Dr. Ouakil has always been passionate about rhinoplasty. The information provided here by a specialist aesthetic surgeon should answer all your questions about rhinoplasty. Dr. Ouakil primarily practices ultrasonic rhinoplasty. He is an expert trained by the best Brazilian and French aesthetic surgeons, with over 30 years of experience in the field of facial aesthetic surgery. Please refer to the pricing page for average indicative prices for rhinoplasty.

As a central element of the face, the nose contributes significantly to facial beauty and the expression of personality. It plays a major role in defining and deepening the gaze.

Rhinoplasty requires rigorous analysis and careful preparation for the procedure.

Can a custom nose surgery be performed?

• Rhinoplasty remains one of the most delicate aesthetic surgery procedures. It depends on morphological, psychological, ethnic, and technical factors.
• The aesthetic analysis of the face is crucial (profiloplasty), as the nose must be harmoniously integrated with the rest of the face and the patient's overall morphology; the psychological profile must also be carefully defined to propose a nose that suits the character and personality of the patient. The tastes and preferences of the patient will be interpreted and integrated into the reflection.
  It is essential to define the natural appearance of each individual according to socio-cultural aesthetic criteria, while attentively listening to the request and identifying the patient's expectations as precisely as possible.
• I willingly suggest that the patient select photos of rhinoplasty found on social media that they like and that resonate with them to deeply understand their expectations. These serve as a concrete starting point for developing the project and help visualize the potential limits of the project.
• There should not and cannot be a standard nose. The aesthetic surgeon who claims to specialize in rhinoplasty must master all techniques and approaches to offer the most suitable result. Dr. Ouakil regularly participates in conferences and additional training to stay at the forefront of the latest innovations in rhinoplasty. Rhinoplasty (aesthetic nose surgery) will always be personalized, with broad possibilities for modifications and varied options. If one claims to be one of the best aesthetic surgeons specializing in rhinoplasty, one must dedicate a lot of energy and time, constantly staying informed about innovations and advancements in the field. Current and modern rhinoplasty techniques are radically different from those taught to me in the 80s and 90s by my mentors.
• An aesthetic nose surgery that corresponds to your natural appearance will be developed, and a before/after simulation of the rhinoplasty will be created.
• However, the options and proposals will still be subject to morphological, anatomical, and technical constraints. It is important to keep in mind that many criteria, particularly skin quality (thickness, lack of elasticity), sometimes limit the objectives of the surgical correction of the nose. For example, it is impossible to create a fine and shortened tip on a wide nose with thick skin.

What methods can be used to develop a personal project?

• Visualizing "before-after" photos of cases similar to yours will help understand the expected result. A simulation using photos taken during the consultation will be performed by the aesthetic surgeon to refine the preparation for the rhinoplasty procedure and ensure a complete understanding of the project.
• The design of the custom surgical project will be the result of in-depth communication where all your aspirations will be discussed, and all realistic possibilities for change that the aesthetic surgeon can bring to your nose will be conveyed. The patient's selection of photos of noses, in a "like/dislike" format, will help align closely with their wishes. Under no circumstances can the patient "choose" a nose. It is their future nose that must be designed based on an existing foundation.
• The development of new technologies such as ultrasonic rhinoplasty (rhinosculpture) using piezoelectric energy allows for even more refined actions by the aesthetic surgeon who will perform a true aesthetic micro-surgery of the nose. We have moved from the Stone Age to diamond cutting; this can be compared to goldsmithing.
• This involves an open rhinoplasty, "in the open air." Consequently, this technique is much more precise and reliable, thanks to the direct visualization of the structures to be modified.
• Similarly, Preservation Rhinoplasty techniques that preserve and modify certain structures like the dorsum offer very reassuring options regarding the final natural appearance of the rhinoplasty. They increase the reliability and safety of creating the new dorsum of the nose.

What structures can be modified during a rhinoplasty?

The dorsum of the nose

If it is too wide from the front, it needs to be refined; if the nose is twisted, deviated to one side, and highly asymmetrical, it can be straightened (not to be confused with a deviated septum, which is an internal problem requiring a septoplasty). If it is too prominent from the side (hump), it needs to be reduced; this is referred to as Structural Rhinoplasty. If the nose is overall too large without presenting a pronounced hump, we can modify and retract the entire nasal pyramid, including the dorsum, without resecting the hump; this is called Preservation Rhinoplasty.

An ethnic rhinoplasty correcting a nose deemed too flat or broad, or a secondary or post-traumatic rhinoplasty for a saddle nose (too sunken) will involve adding material (cartilage graft, bone, or implant) to (re)create a fine and projected dorsum.

The cartilage for augmentation rhinoplasty will be harvested either from the nose at the level of the septum, from the ears, or through a rib harvest if a solid architectural support is needed and if significant quantities are required.

Medical Rhinoplasty finds its ideal application in the desire to conceal irregularities or camouflage a small hump without surgery through the injection of Hyaluronic Acid. It is performed in the office and the result lasts for several years.

The tip of the nose

If it droops, it will be elevated, projected, and stabilized. If it is too long, it can be shortened but generally only moderately, especially if the skin is thick. If it is too flat, too round, or poorly "shaped," it will be reconstructed; this is referred to as tip definition.

A radical modification may sometimes be necessary, involving minimal resection, restructuring, and addition. It is always essential to preserve the strength of the nasal respiratory valve.
A remodeling to refine a tip that is too wide or too square can indeed be done alone, without touching the rest of the nose. This is referred to as Tip Rhinoplasty.

I emphasize here the difficulties, if not impossibilities, due to thick skin. The lack of retraction capacity prevents the shortening of the profile, risking a rounded tip resembling a ball. One should not hesitate to decline the procedure if this crucial point is not understood, accepted, or integrated. The objectives will always be adapted to reality, and the project will always be considered with transparency and honesty. Dissatisfaction after rhinoplasty often stems more from a lack of communication and preoperative explanations than from a technical execution problem.

The nostrils

If they are too wide or too thick, they can be reduced at the cost of a small scar hidden in the rounded hollow at the base of the nostrils, in the lower half of the alar groove at the top of the nasogenian groove, and ending at the level of the nostril threshold.

This is referred to as Reduction of the nasal alae. This will be almost systematic during ethnic rhinoplasty.

Can a septum problem (septoplasty) be treated at the same time as a rhinoplasty?

Yes, it is sometimes necessary to straighten a deviated nasal septum, which can cause respiratory discomfort. It sometimes contributes to a global deviation of the nose. Treating a septal deviation is part of the aesthetic rhinoplasty project as it is part of the architecture of the nose.

Moreover, any functional issues such as a blocked nose, tendency to allergic rhinitis, or even sinusitis will be investigated. A preoperative consultation with an ENT doctor will almost systematically be requested in this case. A preparatory medical treatment for nasal surgery or surgical intervention such as turbinate surgery (turbinectomy) should be proposed, possibly simultaneously and with a dual team during the rhinoplasty.

At what age can one benefit from rhinoplasty?

Rhinoplasty can be performed from the age of 16-17, which is the end of growth and development of the nose. However, it is advisable to wait until 18-20 years, a period of maturity, before making such a decision, fully aware and outside of a post-adolescent crisis. The demand for rhinoplasty, driven particularly by social media, is starting at a younger age. It is crucial to analyze the actual level of complex that accompanies it before embarking too early on an irreversible modification.

Regarding the law, parental consent is required before the age of 18.

For older individuals, rhinoplasty is always a possibility. Life circumstances sometimes only allow for self-care later on. It is vital never to give up on such a project if the suffering caused by an aesthetically unpleasing nose appears consistently. A significant degree of facial rejuvenation is often observed as a result of rhinoplasty in such cases.

What type of anesthesia is used?

Rhinoplasty is almost always performed under general anesthesia, but it can sometimes be done under deep sedation (neuroleptanalgesia) combined with local anesthesia.
In certain cases of very localized modification (of the tip or nostrils), pure local anesthesia is possible. This is the case for some touch-ups.
However, these are relatively rare cases; in most instances, we will resort to general anesthesia.

On the other hand, it is most often performed on an outpatient basis (discharge on the same evening).

What are the aftereffects of rhinoplasty?

After a short hospitalization of 12 to 36 hours maximum, returning home is permitted. The aftereffects are almost painless.
Upon waking, you will either have gauze or soft mini sponges blocking the nostrils, or silicone tubes allowing air to pass through.

The gauze will most often be removed the next day by the patient themselves.

If a septoplasty (i.e., straightening the internal septum) or cartilage harvesting is performed at the level of the septum during the rhinoplasty, then soft silicone tubes will be placed. These will be removed by your surgeon after one week.

A resin splint is systematically placed on the nose for 6-8 days. During this period, the eyelids and upper cheeks will be swollen and may show bruising (ecchymoses) to varying degrees. Cold saline masks will be prescribed. The marks will appear gradually (even if one is sometimes less swollen at the clinic), peaking at 48 hours. Within 10 days, during which the bruises descend on the cheeks and change color, the face regains an appearance compatible with normal social and relational life. Ultrasonic rhinoplasty (rhinosculpture) helps reduce postoperative bruising (ecchymoses) through the gentle technique of bone cutting, thus offering a faster recovery.
Saline rinses will be performed 4 to 5 times a day after the gauze is removed.

During the first follow-up at one week, the stitches, splint, and tubes will be removed at the aesthetic surgeon's office.

Where are the scars located during a rhinoplasty?

For a long time, rhinoplasty scars (known as closed) were located only in the mucous membranes, hidden inside the nose, made with absorbable stitches.
The development of open rhinoplasty (notably thanks to American surgeons in the 90s, led by Dr. Gilbert Aiach in France) results in an additional skin scar at the level of the columella, connecting the two intra-nasal mucosal scars (right and left). This allows for lifting the skin of the nose, providing a direct "open-air" view.

It has become routine (it is even mandatory in ultrasonic rhinoplasty), allowing for subtle, anatomical, and precise work.

In cases of overly long, wide, or asymmetrical nostrils, a reduction of the nasal alae will require a scar hidden in the hollow around the nostril, connecting to the entrance of the nostrils.

When can the final result be judged?

This is a fundamental point. The journey is long, and one must be patient regarding rhinoplasty. The nose evolves over a long period of 12 to 24 months. After 2 months, the result of a rhinoplasty is considered advanced, but in some cases, it may still be far from the final appearance. The nose is normally solid after these 2 months, and all activities, including sports, are then permitted.

The details of the contour of the nose, particularly the tip, will always appear gradually and sometimes very slowly during the year following the procedure. A certain degree of prolonged swelling and sometimes the appearance of fibrosis can delay this process.

Sun exposure is prohibited for one month after rhinoplasty.

If small defects such as irregularities or slight asymmetry of the tip appear, additional time under local anesthesia is generally possible, but not before 12 months. In the meantime, injections can be done.