Rhinoplasty in San Francisco & Sonoma County

Rhinoplasty, or nose surgery, is a complex procedure that can improve both the shape and function of your nose.

• An ideal esthetic outcome helps bring your nose into harmony with the rest of your face and in some cases, can help you look younger or more feminine / masculine.
• An ideal functional outcome improves airflow through your nose, optimizes exercise performance, and can relieve nasal congestion, mouth-breathing, and dry-mouth. Rhinoplasty can also improve deformities inside your nose (intranasal pathology), which can decrease sinus or headache symptoms in some patients.

• Dr. Pourtaheri is a rhinoplasty specialist who is passionate about the procedure and providing you with the best possible result.
• Dr. Pourtaheri’s philosophy is that great results should be unique to your tastes, be in balance with your face, be achievable within the bounds of your anatomy, and optimize your function.
• Dr. Pourtaheri has a PhD in medical modeling and imaging. He performs extensive 2-D and 3-D photography to analyze your nose and face from every angle. He uses presurgical planning to make your surgery safer, faster, and more accurate.
• Dr. Pourtaheri completed some of the most extensive rhinoplasty training available from recognized experts in the field.
• Through his six years of plastic surgery residency, Dr. Pourtaheri trained with one of the top rhinoplasty surgeons in the world, Dr. Bahman Guyuron. He learned sophisticated techniques to analyze the face, scientifically create a patient-specific plan, and deliver long-lasting results.
• Dr. Pourtaheri also completed a craniofacial fellowship and trained with Dr. Derek Steinbacher. He learned modern approaches to evaluate and correct the nose in context of the rest of the face and how to optimize the nose when performing jaw surgery.
• Dr. Pourtaheri has given numerous national and international presentations and written several articles on rhinoplasty published in peer-reviewed scientific journals.

It’s time to take the next step and see the difference rhinoplasty can make for you. Please contact us online or call 415-523-5235 to schedule a consultation with Dr. Pourtaheri.

Rhinoplasty is commonly performed after facial growth is nearly complete, around 16 years of age. There are gender differences in facial growth and reasons to perform surgery sooner or later. If you are also interested in jaw surgery, we recommend that you undergo jaw surgery prior to rhinoplasty because changes to the jaws can affect the nose.

If you recently suffered an injury to your nose or facial bones, we will plan your surgery at least 3 months after injury to allow swelling to resolve before performing rhinoplasty. If you have any questions about your eligibility for the procedure, please request a consultation.

Common reasons why patients pursue rhinoplasty include having:

• A large nose or wide nose
• A small nose or pinched nose
• A hump on profile view, or crooked on front view
• A tip that droops or tip that is too upturned
• A tip that is too bulbous or too flat
• A nose that is too long or too short
• A nose that is too masculine or feminine
• Collapsing nostrils, or nostril asymmetry
• A deviated or perforated septum
• Difficulty breathing through the nose

A history of prior nasal trauma can explain some deformities. Other concerns may be due to under- or over-development of certain structures. It can help if you bring images of noses that you do like to help us understand your goals. Please keep in mind that example noses are best selected from people who otherwise look similar to you. Also be aware that many photos you find online are digitally enhanced.

Before your first visit, you will be asked to complete an intake form to document your personal and medical history, prior surgeries, medications, and allergies. We also ask that you bring photographs of your nose from prior to your injury, if that is applicable.

At your visit we will review your goals and concerns. We will also want to learn more specifically about any prior facial procedures you have had performed. We will examine your overall face and nose from various angles, including the inside of your nose. The examination will not be uncomfortable. Sometimes a CT (computed tomography) scan is helpful to assess for causes of breathing difficulty, sinus problems, or migraine headaches. We will take photographs that will be used to plan your surgery and track your progress after surgery. You will have a chance to review these images and discuss the plan with Dr. Pourtaheri prior to surgery.

Dr. Pourtaheri is thoughtful about rhinoplasty and ensures he is satisfied with your results before leaving the operating room. Your procedure can generally take a couple hours depending on the approach and complexity of the necessary changes.

There are many techniques in nose surgery, but four general approaches:

• Liquid rhinoplasty is not conventional surgery and is performed in the office by injecting dermal fillers to camouflage aspects of the nose and improve esthetics – nasal function is generally not improved. It can be a great option for someone not quite ready for surgery but would like to enjoy an improved appearance temporarily until surgery is an option.
• Septoplasty is surgery to correct a deviated or problematic septum inside the nose. This can be done through incisions made inside the nose, leaving no visible scar. Proper handling of the septum is critical to a good outcome in nose surgery.
• Closed rhinoplasty surgery involves reshaping the nose and septum, placing grafts through incisions made inside the nose to improve appearance and breathing, leaving no visible scar.
• Open rhinoplasty surgery allows additional changes to be made under direct vision by making a small, camouflaged skin incision between the nostrils. An open approach can increase recovery time but provides better visualization and access to the nasal structures. If your nasal bones need to be repositioned this may increase recovery time as well.

In addition, Dr. Pourtaheri offers:

• Preservation rhinoplasty, a form of rhinoplasty that involves preservation of existing structures to prevent destabilization of the nose.
• Nasal reconstruction performed to correct deformities from birth defects, trauma, prior surgeries, or cancer.
• Revision rhinoplasty for patients who have had a previous rhinoplasty from another surgeon and desire additional correction. It requires added skill and planning to fix a nose with surgically-altered anatomy.

Dr. Pourtaheri will tailor his approach and technique to optimize your function and suit your nasal anatomy, facial appearance, and desired changes. He strives to provide results that appear natural and accomplishes your goals. During your consultation, he will discuss which approach is best for you and answer all of your questions.

After the operating room, you will be taken to a recovery area to be cared for. You will go home the same day or recover in a hotel if you have traveled in from out of town. You may have splints, bandages, stents, or sutures that should be kept in place. These generally come out 8 to 10 days after surgery. We recommend that you take those days off from work.

Everyone is given antibiotics on the day of surgery but you may also need to take them after surgery. We also prescribe pain medications to limit discomfort. You will receive after-care instructions before and after your surgery and have plenty of time to ask questions.

After surgery, your nose and eyelids may have bruising, swelling, and soreness
that will gradually go away. It is best to sleep with your head elevated on 2 or more pillows and not strain yourself for 2 weeks to reduce swelling. Regular walking is encouraged to prevent blood clots, starting the morning after surgery.

We will call to check on you the day after surgery, and plan to see you in person 8 to 10 days after surgery. We will schedule additional visits to check on your healing progress, which can be done virtually if you live out of town.

Healing takes time. Most patients feel comfortable socializing after 2 to 3 weeks. The bulk of the swelling resolves within 3 to 6 weeks. Your nose will continue to make gradual changes and your final results may take a year to be fully evident.

There are few things that are more personal than the decision to undergo plastic surgery. Dr. Pourtaheri encourages all of his patients to learn all they can before they go through with rhinoplasty surgery. We are ready to answer your questions any time, but you may want to review this list of common questions before you request a consultation to talk more with Dr. Pourtaheri in person.

How Do I Decide What Nose Shape Best Matches My Face?
During your consultation, Dr. Pourtaheri will talk with you about your areas of concern and offer suggestions on what can be done to achieve your goals. If there’s a model, friend, or other person whose nose you like, sharing photos of them may be a good starting point to convey your goals. With these photos in mind, 2D and 3D modeling can show you an approximation of what you may look like with your future nose.

How Can I Ensure My Nose Surgery Will Look Natural?
Thorough communication between patient and surgeon are essential for achieving a highly satisfying nose surgery result. We welcome you to return to our office, call or email with any follow-up questions after your consultation so we can make sure you feel confident that you will be able to achieve the look you have in mind. Also important, is selecting a surgeon who values a natural look, like Dr. Pourtaheri.

Can a Rhinoplasty Improve My Breathing?
Nose surgery done purely for esthetic reasons does not change a patient’s breathing. Functional nose surgery, such as modification of the nasal septum (septoplasty) turbinates (turbinectomy), and nasal vault (bony and cartilaginous dorsum) is designed to open the nasal passages, improving air flow and breathing. During your consultation, Dr. Pourtaheri will talk with you about whether you are having any breathing problems, snoring, or congestion. He will also examine your nose in detail to diagnose any abnormalities or structural concerns. Based on this discussion and review, he can plan the appropriate surgical technique to improve those symptoms. Some patients do not know they had breathing problems until after having nose surgery with Dr. Pourtaheri and feeling the difference.

Will Health Insurance Pay for a Rhinoplasty?
Most health insurance companies will not cover rhinoplasty performed for esthetic reasons, similar to all other types of cosmetic surgery. However, many will cover nose surgery to address breathing difficulties, or to repair damage to the nose (reconstructive nose surgery). Dr. Pourtaheri has a good sense if insurance may cover your nose surgery. If your procedure is in part or completely covered by insurance, we can walk you through the process.

How Old Do I Have to Be to Have Nose Surgery?
Dr. Pourtaheri typically does not perform rhinoplasty on anyone younger than 16 years old, since the nose continues to develop and change shape through the mid-teens. If someone under 16 is experiencing developmental problems or significant difficulty breathing with their nose, it may be appropriate to perform rhinoplasty.

What Type of Anesthesia Do You Use?
Dr. Pourtaheri can perform rhinoplasty with the patient under mild sedation along with local anesthesia, or can use general anesthesia. In either case, you will be safely sedated and not remember any part of the procedure or feel discomfort while the surgery is performed. Note that liquid rhinoplasty does not require anesthesia and can be performed in the office using fillers.

Will I Have Bruising or Black Eyes after My Rhinoplasty?
The nose is a delicate part of the face with a rich blood supply. Any disruption of the tissues often leads to bruising and swelling. That said, Dr. Pourtaheri has been trained in advanced surgical techniques designed to minimize the degree of bruising after rhinoplasty. If you are likely to experience some bruising after surgery, Dr. Pourtaheri will detail what you can do both before and after surgery to minimize a swollen or bruised appearance. This may include avoiding certain medications and taking medications or supplements to control inflammation, high blood pressure, or bruising.

How Soon Can I Return to Work?
We suggest taking around 10 days off of work for most jobs. If your job involves physical labor, you may need to take more time so that you don’t risk negatively impacting your results. On a related note, you should plan to take 2 to 4 weeks off from any heavy exercise so that you give your nose sufficient time to heal. Lighter exercises such as walking and light hiking may be appropriate after a rhinoplasty.

How Long Until I See Final Results?
About 3 months after surgery, most swelling should be gone and you should have a good sense of how your new nose will look. Minor swelling will continue to resolve for up to a year after your procedure.

I’m Disappointed with the Rhinoplasty I Had. Can You Fix It?
Revision nose surgery is much more complex than a primary procedure due to changes in the anatomy, lack of donor cartilage, and scarring. For that reason, it is essential to choose a surgeon who has experience addressing surgically-altered noses. Dr. Pourtaheri has extensive experience in all forms of rhinoplasty and can offer techniques to help get your nasal appearance and function back on track.