinate is a smaller structure, connected to the middle turbinate by nerve endings and is responsible for protecting the olfactory bulbs. The mucous membranes that cover the turbinates undergo a cycle of expansion and contraction mediated by the autonomic nervous system. Size changes (hypertrophy) frequently occur in allergic rhinitis, vasomotor rhinitis, and in cases of bulbous turbinates. When necessary, I treated the turbinates during the rhinoplasty itself, either by turbinoplasty (repositioning) or turbinectomy (partial or total removal). ### Internal and External Nasal Valves The nasal valve is an important regulator of airflow dynamics and is divided into internal nasal valve and external nasal valve. The internal nasal valve is the angle formed between the septum and the anterior margin of the triangular cartilage. Preserving this valve is essential to avoid collapse of the nasal wings during inspiration. When a patient arrived with this complaint, I used a cartilage graft called spreader graft to open the airway. The external nasal valve is located at the entrance of the nose. It may be obstructed by weakened alar cartilages (sometimes due to previous surgery), loss of vestibular skin, or scar narrowing. Treatment depends on each case, and I evaluated the best approach during the consultation. ## Most Common Types of Nose in My Former Rhinoplasty Practice ### Bulbous Nose (Bulbous Tip) The bulbous nose gets its name because of the rounded, wide shape of the tip. Colloquially called a "potato nose," it is characterized by a bulbous tip, and its treatment is detailed below. ### Wide Nose The nose may have a wide dorsum. I assessed this by palpating the nasal bones during the consultation. The treatment consists of fracturing (osteotomy), which brings the lateral walls of the nose closer together, narrowing it. ### Large Nose The nose may be enlarged in all dimensions: high dorsum, wide, long, wide tip, and open nostrils. In these cases, I reduced the nose in three dimensions, taking care to preserve breathing. ### Crooked Nose or Deviated Nose The nose may have a deviation in the dorsum or tip. A crooked nose is very bothersome aesthetically, and surgery usually yields excellent results, improving 90 to 100% of the deviation. It generally occurs together with a deviated septum, which I treated in the same surgery. ### Hooked Nose This term was widely used in the past but is falling out of use. What is not disappearing are the cases of hooked noses in the offices of rhinoplasty specialists. Characteristics: High dorsum and curved downwards, with a drooping tip, very common in descendants of Italians. ### Afro-Descendant Nose The nose of an Afro-descendant can be summarized as: short, wide, with a low dorsum, with a low and wide tip, lacking tip support, and with open nostrils. Read more below in the ethnicity topic. ### Drooping Tip Nose This is certainly one of the most common complaints, along with complaints of a wide tip. No one wants to have a drooping nasal tip, and most are afraid to undergo surgery for fear of looking like they have a pig's nose. ## Common Complaints ### Nose Size When I operated on a large nose, I reduced it in three dimensions to maintain harmony with the face. Most of the time, the problem is a high and long dorsum. When I lowered the dorsum, the nose began to appear proportionally longer. That’s why I almost always needed to shorten it, also lifting the nasal tip. ### Bulbous (or Wide) Tip The bulbous tip is one of the most frequent complaints about the nose in a plastic surgery office. Patients feel uncomfortable with the famous "bulbous nose" and wish to see their nasal tip refined and more delicate. To refine the nose, there are some maneuvers, such as: * Partial removal of the cephalic third of the alar cartilages; * Structuring the tip; * Alar cartilage graft at the tip; * Suturing the dome; * Light debulking of the tip, when necessary. ### Drooping Tip The natural aesthetics of the nose states that the tip should have a higher projection than the nasal dorsum. When this does not occur, it is said that the nose has a drooping tip, meaning it is lower than the dorsum. This can be due to one of two (or both) reasons: a very high dorsum or a very low tip, both correctable by surgery. In the case of a very high dorsum, the treatment is lowering the dorsum with a chisel and/or rasping. When the tip is too low, it can be simply sutured higher after shortening the caudal septum (more frequent), or supported with a cartilage strut in the columella. ### Nasal Deviations I treated deviations with dorsum lowering and fracturing, along with repositioning the septum when necessary. In deviations that involve the tip, I released the septum from the columella and could perform relaxing incisions at the upper part of the caudal septum, on the concave side. In some cases, I performed complete septorhinoplasty to rectify the septum and adequately treat the nasal deviation. ### Open Nostrils I could close them by removing a small segment from the lower and lateral part. I used a compass to measure the nostrils and plan the removal symmetrically. The scars are positioned in natural folds to make them as discreet as possible. ### Allergic Rhinitis Allergic rhinitis is a condition in which the nasal mucosa exhibits hyper-reactivity, causing itching, sneezing, poor sense of smell, headaches, and a runny nose. Rhinoplasty does not improve or worsen allergic rhinitis. This condition can improve by avoiding agents such as dust, hair, curtains, paints, insecticides, and perfumes, or with local (topical) treatment with sodium cromoglycate or corticosteroid in spray, for example. ## Types of Rhinoplasty ### Closed Rhinoplasty Technique developed by Joseph in the early 20th century, in which rhinoplasty is performed without external cuts. The entire surgery is done inside the nose. Although it still has specific indications, it has given way to open rhinoplasty, which allows for better visualization, more precise definition of the tip, and greater ability to structure the nose with cartilage grafts. ### Open Rhinoplasty In this technique, I made a small incision in the columella, which allowed me to expose almost the entire nose. This enables a complete approach to everything that needs to be done. It has become increasingly widespread because it offers better results in most cases, especially when I used many cartilage grafts. ### Aesthetic Rhinoplasty Its goal is to improve the appearance of the nose, making it more attractive and balanced with the face. Whenever possible, I combined the functional aspect in the same surgery. ### Functional Rhinoplasty Focuses on improving nasal breathing. I addressed the septum, turbinates, and internal and external nasal valves. In my former rhinoplasty practice, I rarely performed one without the other. ### Reconstructive or Repair Rhinoplasty In this surgery, I aimed to give the most natural shape possible to the noses of people who were born with some deformity or who suffered trauma with loss of nasal structure. ### Reducing Rhinoplasty This is the oldest technique for nose surgery. In it, bone and cartilage are removed to decrease the size of the nose. There is little reinforcement of the internal structure. Over time, the lack of support can cause problems: the tip may droop, the dorsum may bend, and breathing may worsen. Today, this isolated technique is used more selectively. ### Structured Rhinoplasty This is the technique I performed the most. Instead of just reducing, I reconstructed and reinforced the structure of the nose from within, using cartilage grafts from the patient’s own body when indicated. The cartilage can be taken from the nasal septum or, when necessary, from a rib. The goal is facial balance, structural support and, in selected cases, improved breathing at the same surgical time. ### Rib Cartilage Graft Rhinoplasty In some cases, the cartilage from the septum is not enough for all the necessary grafts. This happens more in patients who have had previous nose surgeries or who need more extensive reconstructions. In these cases, I removed a small piece of cartilage from a rib. It is an abundant, strong material that allowed me to create various types of grafts from a single piece. ### Secondary or Revision Rhinoplasty The first rhinoplasty a person has is called primary rhinoplasty. The second is secondary rhinoplasty. The third is tertiary rhinoplasty, and so on. In any case where there is a desire to improve something left by the primary rhinoplasty, it is a revision of rhinoplasty, or a revision rhinoplasty. Secondary, tertiary rhinoplasties, etc., excluding the primary, are all revision rhinoplasties. ### Fractured Nose Rhinoplasty This is a simpler rhinoplasty, where the goal is to restore the shape that the nose had before being broken by trauma. It does not aim to correct all aesthetic defects of the nose but seeks to improve deviations caused by the fracture. ## My Former Technique: Structured Rhinoplasty What distinguished my rhinoplasty practice was a dual aesthetic and functional approach. I did not simply reshape the nose for beauty; I simultaneously optimized nasal breathing. During my advanced training in the United States, I studied the four pillars of nasal airflow: the septum, the turbinates, the internal nasal valve, and the external nasal valve. In every rhinoplasty I performed at my clinic in Londrina, Brazil, I evaluated and corrected each of these pillars when needed, using techniques such as spreader grafts to widen the internal valve and turbinoplasty to reduce obstruction. In my rhinoplasty practice, this comprehensive methodology meant my patients breathed better and looked better after a single surgery, without needing a separate procedure with another specialist. With over twenty years of experience and more than eight thousand surgeries performed, I could confidently say that neglecting the functional aspect of the nose is the most common mistake in rhinoplasty worldwide, and one I was committed to avoiding. Structured rhinoplasty is the technique I performed most often in my former rhinoplasty practice. Instead of just reducing the nose, I reconstructed and reinforced the entire nasal structure from within, using cartilage grafts from the patient’s own body. Think of the nose as a house. Reducing rhinoplasty (the old technique) removes walls and beams to decrease the house. It may work at first, but over time the structure weakens. Parts may give way. Structured rhinoplasty remodels the house from within. It places support beams in the right spots. The intent is a more balanced, better-supported structure that can remain stable over time. That’s why I structured every nose I operated on. My goal was a result that looks beautiful not just in the first month but tends to remain stable over many years. ### Why Does Structured Rhinoplasty Yield Better Results? The difference lies in the way the surgery is approached. The reducing technique removes tissue from the nose to decrease it. The problem is that, over the years, healing and aging can change the shape of the nose. Without support, the tip may droop, the dorsum may bend, and airflow may be compromised. Structured rhinoplasty works differently. It reinforces the skeleton of the nose with cartilage grafts. These grafts act as pillars that keep the nose firm in the right position. Here are the advantages: * More stable results over the years, without late deformities; * More natural appearance, without the "operated nose" look; * Significant improvement in nasal breathing; * Lower chance of needing a second surgery; * Can be performed from age 15, at any time of the year; * It is individualized for the ethnicity and anatomy of each patient; * Can be combined with other surgeries, such as [mentoplasty](https://deepplanefaceliftbrazil.com/surgery/chin-augmentation/ "Mentoplasty in Brazil") (chin surgery) or [facelift](https://deepplanefaceliftbrazil.com/ "Deep Plane Facelift in Brazil"), improving facial profile; * Does not require prolonged rest in the postoperative period. Recent studies published in international scientific journals show that more than 90% of patients are satisfied with the results of structured rhinoplasty. The revision rate is much lower than with the reducing technique. ### Where Does the Cartilage for the Grafts Come From? The grafts used in structured rhinoplasty are made with cartilage from the patient’s own body. This is very important. Because the graft is autologous cartilage from the patient's own body, immune rejection is not expected in the way it can occur with donor tissue or synthetic material. The cartilage is planned to integrate naturally into the nose. I primarily worked with two sources: #### Nasal Septum Cartilage This is the first choice. The septum is the wall that divides the nose in half. It has enough cartilage to be harvested without compromising the support of the nose. It is the ideal material: straight, firm, and easy to sculpt into the necessary shapes. In most primary rhinoplasties (the first surgery), the septal cartilage is sufficient for all grafts. #### Rib Cartilage In some cases, the septal cartilage is not enough. This happens when: * The patient has had previous nose surgery and the septum has already been used; * There is a need for more extensive reconstruction; * The nose requires a lot of support or dorsum augmentation; * The cartilaginous septum is naturally small. In these cases, I removed a small piece of cartilage from a rib. The collection is done through a small incision, which leaves a discreet scar. Rib cartilage is abundant, strong, and allowed me to create various grafts from a single piece. The recovery of the donor area is quick. There may be slight discomfort in the rib area for a few days, but it is usually not significant. ### The Grafts in Structured Rhinoplasty Each nose is different. Therefore, I combined different types of grafts according to the needs of each patient. Here are the main ones: #### Spreader Graft This is one of the most important grafts in structured rhinoplasty. It consists of a thin strip of cartilage placed on each side of the nasal dorsum, between the septum and the upper lateral cartilages. What it’s for: * To keep the nose straight and aligned in the center of the face; * To open the internal nasal valve, improving airflow; * To avoid pinching of the dorsum, which gives the appearance of an operated nose; * To reinforce the structure of the dorsum after lowering. The grafts can be taken from the septum or from rib cartilage. I learned the technique for placing spreader grafts in both open and closed rhinoplasty in the United States, with Dr. Ali Sajjadian (California) and Dr. Dean Toriumi (Chicago). This closed technique is still not widely practiced in Brazil. Since I started combining spreader grafts with the treatment of the turbinates, my rhinoplasty patients noticed a significant improvement in breathing within the first week, even with the nose still swollen. #### Septal Extension Graft This graft provides firm support to the tip of the nose. It is a piece of cartilage positioned vertically, as an extension of the nasal septum. It is fixed at the anterior nasal spine (at the base) and between the spreader grafts (at the top). What it’s for: * To lift the tip of the nose durably; * To give projection to the tip, ideal for those with a flat or unsupported nose; * To open the angle between the nose and the lip, creating a more balanced profile; * To keep the tip firm in place, without the risk of drooping over time. It is especially recommended when the tissues of the nose are heavy or when the tip needs robust support. This graft is performed in open rhinoplasty. #### Columellar Strut Graft The columella is the part between the nostrils that supports the tip of the nose. The strut graft is a small rod of cartilage placed between the two tip cartilages, inside the columella. It is fixed with absorbable PDS sutures. What it’s for: * To provide light to moderate support to the tip; * To subtly improve the projection of the tip; * To reinforce the structure of the columella. It is a more discreet option than the septal extension graft. It works well when the tip needs reinforcement but not maximum support. It can be done in both open and closed rhinoplasty. #### Radix Cartilage Graft The radix is the root of the nose, the highest part, near the eyebrows. In some patients, this area is too low. If rhinoplasty were performed from this height, the entire nose would be lowered. To resolve this, I used small pieces of chopped cartilage, placed inside a syringe and injected into the radix. Then, I shaped the material in place. It’s like a filler, but made with cartilage instead of hyaluronic acid. After healing, the graft consolidates and becomes even firmer than the original cartilage. The result is quite durable. #### Dorsal Augmentation Graft The same technique of chopped cartilage used in the radix can be applied along the entire nasal dorsum. It is a safe way to increase the height of the nose in patients with a low dorsum, such as in some African, Asian noses, or in cases of secondary rhinoplasty where the dorsum has been excessively lowered. #### Ala Cartilage Graft at the Tip When the tip needs more definition, I positioned a small cartilage graft at the tip, horizontally. This graft is made with cartilage taken from the patient’s own alar cartilages during the refinement of the tip. Nothing is wasted. What it’s for: * To project the tip forward, with more definition; * To smooth asymmetries between the tip cartilages; * To control where the point of greatest projection will be. ### Closed or Open? My Experience with Both I used both techniques and chose the approach that fits the anatomy and objective of each case. In **closed rhinoplasty**, all incisions are made inside the nose. There are no external scars. Recovery tends to be a bit faster. In **open rhinoplasty**, there is a small incision in the columella. This allowed me to see the entire structure of the nose clearly. It is the preferred technique when the case requires many grafts or complex work on the tip. In both techniques, I performed complete structuring of the nose. My training combines the teachings of Professor Ivo Pitanguy in Brazil with training alongside Drs. Dean Toriumi and Ali Sajjadian in the United States - references in structured rhinoplasty. Each has contributed to the approach I used in my rhinoplasty practice, uniting natural aesthetic planning with respiratory evaluation. I structured all the noses I operated on. Previously, rhinoplasty was done mainly by removing. In that practice, I reconstructed and supported the nose according to the anatomy of each case. The goal is a natural-looking nose, functional assessment and long-term stability, while recognizing that healing and final definition vary between patients ([Levin AM et al., *Facial Plast Surg*, 2020](https://pubmed.ncbi.nlm.nih.gov/32750725/)). ## Structured vs Open vs Closed Rhinoplasty: Technique Comparison Patients frequently ask which rhinoplasty technique fits their case. This table summarizes the key differences I explained during consultations: | Criteria | Structured (Dr. Zamarian) | Open Conventional | Closed | Reductive (old) | | --- | --- | --- | --- | --- | | Principle | Reconstruct and reinforce with grafts | Direct visualization, may or may not use grafts | No external incisions, limited access | Simply remove bone and cartilage | | Cartilage grafts | **Yes (septum or rib)** | Variable | Limited by access | Not used | | Functional correction | Septum + turbinates + valves (4 pillars) | Possible, depends on surgeon | Limited | May worsen breathing | | Result longevity | **Stable long-term** | Good, but may change | Variable | Frequent deterioration over time | | Natural appearance | High (preserves and rebuilds anatomy) | Good | Good for simple cases | Risk of operated look | | Visible scar | Small columella scar, usually discreet after healing | Minimal on columella | No external scar | Variable | | Main limitation | Longer dissection and swelling phase | May not address all structural needs | Limited visualization in complex cases | Higher risk of late loss of support | | Revision rhinoplasty | Ideal for correcting prior surgeries | Possible | Difficult due to limited access | Often requires revision | I chose structured rhinoplasty as my primary technique because, in my experience of over twenty years, it delivered the most natural, lasting, and predictable results for my patients in Brazil and around the world. ## Indications for Nose Plastic Surgery In my former rhinoplasty practice, for both men and women, I recommended rhinoplasty starting at age 15. At this age, the bony and cartilaginous structures of the nose and face are practically developed. Operating before this can hinder the growth of the middle third of the face. Besides age, it is important that the patient is emotionally prepared to deal with the change in appearance. If your nose seems too big or too small for your face, if it is crooked or asymmetrical, if it has a hump on the bridge or is flat (saddle nose), if the tip is bulbous, drooping, or too wide, if the nostrils are too open, with or without difficulty breathing - you are a good candidate for rhinoplasty. These are just a few examples. I no longer perform rhinoplasty. For procedures I currently offer, you can [schedule a consultation](https://www.walterzamarianjr.com/us/contact/ "Get in touch with us") at my clinic in Londrina, Brazil. ## Female Rhinoplasty The female nose may allow for a more open columellolabial angle, between 90 and 114 degrees, and a straight or slightly curved bridge, depending on the face. In other words, the female nose can sometimes be a bit more rotated than the male nose. Even when shortening or lifting the tip, the goal is to avoid over-rotation, excessive nostril show or an artificial-looking result. ## Male Rhinoplasty The male face calls for a straighter nose, with a columellolabial angle around 90 degrees. I could project the tip forward and support it with grafts, but the male nose should not be short or upturned as a female nose can be. The goal is to improve facial balance without making the nose too delicate. I prioritized natural results, both for women and men, respecting each individual's characteristics. Male rhinoplasty deserves its own considerations: stronger dorsal bone, thicker skin (common in men), prominent frontonasal angle, and the need to preserve masculine facial cues. Over-reducing a male dorsum or over-rotating a male tip feminizes the face and produces an operated look that male patients consistently want to avoid. In my former rhinoplasty practice I preserved a straight or very lightly curved dorsum, kept the tip projection strong, and avoided narrow pinching of the lateral walls. See the dedicated page on [male rhinoplasty in Brazil](https://www.walterzamarianjr.com/us/face/male-rhinoplasty/ "Male Rhinoplasty in Brazil") for more detail on male-specific anatomical goals, recovery in an active lifestyle, and cases from my former rhinoplasty practice. ### Surgical rhinoplasty or non-surgical (liquid) rhinoplasty: what's the difference? "Liquid rhinoplasty" — also called non-surgical rhinoplasty — uses hyaluronic acid filler injected along the dorsum, radix or tip to mask small irregularities and temporarily improve the profile. It is a 15-minute office procedure with no downtime and an immediately visible change. However, it has important limitations: it can only *add volume*, never reduce a hump or narrow a wide nose; it is temporary (typically 9–18 months depending on the product and location); it carries a real risk of vascular complications including skin necrosis and, rarely, blindness when filler reaches the ophthalmic artery through nasal vessels; and repeated sessions over years can produce fibrosis and tissue changes that may complicate future surgical rhinoplasty. Surgical rhinoplasty, in contrast, is a structural operation that physically reshapes the nose: it can reduce, augment, narrow, rotate, straighten and functionally open the nose in the same operative time. The result is stable long-term and addresses both form and respiratory function. The trade-off is obvious — it is a real surgery with anesthesia, recovery and surgical risks. **Important disclosure**: I do not perform liquid rhinoplasty. I no longer perform surgical rhinoplasty either. In my former rhinoplasty practice I offered only surgical (structured) rhinoplasty, because it is the only approach that can deliver the complete aesthetic and functional correction my patients seek. Patients looking for a quick, reversible aesthetic adjustment should seek a qualified dermatologist or facial plastic surgeon who specifically offers and is experienced with nasal filler injections, and should be counseled about the vascular risks involved. ## Factors for Successful Rhinoplasty There are some basic factors that I took into consideration to plan a rhinoplasty safely and realistically. ### Nasofacial Analysis Before any rhinoplasty, I conducted a meticulous evaluation of the nose and face. I needed to fully understand the structure I would be working on, sculpting, and shaping. Besides aesthetics, I based my work on mathematical proportions such as the thirds of the face and angles of facial anatomy. This allowed me to predict more accurately how the nose would look in relation to each patient's face. From this analysis, I began to outline the surgical plan for your rhinoplasty. ### Surgical Plan During the consultation, I explained which corrections were possible and which techniques I intended to use. After discussing the case with you, I outlined the ideal surgical plan for your nose. I followed this plan rigorously during the surgery - the only exception was when something unexpected required an adaptation at the moment. I took all the planning with me to the operating room, along with your standardized photos and complete file, to ensure maximum precision during the surgery. ### Favorable Anatomy During the first consultation, I could already perceive, from the anatomy of your nose, which maneuvers would be necessary and which results were possible. There are limits to what surgery can achieve, and I was always honest about that. If the anatomy does not favor the result you dream of, I preferred to explain the reality rather than promise something I could not deliver. My role was to show the maximum possibilities for modification and, when necessary, present alternatives that respect your nasal structure and preserve your health. ### Critical Analysis Rhinoplasty is one of the most challenging surgeries in plastic surgery. It is not enough to think only about aesthetics: I needed to critically analyze what each modification would cause to the structure and function of the nose. It is a cause-and-effect relationship. Each change generates consequences, which can be positive or negative. Good results come from the combination of detailed prior analysis, a well-drawn surgical plan, and favorable anatomy. ### Experience and Skill of the Plastic Surgeon The experience and skill of the surgeon are fundamental. Over more than twenty years, I have been constantly updating myself at national and international conferences. I completed my residency in plastic surgery with Professor Ivo Pitanguy in Rio de Janeiro, where I assisted him in hundreds of surgeries over three years. I studied anatomy in depth and specialized in facial analysis. Patients comparing **rhinoplasty surgeons in Brazil** should verify credentials, specialist registration, hospital setting, anesthesia team, specific rhinoplasty experience and follow-up structure. I am a member of the SBCP (Brazilian Society of Plastic Surgery) and ASPS (American Society of Plastic Surgeons), and I received patients from Brazil and abroad at my clinic in Londrina, Brazil -- many through **medical tourism for rhinoplasty in Brazil**. This is historical experience with **nose surgery in Brazil**; I no longer offer rhinoplasty. For procedures I currently offer, you can [schedule a consultation](https://www.walterzamarianjr.com/us/contact/ "Get in touch with us"). ### Comprehensive Approach to the Nose, Both Aesthetic and Functional In the past, aesthetic nose surgery was often separate from functional surgery. The plastic surgeon took care of the appearance and the ENT handled the breathing. For many years, I worked this way. But I realized that to perform the grafts in structured rhinoplasty, I needed full control over the septum and the cartilages. So I underwent training in the United States specifically to deepen the functional aspect. In that practice, I created the complete surgical plan - aesthetic and functional - so that one approach does not hinder the other. ## Ethnic Rhinoplasty Today, ethnic rhinoplasty is one of the fastest-growing areas. The challenge is greater: I needed to respect the characteristics of each ethnicity, correcting only what is necessary. Making identical noses, like mass production, is a thing of the past. Even patients who want changes want to maintain their identity. They want a better nose, but one that still looks like their nose. Therefore, I kept some characteristics intact while improving what bothers them. ### Afro-Descendant and Indigenous Nose The noses of Afro-descendants and Indigenous people typically have a low bridge (or flat), bulbous tip, open nostrils, and little support at the tip. To treat this, I elevated the bridge with grafts and fractures, refined the tip with dome sutures and partial removal of alar cartilages, defined the tip with alar cartilage grafts, and finished with a graft on the columella for support. The Indigenous nose often has a low radix, needing small cartilage grafts to fill the depression. The Afro-descendant nose tends to have a low bridge overall, possibly requiring more cartilage. ### Asian Nose Just like the Afro-descendant nose, the bridge of the Asian nose needs to be elevated with grafts and fractures. I could slightly reduce the nostrils and improve the definition of the tip with the described maneuvers. Sometimes, I used cartilage grafts for tip definition and in the columella for support. ### Arab or Lebanese Nose It is very characteristic of this ethnicity to have a high bridge (hump) and a rounded, drooping tip. I performed maneuvers to even out the bridge, lowering it, and rotated the tip upward at the same time. I refined the tip by treating the alar cartilages, suturing the dome, and performing alar cartilage grafting. The nose becomes more proportional to the patient's face. ### Italian Nose Peculiarities such as a high bridge with a hump and disproportionate tip lead the Italian nose to receive treatment similar to that of the Arab or Lebanese nose. I always respected the individual characteristics of each patient, maintaining the naturalness of the result above all. ## Pre-operative The following describes the approach and protocol from my former rhinoplasty practice. ### Nose Evaluation During the consultation, I performed a thorough evaluation of your nose and face. I explained the procedure, studied the facial structure based on mathematical proportions, and determined which areas would undergo the most significant changes. I also identified any limitations - such as skin thickness or bone fragility - that may influence the outcome. #### Aesthetic Parameters of the Nose I used some mathematical parameters and proportions to determine the points to be improved. They helped me measure what is visibly altered. However, they serve only as guidance: each nose has its particularities, and measurements outside these parameters are entirely acceptable, as long as there is harmony with the face and respect for ethnic differences. #### The Thirds of the Face To achieve predictable results, I divided the face into three parts, using four horizontal lines: * one tangent to the hairline (a variable and less important line); * one line at the level of the eyebrows; * another at the nasal base; and * the last tangent to the chin. Divergences in these proportions may indicate maxillofacial alterations, such as vertical excess of the maxilla, known as "bird face" or maxillary hypoplasia. Since this is the foundation of the nose, meaning where it is situated, significant alterations of the maxilla should be addressed before rhinoplasty. #### Nose Length To assess the length, I checked if it is equivalent to the vertical distance between the corners of the mouth and the chin, in a frontal view. This confirms whether the nose is proportionally long or short for the face. #### Nasal Deviations I drew a straight vertical line from the middle of the glabella (between the eyebrows) to the chin, dividing the nasal dorsum and the lip in half. Any nasal deviation from this line - called laterorrhinia or "crooked nose" - will likely require osteotomy (fracture) and septoplasty. #### Nostrils Base The normal distance between the nasal wings is equivalent to the distance between the inner corners of the eyes (intercanthal distance). If the nostrils are wider, I first studied the cause. If the distance between the eyes is narrow, I preferred to keep the nostrils proportional. But if the nostrils are truly wide, I might recommend alar base reduction. #### Tip Shape I assessed the tip by drawing two triangles with opposite bases, guided by the supratip break and the columelolabial angle. If these triangles are asymmetric, I might need to modify the tip. In addition to correcting asymmetries, I often needed to refine the nasal tip, especially in patients with a bulbous tip. #### Basal View of the Nose In the basal view, I evaluated the nostrils and the base of the nose, which should describe an equilateral triangle, with a ratio between the lobe and nostril of 1:2. The nostril should have a teardrop shape, with the longer axis slightly medial. #### Frontonasal Angle This angle connects the glabella (space between the eyebrows) to the root of the nose, in a smooth curve, with an angle between 128 and 140 degrees, more specifically 134 degrees in women and 130 degrees in men. #### Tip Projection In the lateral view, the projection of the tip should equal the width of the nostrils in the frontal view and correspond to 67% of the length of the nose (from the root to the tip). Another way to assess: the anterior projection, from the upper lip, should be 50 to 60% of the total projection of the tip. #### Nasal Dorsum I started by drawing a line from the root to the tip. In women, the ideal dorsum is about 2 mm below this line. In men, it should be very close to it, to avoid feminization. Normally, the tip is slightly more projected than the dorsum. I could lower the dorsum, raise the tip, or do both in the same surgery when the anatomy and surgical plan support that indication. #### Columelolabial Angle This is the angle formed between the columella and a plumb line perpendicular to the natural horizontal plane of the face. This angle should be between 95 and 100 degrees in women and should be between 90 and 95 degrees in men. #### Columella Also known as sub-septum or mobile septum, the columella, the column of skin between the nostrils, can also be a target for correction. Basically, there are two unaesthetic defects of the nose that may involve the columella: the retracted columella and the hanging columella. The retracted columella is "hidden" due to a lack of skin or cartilage. The hanging columella, on the other hand, has excess skin and cartilage, protruding between the nostrils. How to know if it is hanging? Not all formulas apply. Often, I detected the problem visually, but I also used calculations: when A - B is greater than 4 mm, the columella is altered. Fortunately, both defects can be resolved. I used removal or cartilage grafts to correct these issues. ### Evaluation of Skin Thickness of the Nose The nasal dorsum is formed by the osteocartilaginous structure and the skin that covers it. This skin does not have uniform thickness: it is thinner in the upper two-thirds (root) and thicker at the tip. Additionally, the skin of the root has more mobility and fewer sebaceous glands. The skin covers everything I did during rhinoplasty, and that’s why I drew attention to this important detail: thick skin reveals less of the refinements made. It’s like a thick blanket - hard to show what’s underneath. On the other hand, thin skin shows the smallest details. This means that a person with thick skin may have more difficulty achieving a very thin tip. #### Thin Skin X Thick Skin In general, patients with predominantly thinner skin on the nose will achieve the desired results more quickly and more visibly compared to patients with predominantly thicker skin. These patients will need to wait longer for the results to reach complete healing. ### Evaluation of the Anterior Septal Angle: Is There Support at the Tip? To determine if the tip has support, I performed a simple test: I pinched the tip with my finger. If it sinks, it has little support and I could correct it with grafts. If it remains firm in place, the tip is well supported and does not need reinforcement in this aspect. ### Medications to Be Discontinued Before Surgery Certain medications must be discontinued before surgery. Some interfere with blood coagulation, sedation, anesthesia, and epinephrine. They should be discontinued two weeks before and after the surgery. Among them are: * Acetylsalicylic acid, known as ASA, marketed under the name Aspirin, Alka seltzer, Bufferin, etc.; * Ginkgo biloba; * Arnica, as it directly interferes with blood coagulation; * Tricyclic antidepressants (amitriptyline, clomipramine, nortriptyline, etc.); * Oral anticoagulants (marcumar, marevan, etc.); * Appetite suppressants and weight loss medications (amphetamines, sibutramine, etc.). Always inform your plastic surgeon about all medications you take, including natural ones. ### Necessary Exams Before the surgery, I requested some exams to evaluate your health and provide greater safety for the procedure. The exams I usually requested included: * Complete blood count (CBC); * PT/INR + aPTT; * BUN and creatinine; * Fasting blood glucose; * AST and ALT; * TSH and free T4; * Vitamin C; * Vitamin D; * HBsAg; * Anti-HBs; * Anti-HBc IgG and IgM; * Anti-HCV; * HIV serology; * Total protein and albumin; * Urinalysis; * EKG; * Pre-operative cardiac clearance; * CT scan of the nose and sinuses. I needed to know about your respiratory capacity, history of trauma, previous surgeries, rhinitis, or sinusitis. I evaluated septal deviations and the nose as a whole. I usually examined the inside of the nose for synechiae, septal deviations, or turbinate hypertrophy for a complete assessment. ### General Anesthesia For a complete rhinoplasty, which involves osteotomy (fracture), grafts, and tip treatment, the recommended anesthesia is general. Only local anesthesia is not satisfactory and safe in these cases. When I recommended only tip treatment, the procedure can be performed with local anesthesia and venous sedation. We use the term "general anesthesia" to refer to the anesthetic technique that promotes total unconsciousness (hypnosis) of the patient, pain relief (analgesia), and muscle relaxation. General anesthesia allows for the performance of any necessary maneuvers during the nose surgery, as intubation protects the airways. Local anesthesia left me a bit limited, as this type of anesthesia is not recommended when the patient must undergo osteotomy, for example. After the anesthetic induction, which is the transition period from consciousness to the unconscious state of the patient, the preparation of the nasal vestibules is necessary, at which point I trimmed the nasal vibrissae (nose hairs) and performed antisepsis on the inside and outside of the nose. Once the vestibules are prepared for the plastic surgery of the nose, about 20 ml of a solution with 1% lidocaine and 1:80,000 epinephrine is injected to minimize bleeding during rhinoplasty, thus also avoiding bruising and pain in the postoperative period. The areas where I applied this solution were: nasal dorsum, tip, anterior nasal spine, fracture line, alar mucosa, and septum. I waited approximately 12 minutes for the complete effect of the epinephrine before starting. For greater safety, a specialized anesthesiologist accompanied the entire surgery with me, from start to finish. They monitor blood pressure, pulse, temperature, respiration, level of sedation, and hydration throughout the procedure. ## The Surgery The following describes the approach and protocol from my former rhinoplasty practice. ### Incision After anesthesia, I began the rhinoplasty using either the open or closed technique, with an incision in the columella (if open) or between the alar and triangular cartilages (if closed). This way, I exposed the entire interior of the nose for dissection. ### Dissection I performed the dissection of the nasal dorsum with scissors in the subcutaneous plane, above the periosteum, keeping the layer of fat under the skin intact to avoid irregularities. I used various maneuvers according to the surgical plan: removal of the cephalic portion, lateralization of the dome, interdomal suture, cartilage graft, among others. At this stage, I could remove excess cartilage at the tip or dorsum. The following areas can be remodeled: * dorsum; * septum; * spreader graft; * strut or septal extension graft; * fracture; * tip; * columella; * nostrils and * turbinates. ### Dorsum When necessary, I treated the dorsum to correct excess (hump) or deficiency, always respecting the internal structure and the integrity of the mucosa of the nasal dorsum. In the treatment of the dorsum, I corrected: the bony or cartilaginous hump, which is a type of elevation on the dorsum caused by excess bone or cartilage; the dorsum with depressions or low dorsum, also known as saddle nose, which, due to congenital defects or trauma, leaves the dorsum sunken and with little projection in certain places; the dorsum that has both the hump and depressions (saddle nose) combined; septal deviations, asymmetries, laterorrhines, etc. #### Treatment of the Nasal Hump In cases of bony or cartilaginous hump, I lowered the dorsum with diamond rasping or chisel. In the "saddle" nose, with a very low dorsum, I increased it with a cartilage graft taken from the septum or rib. Remember: the male dorsum is generally left straight, while the female can be straight or have a gentle curve. ### Fracture: Breaking the Nose At this stage, I performed nasal osteotomy (fracture) to correct deviations and narrow the dorsum. I used a chisel and hammer along the maxilla and lateral wall of the nasal bones, finishing with a squeezing maneuver with my fingers to bring the walls closer to the center. ### Nasal Tip The tip is the most delicate and complex part of the nose. It requires an accurate approach to achieve a good result. The tip can have various defects: bulbous, thick, too high, drooping, bifid (separated cartilages), among others. I could correct all these defects, achieving excellent results. Depending on the area in question, the skin surrounding the nasal tip has very variable characteristics. Additionally, the nasal tip may have an important layer of subcutaneous cellular tissue, that is, fat, and also has large amounts of sebaceous glands. After treating the dorsum, I delicately dissected the tip with Fomon scissors, which have a curved shape to follow the nasal anatomy. During this dissection, I sectioned the dermocartilaginous ligament of Pitanguy. The tip can then be refined by removing the upper third of the alar cartilages, with or without a cartilage graft. One of the techniques I used most was the alar cartilage graft at the tip, combined with structuring via strut or septal extension graft. #### Raising the Nasal Tip A drooping tip can be elevated through maneuvers, which include sectioning the dermocartilaginous ligament of Pitanguy, removing the caudal septum, and supporting the tip with a cartilage graft in the columella in noses that require it. The angle formed between the columella, the column that supports the tip of the nose, and the lip, called the columelolabial angle, should be about 90 to 95 degrees in men and between 95 and 100 degrees in women, meaning that the female nasal tip may be more upturned than that of the male. ### Dermocartilaginous Ligament of Pitanguy In facial dynamics, we must also evaluate the muscle that depresses the tip, called the depressor of the tip or also the dermocartilaginous ligament of Pitanguy. Professor Ivo Pitanguy, my mentor, described the dermocartilaginous ligament that runs along the nasal dorsum, descends through the tip, and inserts into the anterior nasal spine. Its function is to lower the tip when the person speaks - you can test this by asking someone to say "jujuba." In closed rhinoplasty, I sectioned this ligament to relax the tip, discreetly elevating it and preventing it from lowering during normal conversation. ### Nasal Septum The septum is the vertical wall that separates the nasal cavities. It can have defects that interfere with aesthetics and function. When I detected a septal deviation - bony or cartilaginous - I corrected it to align the nose and improve breathing. I could partially or almost completely remove the cartilaginous septum to perform the necessary grafts and remove bony alterations such as the spur. ### Columella If in the pre-operative evaluation I detected a hanging or retracted columella, I corrected it by removing excess cartilage or with grafts, so that the columella returns to being proportional. ### Nostrils Overly open nostrils draw attention, especially in Afro-descendant and Asian noses. I could reduce them naturally, without compromising breathing. Even in the closed technique, an incision at the bases of the nostrils is necessary - it is the only procedure that leaves a small external scar. But this area heals very well, and the incision is discreet. ### Cartilage Grafts Nasal grafts are used only when strictly necessary. The donor areas for cartilage grafts include the septum (fibrous cartilage, stiffer), ear cartilage (hyaline cartilage, softer), and very rarely rib cartilages (also fibrous). To increase the nasal dorsum, it may be necessary to use hyaline cartilage graft in one or more layers, positioned along the dorsum, to increase its projection, especially in some Asian or Afro-descendant noses, or secondary to a previous rhinoplasty where the dorsum was excessively lowered. The fibrous septal cartilage is excellent for providing tip support when placed between the medial crura, in the columella, especially recommended for noses without tip support and in Afro-descendant noses. ### Turbinates At the end of the surgery, I checked the airflow through both nostrils. If there is difficulty, I preferred turbinoplasty: I mobilized the turbinates laterally to increase the passage space. This maneuver is more physiological than turbinectomy, as it preserves the function of the turbinates in humidifying the air. But in cases of severe obstruction, I might perform partial or total turbinectomy. ### Suture I finished the closed rhinoplasty with four Vicryl 4-0 sutures (absorbable): one in each internal nasal valve and two between the columella and the septum, elevating the tip (which gives a little in the first month). In open rhinoplasty, there are external stitches in the columella and two on each side for the fracture, as well as stitches in the nostrils when closed. ### Dressing The dressings immobilize the nasal structure, keep everything in place, prevent blood accumulation, apply compression to reduce swelling, and assist in molding the result. I used nasal packing or silicone splints when necessary, and immobilized with a thermoplastic splint. In total, there are two weeks of dressings: in the first week, the thermoplastic splint; in the second week, I replaced it with skin-colored surgical tape. ### Nasal Packing After suturing, a packing is placed in each nostril, elevating the triangular cartilages to reduce dead space and promote faster healing. The packs are made of gauze soaked with Nebacetin and are removed the next day, except when septoplasty is performed simultaneously. In the case of combining rhinoplasty with septoplasty to improve the functionality of the nose, the packing should remain for 48-72 hours, being removed shortly thereafter. ### Immobilization with Thermoplastic Splint In the past, plaster was used to immobilize the nose. For greater comfort, I used a thermoplastic splint: a heat-moldable plastic that I shaped according to the new contour of the nose. In a week, I removed the splint and placed only skin-colored surgical tape, which remains for another week. Total: two weeks with dressings. ## How long does it last? The time depends on the technique. Closed rhinoplasty, which I performed less frequently in my former rhinoplasty practice, lasted on average 1 hour to 1.5 hours. Open rhinoplasty can take 3 to 5 hours, depending on the need for rib graft or the number of grafts. ## Septorhinoplasty and Turbinoplasty (or Turbinectomy): Functional Treatment of the Nose In the pre-operative evaluation, I could detect septal deviation and hypertrophy of the turbinates. The deviation can be congenital (present at birth) or acquired (after trauma). When the patient needs functional improvement beyond aesthetics, I performed septorhinoplasty with treatment of the turbinates when necessary - I took care of everything in the same surgery. There are several ways to correct a septal deviation: simple removal of the deviated part, or removal, correction with incisions, and reinsertion. When the deviation is low and has a spur, it is called a spur. The turbinates can be treated with turbinoplasty (repositioning) or turbinectomy (removal). ### Turbinectomy or Turbinoplasty: Correcting Turbinate Hypertrophy Often, the septal deviation is not the only villain hindering respiratory function in patients candidates for nasal plastic surgery. The nose is composed of several turbinates, also known as turbinates or shells, which are inserted into the lateral walls of the nose and can be enlarged, making breathing difficult. During rhinoplasty or septorhinoplasty, it may be necessary to combine the surgery with turbinoplasty or turbinectomy. Turbinoplasty modifies the position of the turbinates, increasing airflow. If the enlargement is too great, turbinectomy may be necessary, which consists of total or partial removal of one or more turbinates. Most of the time, the turbinate that interferes with breathing is the inferior one, which is also the largest. ### Silicone Splints and Synechia During rhinoplasty with septoplasty and/or turbinectomy, it is often necessary to place, in addition to the packing, a silicone splint -- a thin silicone plate in each nostril. Besides helping to support and fix the septum postoperatively, it prevents contact between raw areas of the septum and the lateral wall of the nose, also avoiding a condition called synechia. Synechia in the nose is a scar that forms a bridge between the septum and the lateral wall of the nose after surgery involving septoplasty or turbinectomy where there was a raw area (without epithelium) at the same height as the septum and the lateral wall of the nose. Symptoms of synechia can include nasal obstruction or wheezing (whistling during nasal breathing). Its treatment may involve either a cross incision or total removal, followed by protection with a silicone splint. ## Rhinoplasty Recovery: Post-Operative Care The following describes the approach and protocol from my former rhinoplasty practice. The recovery from rhinoplasty follows a staged timeline. I usually recommended five days of rest with the head elevated to help reduce swelling. The nasal packing is often removed within forty-eight hours, and breathing then improves gradually as internal swelling decreases. On day seven, I usually removed the thermoplastic splint and external stitches at my office, and on day fourteen I took off the surgical tape. By the two-month mark, much of the swelling has improved, but subtle refinement continues over the following months, with the final result appearing around one year or longer in thick-skinned or revision cases. Understanding **rhinoplasty recovery** is essential for protecting the surgical plan. After rhinoplasty, I made recommendations that can influence swelling, scarring and comfort: * in the first 24 hours, the patient should breathe through the mouth, due to the nasal packing; * do not wet the dressing with thermoplastic splint in the first week; * remain at absolute rest for the first 5 days, preferably with the head elevated; * patients with rhinitis should prefer airy and ventilated places, as when it occurs, sneezing and the urge to scratch the nose appear; * wash hair as in a hair salon to avoid wetting the thermoplastic splint; * after the dressing is removed, avoid direct water spray on the nose during bathing; * do not perform physical exercises for one month; * sleep on your back for the first month; * do not turn your face or press your nose against the pillow; * do not rest glasses, whether sunglasses or prescription, on the nose for the first two months to avoid marking or deforming the bridge or interfering with healing; * do not go out unprotected in the sun. The use of sunscreen is essential, as the sun can stain the skin of the nose; * direct sunlight should be avoided in the first three months, always remembering that heat causes swelling to increase; * after the third month of rhinoplasty, the patient may sunbathe in the early morning or late in the day with the use of sunscreen; * blowing the nose is not allowed immediately after rhinoplasty; if there is discomfort, I prescribed a good decongestant; * in the first two weeks following rhinoplasty, cotton swabs should not be used for internal cleaning, considering that all sutures were made inside, which may cause the nose to bleed; * for cleaning, the patient should only use saline solution; * any form of exercise that involves a risk of trauma (soccer, volleyball, boxing, etc.) should be avoided for 2 months after rhinoplasty; * cigarettes and alcohol should be avoided, both pre and post-operatively, as they directly interfere with the result and healing. ### Recovery Time In one week, I replaced the thermoplastic splint with skin-colored surgical tape. On the fourteenth day, I removed all the dressing - by this time, any bruising has already disappeared. The nose remains swollen, but when I took photos at two months, recovery was already about 85%. The remaining 15% of swelling can take up to a year to completely disappear. Remember: it is important to give due value to rest in the first days after your rhinoplasty. ### Swelling Swelling is greatest on the afternoon of the day following rhinoplasty, and after that, it slowly decreases. After a week, when the thermoplastic splint is removed, it is already possible to have an idea of the result, but the swelling may prevent the full beauty of the surgery from being evident. By two weeks, when the surgical tape is removed, the swelling is much less and there is almost no bruising, allowing you to be without dressings and many people may not even notice that there was surgery on your nose. ### Bruises The bruising around the eyes is, in fact, a contusion (not a hematoma). The difference is that a contusion does not have a clot - it is blood spread in the fat. By two weeks, it is almost gone and usually disappears before the third week. If there is darkening of the dark circles after a month, I prescribed a lightening cream with hydroquinone, retinoic acid, and thioglycolic acid. ### Sun The sun will be your enemy in the first weeks after rhinoplasty. Up to five minutes of sun per day will not harm, but you should be careful not to overexpose yourself, in order to avoid staining the skin of the nose or lower eyelids. A sunscreen with a factor of 30 to 40 can be used right after surgery, as mentioned above, as well as a hat. You should avoid wearing sunglasses for two months after the surgery. ### Nose Cleaning As we said, you should avoid inserting cotton swabs into the nose, especially in the first week, or trying to remove scabs. This can cause bleeding. Do not worry, as on the seventh-day follow-up, your nose will be clean and all its scabs will be safely removed. After that, continue using saline solution for another week to prevent the formation of more scabs. After two weeks, you may clean your nose using a cotton swab, if necessary. ### What Not to Eat Hard foods should be avoided for about four days. The recommendation is a soft diet for 4 days, but there is no need to blend anything in a blender. You can eat ground meat, well-cooked meat, fish, mashed potatoes, rice, beans. You should avoid tough meat or any food that requires more effort to chew, as the septum, which should have been operated on along with the rhinoplasty, rests on the upper surface of the roof of the mouth. ### Breathing Post-Operatively There is no way: the first two days with packing make nasal breathing impossible. Keep a glass of water always nearby, as the throat dries out. After the packing is removed, breathing improves, but the splint remains until the seventh day. After the splint is removed, nasal breathing improves significantly. But remember: just as the nose swells on the outside, it swells on the inside as well, and this may slightly hinder breathing in the first weeks. ### Removing the Thermoplastic Splint It is on the seventh day that this harder, external dressing is removed. On this day you will be able to appreciate how your nose is looking, but at 14 days, when you remove the surgical tape, you will like it even more, as the swelling will be much less. The thermoplastic splint cannot be wet, but the surgical tape can. ### Removing the Stitches Also on the seventh day, along with the removal of the splint, the external stitches are removed. Internal stitches remain for weeks until they are absorbed or fall out. ### Removing the Dressing (Surgical Tape) As mentioned above, the removal of the surgical tape occurs on day 14, and you will be able to be without external dressing. One tip is: after removing the surgical tape, when you take a shower, wash well by gently rubbing your finger with soap on your nose to remove all the glue and oiliness from the nose, in order to avoid excessive acne. ## Risks Personal experience reported here refers to my former rhinoplasty practice and does not guarantee any future patient's outcome. ### Inherent to Any Surgery The risks of rhinoplasty are the same as any surgery. No procedure is free of risks, so the decision must be based on anatomy, health status, surgical setting, anesthesia safety and realistic expectations. ### Infection Infection after rhinoplasty is uncommon, but it is possible. I used an accredited surgical environment, antibiotic prophylaxis when indicated and close postoperative follow-up to reduce this risk. ### Bleeding It is normal to have a little blood right after surgery, and this usually improves in the first 24 to 48 hours. Larger bleeding is uncommon, but it requires prompt assessment and may need anterior or posterior packing. ### Keloid Keloid formation on the nose is rare, but scar quality varies. I evaluated personal and family scar history during consultation, especially when an open approach or nostril base incision may be needed. ### Not Breathing Temporary nasal obstruction is expected while the packing and internal swelling are present. Most patients breathe through the mouth during this phase, and nasal airflow improves gradually as packing is removed and swelling decreases. ### Thrombosis or Embolism Thrombosis and embolism are rare in rhinoplasty, but they are not impossible in surgery. I evaluated individual risk factors and used prevention measures according to the patient's clinical profile and anesthesia assessment. ### Is there a risk of death? Death is extremely rare in elective facial surgery, but it is not zero. This is why I required preoperative assessment, an accredited hospital environment and a dedicated anesthesia team. ### The risk no patient should ignore The most common concern after rhinoplasty is not a dramatic complication, but a result that does not match what the patient imagined. Careful consultation, photographs, breathing evaluation and realistic planning are essential before deciding. ### What can go wrong in a rhinoplasty? Patients ask me this directly, and they deserve a direct answer. Rhinoplasty is one of the most demanding operations in facial plastic surgery, and no honest surgeon can promise a complication-free result. In my twenty-plus years of practice these are the realistic possibilities a candidate should understand before deciding: * **Residual asymmetry** — small side-to-side differences that may only be visible in close-up photography. * **Dorsum irregularity** — palpable or visible bumps or step-offs along the nasal dorsum, especially in thin-skinned patients. * **Drooping tip** — loss of tip projection over time, more common in reductive rhinoplasty without proper structural support. * **Nasal obstruction** — worsening of breathing if internal valves, septum or turbinates are not addressed alongside the aesthetic correction. * **Persistent tip fibrosis** — firm swelling at the tip that can last 12–18 months in patients with thick sebaceous skin. * **Infection** — less than 1% in structured rhinoplasty when performed in an accredited operating room with appropriate antibiotic prophylaxis. * **Septal hematoma** — blood collection within the septum; less than 1% and treatable when detected early. * **Result below the patient's expectation** — the most common form of "complication" worldwide, which is why I invested so much consultation time in aligning expectations with anatomical reality. The overall revision rate in published literature ranges from **5 to 15%** depending on complexity, surgeon experience and case selection ([Levin AM et al., *Facial Plast Surg*, 2020](https://pubmed.ncbi.nlm.nih.gov/32750725/)). The risk of death in elective facial surgery in a healthy patient is **below 0.01%** — extremely rare, but never zero, which is exactly why I required a full preoperative workup and a dedicated anesthesia team for every case. ### Who is qualified to perform rhinoplasty? Rhinoplasty is one of the most technically demanding procedures in plastic surgery. Traditionally it is performed by **board-certified plastic surgeons** (in the United States: American Board of Plastic Surgery — ABPS; worldwide: local equivalent boards and national societies) or by **board-certified facial plastic surgeons** (in the United States typically AAFPRS members with an otolaryngology/ENT background followed by a rhinoplasty fellowship). International patients should verify, at minimum: board certification in the relevant specialty, membership in recognized societies (ASPS, ISAPS, AAFPRS), specific rhinoplasty case volume (not just "general plastic surgery"), published work or documented advanced training, and an accredited operating environment with a dedicated anesthesia team. In Brazil, where I practice, the traditional qualification is *cirurgiao plastico* — a physician who completed medical school, general surgery residency and plastic surgery residency, holds an RQE (Registro de Qualificacao de Especialista) title and is a member of SBCP (Sociedade Brasileira de Cirurgia Plastica). A recent Brazilian regulatory change (CFO Resolution 286/2026, March 2026) authorized dental specialists in *Cirurgia Estetica Orofacial* to perform rhinoplasty under local anesthesia — a position actively disputed by the Brazilian medical councils and societies as being outside the scope of dental training. My personal recommendation, regardless of country: seek a fully trained medical plastic surgeon with specific advanced rhinoplasty training. In my own case that represents more than 12 years of medical formation — medicine degree, general surgery residency, plastic surgery residency at the Ivo Pitanguy Institute, and advanced rhinoplasty fellowships abroad. My credentials: CRM-PR 17.388, RQE 15.688, SBCP Titular Member, ASPS International Member, Ivo Pitanguy Institute graduate (38th Ward, Santa Casa da Misericordia, Rio de Janeiro), and advanced training with **Dr. Dean Toriumi** in Chicago and **Dr. Ali Sajjadian** in California. A hospital environment and a dedicated anesthesiology team are equally critical for managing any complication safely. ### How to reduce tip swelling and prevent fibrosis after rhinoplasty? Persistent tip swelling is the single most frustrating part of rhinoplasty recovery, particularly for thick-skinned patients. These are the practical measures I prescribed in my former rhinoplasty practice, all backed by structured rhinoplasty literature: * **Nasal taping** at night for 2–4 weeks after splint removal, to gently compress the tip skin as it contracts over the new framework. * **Manual lymphatic drainage** performed by a physiotherapist specifically trained in post-rhinoplasty care — never untrained massage by a generic aesthetician. * **Strict sun protection** on the nose for at least three months (SPF 30–50), since UV exposure increases inflammation and can pigment the thin postoperative skin. * **No self-massage** of the nose — aggressive finger pressure can displace grafts in the healing phase. * **Intralesional corticosteroid injection** (low-dose triamcinolone) performed by the surgeon in cases of localized persistent fibrosis, typically starting after month 3 or 4. * **Head elevation** during sleep for the first month — sleeping on two pillows reduces overnight edema significantly. * **Avoid strenuous physical activity** for 6 weeks, including heavy lifting, running and contact sports, as all increase venous pressure and worsen swelling. These measures together can significantly shorten the visible phase of tip swelling and support the full tip definition appearing closer to the 8–12 month mark. ## Frequently Asked Questions about Rhinoplasty **What is structured rhinoplasty and why did you prefer this technique?** In my former rhinoplasty practice, structured rhinoplasty was the technique I performed the most. Instead of just reducing the nose by removing bone and cartilage - as was done in the past - I reconstructed and reinforced the nasal structure with cartilage grafts from the patient when indicated. I think of the nose like a house: the old technique removed walls to make it smaller, but over time the structure could weaken. In structured rhinoplasty, I remodeled the house from the inside and placed support beams at the right points. The goal is a natural-looking, better-supported nose that respects the patient's anatomy. **Does rhinoplasty improve breathing?** It can, when there is a functional problem to correct. In my former rhinoplasty practice, I assessed the four pillars of nasal breathing during the same surgery: septum, turbinates, internal nasal valve, and external nasal valve. I specialized in the United States to deepen the functional aspect, but breathing improvement depends on the diagnosis, anatomy, healing and postoperative swelling. **At what age can I have rhinoplasty?** In my former rhinoplasty practice, I recommended rhinoplasty from age **15–16 for female patients** and **17–18 for male patients**, because facial growth completes earlier in girls. At these ages the bony and cartilaginous structures of the nose and midface are practically developed, and operating before this can hinder growth of the middle third of the face. Beyond the chronological minimum, I also required emotional maturity, realistic expectations and parental consent for patients under 18. There is no upper age limit — I regularly operated on patients in their 50s, 60s and 70s, provided cardiovascular clearance is obtained. Rhinoplasty can be performed at any time of the year. **How long does the result of structured rhinoplasty last?** Structured rhinoplasty is planned for long-term stability because cartilage grafts can reinforce the architecture of the nose. Unlike purely reductive techniques - which can lose support over time - structural planning aims to keep the dorsum, tip and valves supported. Even so, long-term appearance depends on anatomy, skin thickness, healing, trauma, aging and whether the case is primary or revision ([Levin AM et al., *Facial Plast Surg*, 2020](https://pubmed.ncbi.nlm.nih.gov/32750725/)). **What is the recovery like after rhinoplasty?** In my former rhinoplasty practice, I recommended that my patients rest completely for the first five days. The nasal packing is removed within 24 to 48 hours. On the seventh day, I replaced the thermoplastic splint with skin-colored surgical tape and removed the external stitches. On the fourteenth day, I removed all the dressings - by this time, any bruising has already disappeared. When I took photos at two months, recovery was already about 85%. The last 15% of swelling can take up to a year to completely disappear. **Does rhinoplasty leave a visible scar?** In closed rhinoplasty, there are no external scars because the incisions are inside the nose. In open rhinoplasty, I made a small incision in the columella, between the nostrils, which usually becomes discreet after healing. If alar base reduction is performed, there is a scar at the base of the nostril that is planned to be as discreet as possible. **How long does structured rhinoplasty surgery last?** In my former rhinoplasty practice, structured rhinoplasty lasted on average two to three hours. When I needed to use rib cartilage grafts or combine procedures such as septoplasty and turbinate reduction, the time could extend to four hours. The surgery was performed under general anesthesia in a fully equipped operating room, with a board-certified anesthesiologist who monitored the entire procedure with me. **Do I need to use rib cartilage in rhinoplasty?** In most primary rhinoplasties I performed, the cartilage from the nasal septum was sufficient for all necessary grafts. I reserved rib cartilage for specific cases: secondary rhinoplasties where the septum has already been used, extensive nasal reconstructions, or noses that require a large amount of graft. When necessary, the removal is done through a small incision in the chest that heals discreetly. **I have had my nose operated on before and did not like the result. Is it possible to correct it?** Yes, revision rhinoplasty can correct selected unsatisfactory results from previous nose surgery after detailed structural and functional evaluation. Secondary rhinoplasty was one of the surgeries I performed most to correct unsatisfactory results from previous surgeries. It is technically more complex, as I dealt with scar tissue and modified anatomy. I recommended that my patients wait at least one year after the first surgery for all swelling to disappear and the structure to be completely healed. During the consultation, I evaluated every detail and outlined a new individualized surgical plan. **What are the risks of rhinoplasty?** Rhinoplasty can involve bleeding, infection, scarring, persistent swelling, nasal obstruction, asymmetry, graft issues, anesthesia-related complications, dissatisfaction and the possibility of revision. These risks are uncommon in well-selected patients, but they are real and should be discussed before surgery. **Is a nose job the same as rhinoplasty?** A nose job is the everyday name for rhinoplasty, the plastic surgery that reshapes the nose and, when indicated, improves nasal breathing. In my former rhinoplasty practice the standard was structural rhinoplasty: an open approach in which cartilage grafts support the dorsum and the tip, so the shape stays stable over the years instead of collapsing the way the old reductive technique, which only removed bone and cartilage, often did. **How much is a nose job in Brazil?** The cost of a nose job in Brazil is set case by case, because a simple primary rhinoplasty and a structural revision with rib grafts are very different operations. The final budget depends on complexity, graft needs, hospital structure, anesthesia, estimated surgical time and postoperative follow-up, and the Brazilian Federal Council of Medicine advises against publishing prices on medical pages. An itemized estimate from a treating surgeon covers the surgeon, the anesthesiologist and the hospital. I no longer perform rhinoplasty or provide rhinoplasty quotes; the [pricing page](https://www.walterzamarianjr.com/us/pricing/) refers to currently offered procedures. **What is a “Brazilian nose,” and is there a Brazilian style of nose job?** There is no single Brazilian nose. Brazil’s population is highly mixed, so the noses I operated on ranged from the thin-skinned hooked nose common in descendants of Italians to the Afro-descendant nose with a low dorsum, wide tip and open nostrils, along with bulbous tips, wide dorsums, drooping tips and crooked noses. What people call a “Brazilian nose job” is simply rhinoplasty performed in Brazil, and in my former rhinoplasty practice it was planned for each anatomy with structural techniques rather than toward one standard shape. For the specific case of Afro-descendant noses, see my page on [rhinoplasty for the Afro-descendant nose](https://www.walterzamarianjr.com/us/face/rhinoplasty/ethnic-nose/). ## Fears ### Piggy Nose A short, very upturned nose, with nostrils showing, is one of the biggest fears of those considering rhinoplasty. Avoiding an over-rotated or artificial-looking nose is part of planning. If a requested change would not look natural or would compromise function, I explained that clearly during consultation. ### Michael Jackson Nose Another example of a feared result, with an unnatural nose, full of stigmas of having been operated on, with a tip that is too thin, too straight, with nostrils that have been excessively removed. Michael Jackson's nose was probably the most talked about in history, and at the same time became an anti-example of a desirable rhinoplasty result. After all, 17 nose surgeries were performed, as confessed to me by the American plastic surgeon who did the first rhinoplasty on the singer. ## What does the nose look like after rhinoplasty? This was probably the single most asked question in my rhinoplasty consultations. I believe patients deserve a clear, detailed answer — not a vague promise — so here is exactly what I observed in my practice. ### What changes visually After structured rhinoplasty the nose usually has a smoother dorsum (hump corrected), a more refined and defined tip, a more harmonious profile with the lip and chin, better-balanced nostrils from the frontal view, and subtle correction of asymmetries. In open approach with spreader grafts and septal extension graft, the dorsum stays straight and the tip remains supported over time, without the drooping or pinching that plagued the old reductive technique. The nose should look like a natural, well-proportioned nose — not a "done" nose. ### What patients report Patients often say they wanted a nose that looks more proportional rather than obviously operated. When functional correction is part of the plan, some also report easier nasal airflow after swelling settles. These reports vary, and my former rhinoplasty consultations were where I explained what is realistic for each anatomy. In my former rhinoplasty consultations, standardized photographs of real cases were reviewed in person; my [results gallery page](https://www.walterzamarianjr.com/us/gallery/) explains how that documentation works. ### When the result appears * **14 days**: splint and tape removed. The shape is already visible, but significant swelling remains, particularly at the tip and upper dorsum. This is not the final look. * **2 months**: approximately 85% of the swelling is gone. Photos at this stage already show a marked improvement and most patients feel comfortable in social settings. * **6 months**: the dorsum and bony third are practically settled. The tip still carries residual fibrosis, especially in thick-skinned patients. * **8–12 months**: the final result appears. The last 15% of swelling — mainly at the tip — fully resolves. In patients with very thick skin the full definition can take closer to 18 months. ### Why I don't show before/after photos In Brazil, publication of before/after photos is regulated by CFM Resolution 2.336/2023, which restricts display of surgical results in public advertising. As a physician registered with CRM-PR (the Paraná Regional Council of Medicine), I follow this resolution strictly. During my former rhinoplasty consultations I showed real cases from my own practice with the patient's authorization, within the ethical limits of the resolution. International patients considering rhinoplasty in Brazil should understand that the absence of before/after galleries on my website is a compliance matter, not a lack of results — I have performed over 8,000 surgeries in more than 20 years (today, by deliberate choice, 3 facelifts per week, ~150 per year). ## Does insurance cover rhinoplasty in Brazil? This is another recurring question, and the answer depends on what kind of rhinoplasty is being performed. **Cosmetic rhinoplasty** — when the goal is purely aesthetic — is not covered by Brazilian SUS (the public health system) nor by most private Brazilian health insurance plans. These are considered elective procedures. **Functional components** — septoplasty for a documented septal deviation, turbinoplasty for turbinate hypertrophy causing obstruction, or correction of internal nasal valve insufficiency — can be covered under Brazilian ANS regulations (the national health insurance agency) when there is a clear medical indication supported by clinical exam, nasal endoscopy and imaging (CT scan). Symptoms such as chronic nasal obstruction, recurrent sinusitis or sleep-disordered breathing typically justify the functional indication. **Combined cases** were the most common scenario in my rhinoplasty practice: the insurance plan covers the functional portion (septoplasty + turbinoplasty) and the patient pays the difference for the aesthetic refinement (dorsum, tip, osteotomies, cartilage grafts for aesthetic purposes). The surgical time is the same, so combining both approaches is almost always the most efficient path. Note: this coverage context is specifically Brazilian, since I practice in Brazil. International patients considering medical tourism for rhinoplasty in Brazil should check their own domestic health insurance for any coverage of functional nasal surgery performed abroad — most US, UK and EU private insurance plans do not reimburse elective cosmetic procedures performed outside the home country. ## Secondary Rhinoplasty Secondary is the plastic surgery of the nose for those who have already undergone a primary rhinoplasty (the first one being called primary). Often, it is necessary to complete an incomplete fracture, lower the dorsum, raise the dorsum with cartilage grafts, correct an inverted "V" with a spreader graft, correct the supratip, improve projection or definition of the tip with cartilage grafts or cartilage remodeling, correct superficial irregularities, improve scars from open rhinoplasty or nostril rotation, correct deviations, among others. ### Changes in Surgical Planning When performing secondary rhinoplasty, I did not use the same techniques as in primary rhinoplasty, or conventional rhinoplasty, because there would be the presence of fibrous scar tissue, changes that arose as a result of the previous rhinoplasty (primary rhinoplasty), and, mainly, it must be taken into account that the nasal structure is already more fragile after having undergone possible osteotomies, grafts, rasping, etc. performed in the first plastic surgery of the nose. When I considered the possibility of revising a rhinoplasty, it was ideal for the patient to have waited a year from the date of the primary nose plastic surgery (first rhinoplasty), as this is the necessary time for total recovery from a rhinoplasty, for the entire nasal structure to be completely healed, recovered, and with swelling gone. Technically, secondary rhinoplasty is more complex, as I dealt with distorted or even absent anatomy. Especially due to swelling, it is not advisable for secondary rhinoplasty to be performed before one year from the primary, as swelling is still present. The swelling between the nasal skeleton and the skin covering it could cause me to lose the parameters of the original structure of the nose, posing a high risk for the results, which may not align with what the patient desires. Therefore, I recommended waiting one year from the primary before undergoing secondary rhinoplasty. ### Candidates for Secondary Rhinoplasty In general, there are some prerequisites for a patient to undergo secondary nose plastic surgery, which are: * patients over 15 years old who have undergone a primary rhinoplasty, not achieving the desired results or who have experienced complications that prevented the desired result from being achieved; * patients dissatisfied with any visibly unaesthetic and/or perceptibly functional defect; * emotionally stable patients, that is, who are in good emotional and mental condition; * patients in good health and who have no contraindications to undergo secondary rhinoplasty; * patients aware and willing to undergo cartilage grafting, if necessary; * patients who are prepared, having an optimistic and realistic view of secondary rhinoplasty itself, always remembering the limitations involved in this procedure. These are just some of the general prerequisites, and even if the patient is in compatible conditions according to the requirements, in my former rhinoplasty practice they underwent a prior consultation with me, during which I evaluated the possible aesthetic and/or functional defects to diagnose the reasons for the failure of the previous surgery. I conducted a meticulous assessment of all the problems and points of dissatisfaction that bother the patient, so that I could outline the surgical planning that, this time, would be much more complex than that of a primary nose plastic surgery. ### Cartilage Graft Considering that most cases of treatment through secondary rhinoplasty that came to me involved patients with a lack of cartilage to produce a satisfactory nasal reconstruction, in my former rhinoplasty practice, this procedure had as its basic repair technique the use of grafts. When we deal with primary rhinoplasty, harvesting cartilage is usually not a problem, as this material is found in large quantities in the cartilaginous septum and in both ears. The preference is to use cartilage from the septum, to make the nose plastic surgery as minimally invasive as possible, however, harvesting cartilage from the septum is not always possible, as the patient may have had a deviated septum surgery in the first operation. In my former rhinoplasty practice, nothing prevented me from using cartilage from the septum and ears when they are available and will not weaken the nasal skeleton in secondary rhinoplasty. The cases of grafts vary greatly when the procedure is rhinoplasty, especially secondary. Despite being quite complex, it is also very important to always aim for individuality, naturalness, and compatibility with the patient's ethnicity in performing secondary rhinoplasty, as well as in primary rhinoplasty. ## More pages related to rhinoplasty: [Bulbous Nose Wide tip](https://www.walterzamarianjr.com/us/face/rhinoplasty/bulbous-nose/) [Afro-Descendant Nose Ethnic rhinoplasty](https://www.walterzamarianjr.com/us/face/rhinoplasty/ethnic-nose/) ## Rhinoplasty: current practice I no longer perform **rhinoplasty in Brazil** or offer consultations for **nose surgery**. The educational information on this page covers expectations, breathing, recovery, risks, travel timing and postoperative follow-up for readers considering **medical tourism for rhinoplasty in Brazil**. Information about the [consultation](https://www.walterzamarianjr.com/us/first-consultation/ "First Consultation in Brazil") refers only to procedures I currently offer. For those services, [contact the Zamarian Clinic](https://www.walterzamarianjr.com/us/contact/ "Contact us"). Also, learn about [revision rhinoplasty](https://www.walterzamarianjr.com/us/face/revision-rhinoplasty/ "Revision Rhinoplasty in Brazil"), [septorhinoplasty](https://www.walterzamarianjr.com/us/face/septorhinoplasty/ "Septorhinoplasty in Brazil") for combined functional and aesthetic correction, [ultrasonic rhinoplasty](https://www.walterzamarianjr.com/us/face/ultrasonic-rhinoplasty/ "Ultrasonic Rhinoplasty in Brazil"), and [ethnic rhinoplasty](https://www.walterzamarianjr.com/us/face/ethnic-rhinoplasty/ "Ethnic Rhinoplasty in Brazil"). For men, see the educational page on [male rhinoplasty](https://www.walterzamarianjr.com/us/face/male-rhinoplasty/ "Male Rhinoplasty in Brazil"). Also, see the pages about [bulbous nose correction](https://www.walterzamarianjr.com/us/face/rhinoplasty/bulbous-nose/ "Bulbous Nose Correction in Brazil") and [ethnic nose rhinoplasty](https://www.walterzamarianjr.com/us/face/rhinoplasty/ethnic-nose/ "Ethnic Nose Rhinoplasty in Brazil"). Procedures frequently combined: silicone chin augmentation for profile enhancement, [facelift](https://deepplanefaceliftbrazil.com/ "Deep Plane Facelift in Brazil"), and [blepharoplasty](https://deepplanefaceliftbrazil.com/surgery/blepharoplasty/ "Blepharoplasty in Brazil"). For currently offered procedures, see information about [investment](https://www.walterzamarianjr.com/us/pricing/ "Investment in Plastic Surgery") and [pre-surgical preparation](https://www.walterzamarianjr.com/us/pre-surgical-preparation/ "Pre-Surgical Preparation"). ## Rhinoplasty Cost in Brazil The **rhinoplasty cost in Brazil** is one of the most frequent questions from international patients considering **nose job Brazil** options. People searching for an average cost or price range for rhinoplasty in Brazil should know that the final budget depends on case complexity, whether the surgery is primary or revision, graft needs, hospital structure, anesthesia, estimated surgical time and postoperative follow-up. The Federal Council of Medicine advises that prices not be disclosed on medical pages, precisely because each case is different. A simple primary rhinoplasty has a different cost than a structural rhinoplasty with rib grafts, for example. Cost may differ between countries, but it should never be evaluated apart from surgeon qualification, accredited facility, anesthesia safety, travel logistics and follow-up. A complete budget for **rhinoplasty in Brazil** includes surgeon, anesthesiologist and hospital fees. I no longer perform rhinoplasty, so my practice does not provide rhinoplasty quotes. For procedures I currently offer, you can [schedule your evaluation](https://www.walterzamarianjr.com/us/contact/ "Contact us"). ### Contact for currently offered procedures [](https://wa.me/16402248116?text=Hi!%20I%20saw%20your%20website%20and%20would%20like%20more%20information.) ### [WhatsApp 24/7](https://wa.me/16402248116?text=Hi!%20I%20saw%20your%20website%20and%20would%20like%20more%20information.) ### [Dr. Walter Zamarian Jr.](https://www.walterzamarianjr.com/us/) Plastic Surgeon in Londrina - Brazil Rua Engenheiro Omar Rupp, 186 Londrina - Brazil ZIP 86015-360 Brazil #### YouTube Channel: [Dr. Walter Zamarian Jr.](https://www.youtube.com/@drwalterzamarianjr "Dr. Walter Zamarian Jr.'s Channel") #### Follow on Instagram: [@drwalterzamarianjr](https://www.instagram.com/drwalterzamarianjr/ "Instagram of Dr. Walter Zamarian Jr.") #### Follow on TikTok: [@drwalterzamarianjr](https://www.tiktok.com/@drwalterzamarianjr "TikTok of Dr. Walter Zamarian Jr.") #### Search on our website: #### This page in other languages: [Portuguese (BR)](https://www.walterzamarianjr.com/face/rinoplastia/) | **English (US)** | [English (UK)](https://www.walterzamarianjr.com/uk/face/rhinoplasty/) | [Italian](https://www.walterzamarianjr.com/it/viso/rinoplastica/) | [French](https://www.walterzamarianjr.com/fr/visage/rhinoplastie/) | [Spanish](https://www.walterzamarianjr.com/es/rostro/rinoplastia/) ## Related Procedures * [Ethnic rhinoplasty](https://www.walterzamarianjr.com/us/face/ethnic-rhinoplasty/ "Ethnic rhinoplasty in Brazil") * [Male rhinoplasty](https://www.walterzamarianjr.com/us/face/male-rhinoplasty/ "Male rhinoplasty in Brazil") * [Revision rhinoplasty](https://www.walterzamarianjr.com/us/face/revision-rhinoplasty/ "Revision rhinoplasty in Brazil") * [Ultrasonic rhinoplasty](https://www.walterzamarianjr.com/us/face/ultrasonic-rhinoplasty/ "Ultrasonic rhinoplasty in Brazil") * [Septorhinoplasty](https://www.walterzamarianjr.com/us/face/septorhinoplasty/ "Septorhinoplasty in Brazil") * [Bulbous nose correction](https://www.walterzamarianjr.com/us/face/rhinoplasty/bulbous-nose/ "Bulbous nose correction in Brazil") * [Ethnic nose](https://www.walterzamarianjr.com/us/face/rhinoplasty/ethnic-nose/ "Ethnic nose rhinoplasty in Brazil") * [Facelift](https://deepplanefaceliftbrazil.com/ "Deep Plane facelift in Brazil") * [Blepharoplasty](https://deepplanefaceliftbrazil.com/surgery/blepharoplasty/ "Blepharoplasty in Brazil")