dr manafi / Procedures / Nose / Rhinoplasty

Primary rhinoplasty

The term rhinoplasty means nose (rhino) molding or reforming (plasty). Thus, rhinoplasty aimed at correcting the deformities and anomalies of nose which is known by various names including: nose job, nose cosmetic surgery, nose plastic surgery, nose reduction, and septorhinoplasty. According to Doctor Manafi, those people with nose deformities, whether large, apparently deviated, asymmetric, disproportional, obstructed, or congenitally abnormal caused by surgery, accident, or any other causes, who are dissatisfied can undergo rhinoplasty or nose cosmetic surgery.

Rhinoplasty does not mean to reduce the nose at any cost. Scientifically, reducing and fitting the nose is the ultimate goal of women (reduction rhinoplasty), while the final goal in men with fleshy and thick skin nose is to balance it, i.e., reduction, changing, or even strengthening of different parts of the nose (balancing rhinoplasty).

The first modern rhinoplasty was performed about 130 years ago, since when the surgery had many modifications and achievements and has always gone toward development. The progress was very fast in the past three decades and the open technique was gradually replaced the close technique from the past twenty years. The latter is associated with higher precision, perfection, and predictability of results and reduces the need for retouching and secondary operations.

Rhinoplasty has deviated at some point, especially in Iran, and some surgeons adopted the old style and reduced the nose as much as possible. Unexciting results were appeared in about 10 years as very short, small noses disproportionate with the face. The majority of these patients are willing to modify the defect, some of which are very difficult to perform optimally. This form of destructive surgery has an acceptable appearance in the first few months due to swelling, but the mentioned anomalies appear over the years, in particular in fleshy and thick skin noses.

Excessive reduction and basic reconstruction resulting in a nose with an surgical appearance and sharp angles in the face of an eastern person, known as facial incongruity, is not acceptable in academic circles nowadays. The majority of patients and countrymen from Europe, America, and Canada, ..., who travel to Iran for rhinoplasty, as well as highly educated people and prestigious families demand for repairing the defect, making the nose beautiful, preserving the natural form, and keeping non-surgical appearance and acceptable breathing of the nose. Fortunately, defected, extremely reduced nose cut from all sides is greatly decreased and has lost its proponents, so that the ratio of people who like very small, high-tip or curved, slide-like nose may be reached to 1 in 1000.

I am aware that spouses and the families of spouses of many of my patients do not know about rhinoplasty or surgeries of other parts of their faces, and those who do not express their operation can be assured that no worrying effect and trace of the surgery is remained on their face and their body.

This consciousness and awareness of patients is a promise for creating better noses fitted with faces, maintaining normal breathing and respiratory function and olfaction, and avoiding artificial nose and face for patients.

Of course, reasonable reduction of the nose making it moderately beautiful, especially in big noses, is a fundamental objective for rhinoplasty; however, both the radical, extreme methods in which all parts of the nose including bones and cartilages of septum, tip, and nostrils, were cut and removed, and the number of surgeons who adopted these methods are sharply reducing and moderating. With this moderation, the Iranian standard methods can be introduced to the world and the reputation of Iranian plastic surgeons can be advocated.

Doctor Manafi always states the facts with his rhinoplasty patients and as he performs a realistic examination of their nose, he undertakes logical rather than infeasible promises. Thus patients are happier in most cases after surgery than which had been previously promised.

Most patients pretend that they don’t like the defects of their noses and faces, to be told to them especially in the presence of a companion, while patients should be sincere with themselves and have the right to know the facts about their nose and face. Accordingly, we recommend that patients attend without makeup at the first time visit of Doctor Manafi. This makes obvious the realities of the face and may reveal problems of facial skin and bones, such as chin, cheeks, eyes, eyelids, jowl, neck, ears, or other parts, which repair can result in very pleasing outcomes than correction of nose defects only.

It should be noted that the final result of the operation can be best evaluated at least a year after the surgery and hasty judgment and evaluation is not right.

Most patients are regularly getting the comments of others about their nose and face after operation. It is clear that the expressed views are generally unprofessional and are based on the mind and underlying character of commenters; in whom opinions and obsessions may be mixed and may annoy the patients in most cases, therefore this kind of survey is not recommended.

You are the best judge, because you know the previous condition of your nose; please refrain from hasty judgment. In many cases, this rash affects less experienced surgeons, making them to perform retouch and repair operations or hasty and unnecessary injections, while the nose is still swollen; this is against both surgeons and patients, since compensation of their effects is sometimes very difficult and even impossible.

Mental and emotional stability of patients is a basic and decisive condition for rhinoplasty, either primary or secondary. When the patient correctly identifies the problems and knows what he wants, and when the physical condition of nasal skin and cartilage and ... is acceptable, the task is almost determined. But when someone does not know what is the problem and what he or she wants, the work and decision-making will be very hard for surgeons.


Doctor Ali Manafi


Frequently Asked Questions

  • Those with esthetic problems of the nose, respiratory disorders, deviated septum, previous fracture, or unusual big nose are good candidates for rhinoplasty.
  • Those who want to have cosmetic surgery should realistically describe their nasal problems and have realistic expectations.

  • The patient can be anesthetized either generally or through deep sleep (standby anesthesia). General anesthesia is the best method to provide a safe breathing way, but if the nose cosmetic surgery is not long, the patient can be anesthetized through deep sleep.

  • Patients are discharged after a few hours after rhinoplasty, but in some cases, they may be hospitalized overnight.

  • Taking aspirin or any aspirin-containing medication is prohibited at least 10 days before to three weeks after rhinoplasty and any type of cosmetic and non-cosmetic surgeries. These compounds disrupt blood clotting and may increase the possibility of bleeding. Acetaminophen is a good alternative to aspirin.
  • Let us know if you smoke or have any other habit.
  • Tell us if you suffer from any bleeding disorder or acute and chronic disease, even a welding or colds, especially in the week before surgery.
  • Take a bath the night before surgery and do not makeup and use spicy aroma the day of surgery.
  • Bring all your medical records to the clinic or hospital.
  • Be fasted at the day of surgery (do not drink even water from the morning).
  • Tell us if you are pregnant or breastfeeding.

  • The face and around the eyes will swell and bruise in the first two days after operation; this can be reduced by frequent use of cold compress . Ice is not necessary after 48 hours. Swelling and bruises on the face and eyes will resolve within the first two and three weeks after surgery, but nasal swelling may last for up to six months.
  • Lying with a couple of pillows in the first few days, especially the first two days after surgery, helps the patient. The day after the surgery, the patient can stand and walk with assistance for performing personal tasks.
  • Wet and dirty dressing in the front of nostrils should be replaced.
  • Drink only cold liquids in the first 48 hours and avoid hard and chewy foods for two weeks.
  • Dressing and plaster that must remain for about ten days to two weeks on the nose should not be wet and moved. Intra-nasal wicks and extra-nasal stitches are removed between the third and seventh days.
  • Avoid talking a lot, scream, laugh, cry, intense chewing, and every action that moves the sign of face and nose for two weeks.
  • Avoid lying on the sides and prone during the first two weeks and if possible during the first two months.
  • Keep the mouth open when sneezing and coughing to avoid pressure into the nose.
  • Take the antibiotics on time and analgesics and multivitamins as ordered. Apply ophthalmic antibiotic ointments over the incision line at the base of the nose two or three times a day.
  • Although weak and usually not severe, there is the risk of bleeding from the nose. In case of nosebleed, rest quiet, tilt the head above, and use ice compress.
  • Avoided severe nasal discharge for a month.
  • Use a soft toothbrush from the third day, provided that the upper lip does not move. Light gargle with diluted salt water is recommended to clean the mouth.
  • Do not use glasses for two months; contact lens can be used four or five days after the surgery.
  • Nasal discharge is not drained normally in about a month after the operation, therefore after the removal of the plaster, wet the nose through dropping irrigation saline or diluted salt water and then gently remove nasal discharge near the nostrils with the help of a wet ear cleaner several times a day.
  • Bathing with assistance is permitted four or five days after surgery in the form of washing only the body, not the head. The nose plaster should not be wet and soften by bath steam. After removing the nose plaster, shampooing with a mild shampoo is permitted provided that a manually shower is used with assistance and the nose is not under the flow of water. The nose and face should not be placed under the high-pressure shower up to one month.
  • Nose makeup is permitted after removing the plaster.
  • After removing the plaster, cooking, shopping, and doing personal tasks are permitted provided that the nose is not hit and pressed. Any sport including swimming is forbidden until two months, except walking, and any contact sports such as soccer, volleyball, basketball, wrestling, and martial arts are prohibited for six months.
  • In the first six weeks after surgery, avoid sunlight to the nose; the use of sunscreen is helpful.
  • Avoid excessive reading and tilting of the head in the two to three weeks after surgery, since nasal swelling may increase.
  • Use nasal tape for four to six weeks after surgery; it is very helpful especially in the case of cartilage transplant.
  • The nose is vulnerable in the first three months after surgery. Therefore, avoid hugging children, kissing, and clothing worn from the head.
  • Seriously avoid sexual activity up to a month after the operation. The excitement of sexual activity may greatly increase the risk of nosebleed.
  • In case of high fever or any unusual problem especially in the first week, call the hospital or your physician.
  • If additional cartilage is given to you in a container with saline and antibiotic, keep it in the freezer; it can be held and used up to five years for possible needs.

  • Surgeries requiring anesthesia are associated with some risks, but they can be minimized if the surgeon has more detailed information of the patient’s history, examinations and tests are carried out properly, and the surgery is performed in equipped clinics and hospitals which are approved by the Ministry of Health. In all cosmetic surgeries, including rhinoplasty, patients’ health is the first priority and beautification and resolving the problem is addressed then.

  • The procedure used for rhinoplasty depends on patients, but Doctor Manafi uses the open method in most cases. In fact, there is not much difference between open and close procedures and the main difference is that in open method leaves a thinnest cut point of columella, and 90% of the incisions are inside the nose.

  •  Rhinoplasty preoperative tests include blood tests (coagulation tests, glucose, urea, etc.) and CT scan, especially when there is a deviated septum.

  • Do not use clothing that is worn from the head or is too tight, because it can hit the nose.

  • Yes, the head must be higher than the body for 3 to 4 weeks.

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Doctor Manafi’s office hours: 16:30 to 20:30 on even days