The Nose’s Effect on the Face

When you think of beautiful people—celebrities, models, famed kings and queens—do you remember a specific aspect of their face? Or do you remember their natural beauty and their enduring confidence? Most likely, it’s the latter. And if there’s one feature that gracefully slides into anonymity, it’s their nose. On the other hand, there are those who we remember specifically because of their nose—its size or shape defines their entire face, their entire look. The nose, more than any other, is the defining feature of the face. A fitting, balanced nose can lead to self–confidence and the perception of beauty, while a malformed or anomalous nose can ruin a positive self–image.

Perhaps no other operation in plastic surgery has a greater impact in enhancing the way you look than rhinoplasty. Rhinoplasty is a procedure designed to improve the shape of the nose. Even a subtle change can have a big impact on the attractiveness and balance of the face. Rhinoplasty is also employed in cases where the nose is physically deformed and can alleviate difficulty breathing. In balancing the proportions of the nose in relation to the rest of the face, rhinoplasty—like every procedure at Carmel Valley Facial Plastic Surgery—is intended to bring our patients the confidence and happiness that comes with loving your look!

rhinoplasty patient
Rhinoplasty Patient
before and after nose surgery
Rhinoplasty Patient: Closed rhinoplasty
before and after photo
Rhinoplasty Patient: Tip rhinoplasty and nasal length reduction
before and after rhinoplasty procedure
Rhinoplasty Patient

Our Unique Treatment Approach

Our approach to rhinoplasty is different from what you might find elsewhere, primarily because of our comprehensive approach to all of our procedures. Rather than merely change the nose to the patient’s predisposed dreams or expectations, we take into account their entire face. Often, the patient—and even other surgeons—don’t realize the effect other features of the face (especially the chin) can have on the perception of the nose. A small or undersized chin, for example, can contribute to the illusion of a larger nose. In such cases, it may be a chin augmentation rather than an extensive rhinoplasty that’s required.

We always take into consideration the shape and dimensions of your face as whole, rather than your nose as a single entity, when considering the best course for the rhinoplasty procedure. This ensures that our patients not only look their best, their noses also look natural and suit their face.

Rhinoplasty is one of the most technically demanding and difficult operations in plastic surgery. No other operation requires the depth and breadth of specialized techniques as rhinoplasty, which are required to handle the wide range of nasal types. Dr. Karam’s extensive experience and unique training background in Otolaryngology (ENT), followed by a Fellowship in Facial Plastic and Reconstructive Surgery, allow him to give patients the highest level of care and outcome possible. Creating noses that are attractive, natural looking and functionally safe accounts for Dr. Karam’s high rate of patient satisfaction and low rate of revision surgery.

The Procedures

Primary Rhinoplasty

Primary rhinoplasty indicates that it is the first rhinoplasty surgery performed on the patient. The first operation offers the best opportunity to obtain an excellent and predictable outcome. Seeking out a rhinoplasty specialist like Dr. Karam for this first operation significantly increases the chances of obtaining an excellent rhinoplasty result and decreases your chances of a revision. At Carmel Valley Facial Plastic Surgery, the goal in primary rhinoplasty is to create a nose that enhances the attractiveness of the entire face, while preserving or improving nasal function, specifically breathing. Each nose is unique, and therefore an individualized operative plan is developed for each case, a plan which takes into account the patient’s anatomy and cosmetic goals.

Secondary Rhinoplasty

Secondary, or revision, rhinoplasty is a specialty within a speciality, one which Dr. Karam is expert in. Patients with cosmetic or functional breathing problems following primary rhinoplasty often seek Dr. Karam for resolution of these issues. Usually this is an emotional process; following the questionable results produced at the hands of surgeons, these patients seek out the trusted and talented hands of Dr. Karam. They often travel from around the country in hopes of correcting their nasal deformity.

Secondary rhinoplasties are often the most challenging cases. They require the highest level of planning, judgment and surgical expertise. Many complexities come along with corrective techniques, including reconstruction with multiple grafts and even rib grafts. In certain scenarios, innovative and simple techniques can be used to correct the problem without the need for surgery. If you’re unhappy with your rhinoplasty results or have trouble breathing as a result of rhinoplasty, secondary rhinoplasty with Dr. Karam is your best option for relief.

Special Cases

Dr. Karam’s specialized training and experience allow him to take on the most demanding and unusual cases. He can successfully help patients with challenging tips (boxy, infantile, broad, ptotic, over–projected, under–projected, over–rotated, under–rotated), nostril disproportions, traumatic noses (deviated, crooked, saddle, fractured), size issues (too big or small), skin issues (unusually thick or thin) and length issues (too short or long). Regardless of your nose’s uniquities, Dr. Karam can help you achieve the nose you’ve always desired.

Ethnic Rhinoplasty

Ethnic rhinoplasty is a unique specialty within rhinoplasty and refers to procedures performed on non–Caucasian patients. Dr. Karam specializes in a variety of ethnicities, including the Hispanic nose, the Middle Eastern nose, the Asian nose and the African American nose. Each ethnic group has unique features that need to be respected when performing ethnic rhinoplasty; otherwise, the results will look unnatural and unattractive. Dr. Karam has performed extensive research on the topic of ethnic noses and has lectured and published his work nationally.

Is Rhinoplasty Right for Me?

Rhinoplasty is one of the most metamorphic facial plastic surgeries, and we encourage you to complete extensive research and ask as many questions as possible before you commit to rhinoplasty. After careful consideration, rhinoplasty might be right for you if:

  • Your nose is noticeably disproportionate with the rest of your face
  • You’ve long considered changing the appearance of your nose
  • You experience difficulty breathing through your nose
  • Following a trauma to the face that changed the appearance of the nose
  • You’ve undergone rhinoplasty in the past but are unhappy with your results

Advantages of Rhinoplasty

  • Can completely transform the proportions of your face, while still retaining your personal look
  • Permanent results
  • Short recovery (1–2 weeks)
  • Potential to create harmony and beauty in the whole face
  • Opportunity to improve breathing

Complementary Combinations

The relationship between the nose and chin is often overlooked when assessing the aesthetics of the face. Many individuals with small or undersized chins are not aware of the extent to which this feature is contributing to the illusion of a larger nose. In many cases, only minor refinements of the nose are required to significantly improve the nasal aesthetics when accompanied with chin augmentation. There are many options for chin augmentation, but the most common approach is using a chin implant to balance the proportions of the face. This is most commonly done at the time of rhinoplasty with minimal additional recovery.
The shape and fullness of the cheeks can also have an impact on the nose. Cheeks that have lost fullness as a result of fat loss from age or genetics (in younger patients) will make the nose appear more prominent. Fat transfer is commonly done at the same time as a rhinoplasty to improve this relationship of the nose and the face and make the whole face appear more healthy and attractive.

Procedures and Anesthesia

Rhinoplasty is typically an outpatient procedure performed under general anesthesia and takes anywhere from two to four hours to perform. Procedures are performed in our accredited and certified (JCAHO and Medicare) surgical center, Carmel Valley Surgical Center, located within the suite. The center offers the highest level of safety and state regulations for outpatient surgery. Highly–trained and experienced surgical techs, medical assistants, nurses and a Board Certified Anesthesiologist all work together to create the safest and most comfortable experience possible. Carmel Valley Surgical Center hosts two state–of–the–art surgical suites and a recovery center. The rooms are equipped with only the best equipment and instruments, and the center also has a separate entrance and exit from the main office, which allows our patients to undergo procedures in privacy. Your comfort is always our priority during these surgical procedures.

Post Procedure Care

Following rhinoplasty, you will leave the office and return home or back to your hotel. A gauze bandage will be placed below your nose and taped to your cheeks, which will be used for the first 24–48 hours as a drip pad. You will be asked to apply frozen peas or gel packs to the sides of the cheeks to reduce swelling. The more time spent upright, the better; sitting upright helps resolve swelling. Starting on the day following surgery, you will be asked to use saline spray to keep the inside of the nose moist hydrogen peroxide to clean incision lines inside and outside the nose. Showering is permitted at any time, but the nose and the splint cannot get wet until day seven. Pain medicine is prescribed but often not necessary after the second or third day.


The recovery time following rhinoplasty usually takes between one to two weeks. A splint is placed on the nose, which will be removed after one week. Our patients typically don’t have nasal packing, which significantly reduces post–operative discomfort. Following surgery, several post–operative visits will be made. You will be seen at one week for suture and splint removal. Thereafter, you’ll be seen at one, three, six and 12 months after surgery. The appearance of the nose continues to improve during the first year and beyond. The swelling decreases in subtle but noticeable ways for years after surgery. Dr. Karam believes it is important to maintain a long term relationship with all his rhinoplasty patients in order to ensure an optimal and successful outcome.

What to Expect: Results

Rhinoplasty patients can expect to see:

  • Improved nasal–facial harmony
  • A natural–looking ideal nose that looks like the nose you were born to have
  • Improved or stable nasal function

Why Choose Dr. Karam for Your Rhinoplasty

When choosing a surgeon to perform such a complex and transformative procedure as rhinoplasty, it’s absolutely integral that your surgeon has extensive experience with the surgery. Dr. Karam is a unique plastic surgeon—his specialization in and devotion to facial plastic surgery makes him an expert in the subject, especially rhinoplasties. His background and board certification in both Facial Plastic Surgery as well as in Otolaryngology (head and neck surgery) make him optimally trained in dealing with simple and complex aesthetic and functional aspects of the nose. Whereas most plastic surgeons perform less than 20 rhinoplasties a year, Dr. Karam performs over 150 annually. Although part of Dr. Karam’s expertise in rhinoplasty can be attributed to his extensive experience, much of his expertise actually stems from his innate talent. Much of facial plastic surgery is akin to art; it requires an artistic eye and a sculptor’s touch, both of which Dr. Karam was simply born with. His talent in rhinoplasty far exceeds that of most surgeons. Dr. Karam’s careful and intentional approach ensures that no one changes their identity, but simply looks their absolute best. Dr. Karam’s expertise in the subject has also prompted him to write a number of book chapters and scientific articles on facial plastic surgery topics, including rhinoplasty, secondary rhinoplasty and ethnic–specific (for example, Asian) rhinoplasty.

Double Board Certified by the American Board of Facial Plastic and Reconstructive Surgery and the American Board of Otolaryngology, patients fly in from around the country for Dr. Karam’s advanced techniques. Dr. Karam has successfully treated thousands of patients from around the world using his state–of–the–art approach. Over his years in practice, he has consistently maintained an extremely low complication rate, and the occasions of surgical revisions are incredibly rare. The outcome in every case is the same: natural–looking results.

And perhaps most importantly, Dr. Karam’s caring demeanor, excellent patient communication skills and responsive and knowledgable staff ensure you’re always comfortable and informed. It’s these particular attributes that have earned Dr. Karam the trust to perform these procedures on his medical colleagues and their families. His artistic eye, excellent technique and inherent amiability make him the best possible choice for your rhinoplasty.

Planning Your Consultation

During the consultation, your expectations will be discussed and a personalized treatment plan will be proposed after careful examination and discussion of your goals. Dr. Karam will spend a significant amount of time discussing the aesthetic and functional concerns you have with your nose; he’ll ask you very specific questions about what exactly bothers you about your nose and your expectations. Your history will be reviewed in detail. A detailed nasal and facial exam will be conducted in conjunction with state–of–the–art digital imaging, which helps establish a clear understanding of what can be surgically obtained. Following careful assessment and further discussion, a unique treatment plan is developed. This is the first step in obtaining the nose you’ve always wished for!

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