How Long Does Rhinoplasty Surgery Take?

Regarding total time in the operating room for the average primary rhinoplasty, under two hours is common for the most accomplished rhinoplasty surgeons. Other surgeons, often less specialized and less experienced, can take 5-6 hours.

The length of a rhinoplasty depends on the following specifics of the nasal structure and function:

Is the rhinoplasty a primary or revision rhinoplasty? Correcting the nose during a revision rhinoplasty takes longer than a patient’s first rhinoplasty.
Are breathing, allergy and sinus issues being addressed? A nose job requires more time with functional improvements.
The training, degree of specialization, skill level and experience of the surgeon. The highest level rhinoplasty surgeons bring efficiency and thus shorter operating times.

Technical Factors of How Long a Rhinoplasty Operation Lasts

“Not how quickly, but how well” is the proper theme. Speed for speed’s sake is not wise, but efficiency in the surgical exercise is very important. Here’s why:

Swelling and bleeding start to work against the surgery after 2-2 ½ hours. Depending on what you need when undergoing surgery, the time your rhinoplasty will take should never surpass six hours. Tasks like adding correction of deviated and reduction of internal turbinates and their operation can last 30-45 minutes longer, while other factors only add a few minutes. We expand on those factors below.

GRAFTING

The cases that require harvesting of cartilage from ear or rib take longer. For some patients, it may be necessary to add additional tissue to achieve the optimal result. Typical needs are a round, plunging tip, a bridge or a very crooked nose where some cartilage or bone may be missing. Cartilage is commonly harvested from the nasal septum, particularly if the septum needs correction to improve breathing and prevent sinus infections. It is readily available in the nasal interior. The next choice is cartilage from the ear. The ear is not left deformed, the incisions are on the back of the ear and particularly where cartilage with a natural curve is needed, the ear is a good source. Rib cartilage is the last choice but provides the largest harvestable piece of cartilage. It can be shaven into thin slices. Larger portions are used to raise a low bridge. In respect to the scale of how much tissue is needed, grafting adds only minutes to the length of the operation.

ANESTHESIA

Anesthesia for rhinoplasty is not a factor in the outcome, per se, nor the safety. The technique preferred by most surgeons and anesthesia specialists uses propofol, the great colonoscopy anesthetic, with some other anesthetics, plus local anesthesia injected by the surgeon after the propofol puts you to sleep. Very low-level anesthesia, different realm than that needed for abdominal, chest or brain surgery. Quick to sleep and quick to wake up. Narcotics are not necessary and therefore, there’s a little chance of nausea and vomiting.

A longer operation will demand more of the anesthetic and may generate a longer wake-up and some grogginess for the rest of the day. As we shall discuss below, all things equal less time under anesthesia the better, of course.

Open vs. Closed Nose Jobs

Whether a surgeon chooses open vs closed rhinoplasty can alter surgery time. Closed rhinoplasty, the classic, still superb technique, patient-favored technique has several advantages: no external scar and all sutures, placed to close the hidden, internal incisions, dissolve. Open rhinoplasty, a good approach to teach and develop surgeons in training does make placement of some cartilage and tissue grafts a bit easier. Performing the external incision and then closing it at the end of the surgery should not add more than 20 minutes or so to the operation. For some patients the horizontal scar between the nostrils is not happiness. Others, who healed better, perhaps, are forgiving of what is a hardly visible incision. Typically, like so many other features of rhinoplasty, the surgeon’s skill determines the outcome, not luck.

Experience & Style of the Surgeon

Closed rhinoplasty is an elegant procedure when you step back and realize that an entire operation which may include a nearly total restructure of the nasal architecture and improving the breathing and then stitching the hidden incisions is done entirely through the nostrils. Some younger surgeons not exposed to the technique are amazed when they see an ultra-experienced rhinoplasty surgeon perform the procedure. It is quite impressive. The surgeons who mastered the technique are the product of a training program strong on great teachers and a large volume of experience. Impossible to master without both.

Open rhinoplasty, a great teaching tool, also requires great manual dexterity but does make rhinoplasty and associated procedures easier to understand as a trainee. A surgeon in practice, beyond formal residency training, who wants to enhance his ability to move from the open rhinoplasty to the closed procedure will be challenged without having a large volume of patients on which to develop the skill and judgement to perform it.

Minimal vs. Extensive Surgery

There are few “Minimal” surgeries. Just like an airplane flight, the loading, take off, landing and unloading are the same whether it’s a flight of 400 miles or 4000 miles. Certain time factors are constants.

All rhinoplasties and other facial plastic surgery procedures are best and safest done in a licensed/certified outpatient surgery center or hospital. Personally, I favor having an anesthesiologist specializing in cosmetic facial surgery procedures “ at the controls”. That’s for patient comfort and safety. Given these protections for the patient, the time necessary to prepare a patient for surgery, connect the patient to the ultra-sophisticated anesthesia and monitoring system, induce the anesthesia, prepare the patient, disinfect the operative area, provide local anesthesia, drape the patient in sterile sheets, connect all instrumentation, and then beginning the actual surgery, there’s quite a ramp up. And, all that takes time, whether the actual cutting and sewing is 45 minutes or seven hours. But, that’s what it takes to do it right and who does not want it right?