Rhinoplasty: What it is, Types and Prices – Complete Guide
Updated on • Reviewed by Dr. Gustavo Sordo, plastic surgeon
Rhinoplasty is one of the most sought-after facial surgeries, as it allows for modifications to the shape, size, and proportions of the nose to improve its integration with the rest of the face. Because it occupies a central position, even small changes to its bone and cartilage structure can significantly influence facial harmony. If you are considering it, here we explain how we perform the procedure at our clinic, what it includes, and how much it costs: rhinoplasty in Madrid.
Everything that follows is signed by a rhinoplasty specialist surgeon trained via MIR at the La Paz University Hospital and registered number 282858125.
In addition to its aesthetic component, rhinoplasty can also address certain functional issues related to breathing. Therefore, each procedure must be planned individually, taking into account both the patient's anatomical characteristics and their needs and expectations.
What is rhinoplasty?
Rhinoplasty is a surgical procedure designed to modify the structure of the nose . It allows us to change the shape, size , and proportions of your nose, taking your facial features into account. In addition to the aesthetic aspect, it can address functional respiratory conditions, such as correcting a deviated septum or nasal problems that make breathing difficult.
Because every nose is different, the plastic surgeon will create a personalized plan for you, based on your preferences and needs. It's also important to note that success depends not only on the surgery itself, but also on the recovery process: patients who follow their surgeon's instructions precisely will experience the best possible results.
Benefits of rhinoplasty
Functionality
The nose is the gateway to the respiratory system. Its function is to allow you to breathe properly; when this does not happen, a solution must be found. Getting used to breathing through the mouth decreases the quality of life. Rhinoplasty corrects abnormalities that obstruct the flow of air, thus improving respiratory function.
Customizable result
Based on the principle that each nose is unique, rhinoplasty surgery is personalized, adapted to your individual preferences and needs.
Durability
The results of rhinoplasty are usually permanent, meaning that patients will enjoy their new look for many years to come. It should also be noted that the nose changes over the years.
What types of rhinoplasty are there?
Open or closed: why I operate in open
It's important to understand something from the outset: there's no single best technique . The best one is the one the surgeon is most accustomed to and most comfortable with. That said, I almost always perform open surgery, and I have specific reasons for that.
Open rhinoplasty allows surgeons to work directly on the structures of the nose. It has been a major driver of advancement in this specialty: thanks to it, we have been able to analyze structures that were previously hidden in closed rhinoplasty, and this knowledge has improved the performance of all types of rhinoplasty, including closed rhinoplasty.
In my case, there are two additional reasons, both related to the technology I use. First, ultrasound generates heat , and working blindly, that heat could burn the patient's skin; with open surgery, I can see exactly where I am. Second, the dorsum is better corrected by looking at it , because with a full field of vision, I can spot any irregularities and correct them immediately with diamond burs mounted on my rhinomotor.
There's a third reason, and for me it's the most important: the tip . When I construct it, I need to verify that everything is symmetrical and perfectly organized around the septal extensor. The symmetry of the tip structures is crucial for it to look good, and I want to see it, not just guess at it.
Preservation, structural or hybrid
Today, my favorite surgery for primary cases is hybrid preservation rhinoplasty . I explain it with an image I often use in consultations: imagine a house where you want to lower the roof height. The classic technique removed the entire roof and rebuilt it lower, with the risk of it becoming uneven. Preservation lowers the foundation while leaving the original roof intact.
By not opening the roof of the nose, we preserve the keystone area ( K area ). This area is crucial: classic structural rhinoplasty has taught us that weakening it is problematic and that preserving it is very beneficial for the integrity of the nose and for breathing. Furthermore, preserving it allows us to reposition the nose laterally, so if it is crooked, we can correct its alignment.
Within preservation I use three techniques, and each one addresses a different problem:
- Robotti-Furtado Technique (dorsal split preservation), with upper strip: we preserve the central component and then adapt the lateral cartilages along with subdorsal osteotomies.
- Ferreira-Nakamura Technique, with a lower strip (low strip). I use it when there is a deviation in area K along with a radix I'm low and I don't want to keep decreasing.
- SPQR TechniqueIt also includes a lower strap. It allows for the correction of larger noses and pivots the nose to the sides when there is a large deviation of the bony component.
And here's the important part: by not opening the roof, we save a lot of cartilage that doesn't need to be used for reconstruction. We use that cartilage where it's really needed, which is the tip.
Therein lies the key to hybridization: a preserved back and a structured point. I structure the point according to Froilán Páez's armadillo tip , which fixes the point on a double septal extender and adds a triangular component that supports the intermediate crura, the great forgotten elements of the point's structure.
I don't want to be categorical, because in surgery it's not advisable to be so: what we're aiming for is a firm tip. Loss of rotation, projection, or tip deviation in the postoperative period is one of the most frequent causes of revision surgery , and structuring it properly is the best way I know to prevent it. In a long-term follow-up study published in JAMA Facial Plastic Surgery , Toriumi's team documented precisely a measurable loss of rotation during postoperative healing ( DOI: 10.1001/jamafacial.2017.1127 ).
By combining these two things, structure at the tip and preservation on the dorsum, I have achieved the best results of my career. And this is not my own idea: Enrico Robotti has described and systematized hybrid rhinoplasty as an intermediate entity between preservation and structure ( DOI: 10.1016/j.fsc.2025.01.004 ), and he co-authored the dorsal split variant with Sergio Furtado ( DOI: 10.1007/s00266-024-04120-z ).
Structural rhinoplasty remains fundamental , especially in secondary rhinoplasty, where spreader grafts , radix grafts , and spreader flaps are essential to correct the tissue deficiency that these patients often present.
Ultrasonic rhinoplasty is not a technique: it is a technology
This is constantly misunderstood. Ultrasonic rhinoplasty is not an alternative to previous techniques: it's the technology I use for all of them.
Ultrasound cuts bone by vibration without causing bleeding. The image I always use is: it's like peeling a raw egg without breaking the membrane inside. That's why patients have significantly less bruising and much less pain.
This is not just my impression. A systematic review of eight randomized clinical trials with 440 patients found a significant reduction in edema and ecchymosis with piezosurgery compared to conventional osteotomy ( DOI: 10.1007/s00266-022-03100-5 ). A subsequent meta-analysis of twelve trials and 630 patients confirmed the reduction in edema, ecchymosis, pain, and complications, and found that the benefit was greater with an external approach , i.e., open surgery ( DOI: 10.3390/jcm13133635 ).
I use ultrasound in all my rhinoplasties, even to extract the costal cartilage graft when necessary. I then carve that cartilage using Eren Tastan's oblique method , which allows for obtaining straight grafts of varying thicknesses without the risk of them curving over time ( DOI: 10.1055/s-0033-1360599 ).
And I combine them with the rhinomotor and its burs. The rule is simple: the bur reshapes, the ultrasound cuts. Robotti and his team published on this combination in more than 350 patients, describing the same thing I see in the operating room: more control, fewer asymmetries, a smoother dorsum, and more precise handling of the septum and turbinates ( DOI: 10.1007/s00266-024-04278-6 ).
I also use fibrin-rich plasma , which I use to deliver cartilage powder and camouflage small areas of the back where I need to create smoothness.
When a patient walks through my office door, I see what's wrong with them and, based on their anatomy , I decide what needs to be done. Not the other way around.
A helpful clarification for patients navigating the many brand names: today, there are three main types of rhinoplasty. Structural rhinoplasty involves opening the nasal dorsum and reconstructing it with grafts; preservation rhinoplasty preserves the dorsum by lowering it as a single unit through impaction without opening it; and hybrid rhinoplasty is the one we perform in most cases: we preserve the dorsum and all the ligaments, and we structure the tip with grafts from the patient's own septum. By not using cartilage to reconstruct a roof that hasn't been opened, much more material remains available to support the tip.
All bone work is done with ultrasound (piezo) , without a hammer or chisel, which greatly reduces bruising and swelling. And there's a key principle we always repeat in consultations: where the septum goes, the nose follows . Without a straight and well-supported septum, no dorsal technique will maintain the result over time; that's why aesthetics and function are always planned together, never as two separate surgeries.
closed rhinoplasty
open rhinoplasty
If you want to learn more about this topic, below you'll find another article about open or closed rhinoplasty and which one is best for you.
Reduction rhinoplasty
The goal is to reduce the size of the nose, either by reducing the nasal septum or reshaping the nostrils. Alar base reduction, also called alarplasty or alarplasty, narrows the base of the nose and changes the shape of the nostrils. I make the incision right in the crease where the alar meets the face because I believe the scar is less visible there; other surgeons prefer to make it one or two millimeters higher. In the only study comparing the two positions, with 70 patients, the scars were equally discreet in both groups ( DOI: 10.1016/j.joms.2020.06.021 ). You can see this in this case of structural rhinoplasty with alar base reduction.
Augmentation rhinoplasty
Augmentation rhinoplasty , also known as dorsal rhinoplasty, involves increasing the size of the nose. It is performed using cartilage or bone grafts, or a nasal implant, to make a small or flat nose more proportionate to the rest of the face. This procedure can increase the size of the nose and/or modify its shape. People of Asian descent are the most frequent candidates for this type of surgery.
Revision rhinoplasty
Occasionally, some patients who have previously had rhinoplasty and have not been satisfied with the results request a second operation.
Who is a candidate for rhinoplasty?
The ideal candidate is someone with realistic expectations about their nose and a desire for a logical change that falls within the bounds of normal anatomy. Most of my patients are perfectly normal people who have been considering changing their nose for years and simply need to trust a professional with sufficient experience and a wide range of techniques to choose the right one for their specific nose.
Now, something that's not usually mentioned. Patients who don't have realistic expectations, or who are going through a very difficult personal or psychological time, shouldn't have surgery until they are feeling better. It's not a matter of scheduling; it's simply that surgery won't solve their problems.
And there is one specific group: patients with body dysmorphic disorder should not undergo surgery. Here I am categorical, and the literature is clear. The one who has best documented this is Mark Constantian: in a series of 100 secondary rhinoplasty patients, those who arrived with previously normal noses and met the criteria for body dysmorphic disorder were 3,8 times more likely to have a confirmed history of trauma ; among those who had undergone surgery more than three times, 85,4% had a history of abuse or neglect in childhood ( DOI: 10.1097/PRS.0000000000000512 ).
In a subsequent study of 218 plastic surgery patients, the same author found that body shame predicted requests for revision: 49% of patients with body shame requested a revision, compared to 17% of those without it ( DOI: 10.1097/PRS.0000000000008567 ).
In other words: if the suffering precedes the nose, surgery won't fix it. And saying no in time is part of the job.
In principle, there is no nose that cannot be operated on. But there has to be a limit, and knowing where that limit is is as much a part of the profession as knowing how to operate.
Although there are no strict age restrictions, it is advisable to wait until the nose is fully developed, which usually occurs by the end of the teenage years. Therefore, any patient over the age of 18 who wants to modify the shape or function of their nose is a candidate. A detailed consultation with the surgeon and a thorough examination will determine your suitability for the procedure.
How is it the procedure?
Initial medical consultation
During your initial consultation with your surgeon for rhinoplasty, you'll openly discuss your expectations and your reasons for wanting this surgery. They will assess your overall facial proportions and profile to determine the most suitable approach. Remember, the key to rhinoplasty isn't finding the perfect nose, but rather one that harmonizes with your face and gives it a natural appearance.
Remember that during your first consultation, we will perform a simulation so you can see what your rhinoplasty would look like:
In addition, a physical exam will be performed during this initial consultation, which will determine how rhinoplasty will affect your breathing. The doctor will also want to know your history of nasal obstructions, surgeries, and any medications you are taking.
Last but not least, photographs of your nose will be taken from different angles; this will serve as a reference for the "before and after" image we all want after plastic surgery.
Anesthesia
At the time of surgery, anesthesia is administered, which is a medication to induce a sleep-like state. The type of anesthesia used will depend on the complexity of the surgery and what the surgeon and patient have previously discussed. It may be general or local anesthesia, along with sedation.
incisions
Depending on the type of rhinoplasty agreed upon, the corresponding incisions are made, which may be closed or open. The incision will be made inside the nose, if it is a closed rhinoplasty, or a small external cut will be made at the base of the nose and between the nostrils, when it is an open rhinoplasty.
Modification of the nasal structure
Here the surgeon will work his magic, working on your bones and cartilage in your nose to make the necessary changes, which will give you better breathing and a nose that looks harmonious on your face.
Incision closure
Once the modifications to the nasal structure are complete, the nasal skin and tissue are replaced, and the cuts are closed with sutures.
Application of the splint
Your surgeon will place a splint on your nose to provide support and protect the new shape of your nose during the recovery process. You will need to wear this splint for the first week.
How long is the procedure?
The duration depends on the complexity of the case. A rhinoplasty can take between two and a half and four hours, and three to three and a half hours is typical.
It takes considerably longer than it did three decades ago, and that's by design: operating under direct vision, preserving the nasal roof, structuring the tip, and working with ultrasound and burrs all take time. That time is precisely what separates a natural result from a recognizable one.
Preparation for rhinoplasty
Before rhinoplasty, you should prepare according to medical instructions to maximize results and minimize risks. Some pre -operative preparations for rhinoplasty include:
Adjustment in medications
A few days before surgery, you should apply a liquid antibiotic to your nostrils to decontaminate them. Also, stop taking any drugs sold in herbal stores, aspirin, or anti-inflammatories three weeks before surgery. These drugs affect coagulation, causing bleeding and postoperative edema or prolonged inflammation.
Quit smoking and avoid alcohol
If you are a smoker, I know you must be sorry to read this, but here's the deal: you must stop smoking three months before the procedure. We don't want to take any risks with regard to the patient's healing and recovery. So, do it. Your health will thank you.
Regarding alcohol, it is not essential to give it up completely, but it is essential to drink in moderation and in small quantities.
Planning for recovery
Find someone who will accompany you and assist you during your first night in the hospital and then at home on your days of rest. It is also important to purchase in advance the medications you will take after surgery and the nasal cleansing solutions. Your doctor will inform you about this.
What if I have a nose piercing? This comes up frequently in consultations. A piercing doesn't prevent surgery: it's removed and the hole is closed, as seen in this case of ultrasonic rhinoplasty on thin skin . Sometimes the piercing tract retracts after surgery, leaving a small depression; in this case, I released that tissue during the operation. What we do recommend is not putting it back in afterward, because it can infect the surgical site or the cartilage. We consider nose piercings to be dangerous.
How much does it cost? What is the price of rhinoplasty?
The price depends on several factors, and I prefer to explain them rather than give a single figure. It depends on where the surgery is performed (the facilities must be good, and that comes at a cost), the technology (ultrasonic rhinoplasty increases the cost of the surgery because the piezoelectric scalpel inserts are consumable, require payment, and have a limited number of uses), and the complexity of the case.
These are our indicative figures:
- Primary rhinoplasty: €10.040
- Primary rhinoplasty with rib graft (for example, many Latin rhinoplasties): 15.000 €
- Secondary rhinoplasty: €20.000
You can find the complete and up-to-date breakdown of the price of rhinoplasty in Madrid on the procedure page.
These prices are subject to change depending on each patient's specific circumstances. For example, if there is a septal perforation requiring additional grafts, the procedure is assessed on a case-by-case basis: the cost of the rib graft reconstruction is in addition to the fees charged by the ENT specialist who closes the perforation. Because it is an elective cosmetic procedure, it is not covered by social security.
What's included in our budget? We include everything:
- Anesthesia and our own anesthesiologist, who is part of the team
- Entry
- All necessary revisions
- Fibrin-rich plasma
- Ultrasound machines, with all the necessary inserts
- The rhinomotor with its diamond bur
- In secondary surgery, also the hyperbaric chamber
But above all, it includes two things that don't appear in any budget: my passion for this surgery and the time I'm going to dedicate to each patient. In the eighties and nineties, a rhinoplasty was completed in forty or forty-five minutes: the bridge was filed down, the bone was fractured with a chisel and hammer, some cartilage was trimmed from the tip, and that was it—almost a chain of identical steps from one patient to the next. Today, I dedicate several hours to each nose. Increasing the surgery time hasn't been by chance: it's the result of a much better understanding of the nose.
How to choose a surgeon for rhinoplasty
Check out the “before and after”
Photographs of the surgeon's previous patients are the most readily verifiable demonstration of his work.
When will the final result be seen?
The result should be permanent , with one important caveat that almost no one explains: the patient will continue to age above their nose, and the nose is one of the few organs that continues to grow throughout life. Along with the ears, it's one of the few things that doesn't stop growing.
That's why I don't like to create a nasal tip without a solid structure underneath: otherwise, it will continue to grow and droop over time. By placing an armadillo -type septal graft , the tip stays in place for many years. Ideally, a rhinoplasty should only be done once in a lifetime.
Regarding the timeline, let's be honest and not make promises: approximately 50% of the inflammation will have subsided within a month , and we'll see roughly the final result within a year . For oily skin, which sometimes requires specific treatments to control sebum production, this result may appear somewhat later.
And something that I still find fascinating: it's estimated that the nose continues to heal and evolve for three to five years after surgery , as Toriumi points out in several of his works. It's astonishing that such a small organ continues to heal for so long. Everything else follows from this: if the nose is going to be healing for years, the underlying structure must be extremely well prepared to withstand the stresses of that healing process.
Recovery and postoperative care
The recovery period after rhinoplasty is so important that the final results depend on it. Take into consideration the following aspects:
Break time
The ideal is to stay at home for 7-10 days of rest, to allow the body to begin recovery.
Keep your head up
It is very important to sleep with your head elevated for the first 5 to 7 days; this way you help reduce swelling and prevent blood from accumulating in the nose.
Use of splint
The splint that the surgeon has placed on your nose is used to protect the nasal structure, and you will have to wear it for the first week. In the case of nasal plugs, the doctor will remove them on the third day.
Avoid intense physical activity
Sports, exercise, and lifting heavy objects should be kept out of your activity schedule until your doctor tells you otherwise. Anything that can increase blood pressure or cause trauma to the nose should be avoided.
Avoid blowing your nose and wearing glasses
If you feel congested, nasal washes with saline solution will help relieve it and keep your nose clear. On the other hand, if you wear glasses, you should use a support for them, since you will not be able to rest them on the bridge of your nose during the first 6 weeks.
Risks and side effects of rhinoplasty
Like any surgery, rhinoplasty can have complications and may require revision. I prefer to be upfront about that.
Complications are extremely rare , as demonstrated by the medical literature. The main ones are bleeding and infection. If they occur, our team is prepared to assist the patient and help them overcome these complications, taking the necessary measures: antibiotic therapy, surgical revision, hyperbaric oxygen therapy, nanofat grafting, or fat grafting, depending on the case.
Touch-ups are different from complications. By far the most common is correcting a small residual hump, also known as a mini hump . These are short, outpatient procedures that cause minimal discomfort to the patient and have a quick recovery. It is estimated that they affect between 5 and 10% of patients.
When this happens at our clinic, the patient usually only pays a small fee for the operating room, and we cover the rest. Each case is evaluated individually.
The reason I structure the tip so much is precisely to reduce the most frequent cause of revision: that the tip loses rotation or projection over time.
Visible scars
Some people develop more noticeable scars, and even keloids may appear, but remember that not all people heal in the same way.
septum piercing
Surgery may create a hole in the wall between the two nostrils and require additional surgery.
Frequently asked questions about rhinoplasty
Is rhinoplasty painful?
The perception of pain varies from person to person, but in general terms, it is described as a mild to moderate discomfort, easily controlled with painkillers. In the postoperative days, it is the inflammation that is more uncomfortable than the pain.
When can I exercise after surgery?
Your doctor will provide specific guidelines based on your recovery progress, but the general recommendation is to avoid strenuous exercise for at least 4 to 6 weeks after rhinoplasty.
What are the scars like after rhinoplasty?
Depending on the type of rhinoplasty, the scars will be more or less visible. In other words, in the case of closed rhinoplasty, the incisions are internal and there are no visible scars. If the surgery requires open rhinoplasty, the scar from the small incision made in the columella tends to fade and become less visible over time.
Can the nose become deformed after rhinoplasty?
The results of a rhinoplasty are long-lasting, but external factors such as physical changes, aging or trauma must be taken into account, which can affect the shape of the nose in the long term.
Conclusion
Having a skilled and trusted plastic surgeon is essential to ensure a satisfactory result and minimize associated risks, regardless of the type of nose.
About the Author
Dr. Gustavo Sordo Miralles
Specialist in Plastic, Aesthetic and Reconstructive Surgery
Membership number: 282858125 (Official College of Physicians of Madrid)
Member of the Spanish Society of Plastic, Reconstructive and Aesthetic Surgery (SECPRE), the Spanish Association of Aesthetic Plastic Surgery (AECEP), the Rhinoplasty Society of Europe, the European Association of Societies of Aesthetic Plastic Surgery (EASAPS) and the American Society for Aesthetic Plastic Surgery (ASAPS).
This article is for informational purposes only and does not replace a medical consultation. Every nose is different, and each case is evaluated individually during a consultation.