Rhinoplasty Explained: Functional vs Cosmetic Nose Surgery | Vitality Unfiltered

Host: David J. Bauder, PA-C
 Founder – Weight Loss & Vitality

Guest: Alicia Sanderson
 Double Board-Certified Facial Plastic Surgeon & Otolaryngologist

In this episode of Vitality Unfiltered, we explore the complex world of rhinoplasty and the important relationship between nasal appearance and nasal function. 

Many people think of rhinoplasty simply as cosmetic surgery, but the nose is a highly functional three-dimensional structure that directly affects breathing, airflow, facial balance, and overall quality of life. 

David J. Bauder, PA-C, sits down with Alicia Sanderson to discuss how functional and cosmetic rhinoplasty often overlap, why airway preservation is critical, and how experienced rhinoplasty surgeons balance aesthetics with long-term structural support. 

The discussion also explores revision rhinoplasty, cartilage grafting, nasal trauma, healing timelines, patient expectations, and the importance of individualized surgical planning. Additional topics include masculine versus feminine nasal aesthetics, how swelling and scarring influence long-term healing, and why “liquid rhinoplasty” with fillers can carry significant risks in inexperienced hands. 

A central message of this episode is that successful rhinoplasty is not about creating a trendy or artificial appearance—it is about improving harmony, preserving function, and respecting the unique anatomy of each patient.

In This Episode We Discuss

• Cosmetic vs functional rhinoplasty
 • How nasal structure affects breathing
 • Why rhinoplasty is considered highly complex surgery
 • Primary versus revision rhinoplasty
 • Healing timelines after nose surgery
 • Cartilage grafting and reconstruction
 • Realistic patient expectations
 • Masculine vs feminine nasal shaping
 • Risks associated with liquid rhinoplasty
 • The importance of surgeon experience in rhinoplasty 

Key Takeaway

Rhinoplasty is not simply about changing appearance. The best outcomes preserve breathing, support facial harmony, and create natural structural balance tailored to the individual patient.

Learn More About Dr. Alicia Sanderson, MD

🌐 Dr. Alicia Sanderson, MD | Weight Loss & Vitality

📞 Weight Loss & Vitality: 571-550-9000

About Vitality Unfiltered

Vitality Unfiltered is a medical podcast exploring the science of hormones, longevity, metabolism, weight loss, aesthetics, and precision medicine.

Each episode provides clinical insight from healthcare professionals who treat these conditions every day.

Our goal is simple: to help people better understand the biology of their health so they can make informed decisions about wellness, prevention, and long-term vitality.

⚠️ Disclaimer
This podcast is for educational purposes only and does not constitute medical advice. Listening to this episode does not establish a provider-patient relationship. Always consult your qualified healthcare professional regarding medical concerns, diagnosis, or treatment.

Transcript

SPEAKER_01 0:00

Vitality.

SPEAKER_00 0:02

Vitality Unfiltered.

SPEAKER_01 0:04

Unfiltered.

SPEAKER_00 0:05

With David Bowder. Welcome back to another episode of Vitality Unfiltered. Today's conversation is about rhinoplastys. And for those of you who do not know what that is, that is nose jobs. With me today is Dr. Alicia Sanderson, a double board certified head and neck and facioplastic surgeon, expert in rhinoplasties. And we are going to work through and talk about the differences or the perception and clear up any myths about rhinoplastys that our listening audience would be interested in wanting to know. So, Dr. Sanderson, if you could start off by describing what is the difference between functional and cosmetic when it comes to nose jobs.

SPEAKER_02 0:47

Yep. Absolutely. So um so nose jobs or rhinoplastys are probably one of the most complex surgeries that we do in ENT because the nose is a three-dimensional structure that has to function well. When your nose does not function well, you can't breathe, people are very uncomfortable. So form and function absolutely have to, you know, go together from that. So a lot of times when patients come in and they, you know, want a nose job, a lot of the patients I see from an ear, nose, and throat standard have nasal obstruction, right? So I think it's really important to address what the functional aspects are and then also ask and address what the cosmetic concerns are. Sometimes they'll go hand in hand, and fixing the functional aspect will actually fix the cosmetic aspect. Sometimes they're in direct conflict with each other. And I think that's a very important conversation to have with the patient. So, from my personal opinion, every single rhinoplasty should be a functional rhinoplasty that you do cosmetic things on. And I think that's really important when you're selecting your surgeon to have it. Um, there's a lot of fantastic rhinoplasty surgeons out there making sure that you're um selecting somebody who does a lot of nose jobs because you can have a nose that looks fine, but if it's not functioning, that's a problem. Um so and you need to understand the concepts of how the nose functions.

SPEAKER_00 2:14

So you're saying so. If somebody was coming like they want a cosmetic nose job and you you do the evaluation, you get ready and be like, look, if we do this no, if we do this procedure, we are going to obstruct your breathing. Yep. Is that essentially what we're saying?

SPEAKER_02 2:28

Right. And I actually am pretty, you know, like I'm pretty strict in that I do not want, I want first, do no harm. That's the mantra of um being a surgeon in general. And most patients, it's important just to explain that to them when you're explaining it. You can still get them to an improved nasal appearance, but you know, a lot of patients don't, you know, think about the functional aspect of the nose when they're thinking about, you know, their nose is big, they want a smaller nose, and the the aspects of going through there. Talking about the nose in general, the nose is not a focal point of the face. So, you know, when you think about somebody and you think about, you know, they're attractive, you think about their eyes, you'll think about their lips and their smile from there. You know, everybody knows what Owen Wilson's nose looks like, right? So he had, you know, or somebody, you know, Michael Jackson's nose after he had multiple surgeries, they know what that is. But when you start talking and saying, like, what does um, you know, uh Sharice Therone's nose or Angelina Jolie's nose look like, people don't really know. They can't necessarily tell you because the nose is not the focal point unless it's deformed or it's larger. So the important aspect of that is when you're looking at the cosmetic aspect of the nose, is that you're looking at correcting things that will stop the nose from detracting from the other features of your face.

SPEAKER_00 3:49

I see. Yeah, and then the the uh so when this procedure is done, like in your practice, like what what percentage is functional, what percentage is cosmetic? Yeah.

SPEAKER_02 4:00

So again, in my in my practice, 100% of it is functional because you need to breathe through the nose, and I will address from that aspect. I will do cosmetic procedures, right? And then the the a lot of it would be it, but the the cosmetic procedure is not to detract from the function of the nose. So how we breathe and how the nose works is that you have a nasal septum, which is um bone and cartilage that runs down the middle of the nose and the inside part of the nose. And then you have the outer part of the nose, which is made up of the upper part is bone, the side walls are cartilage, and then you have a really complex, you know, it's a three-dimensional structure of the lower part of the nose, which is the nasal tip, the alar, and the and what we call the columellar or the tip supporting mechanism from that. And a lot of the problems with cosmetic defects of the nose include the size of the nose, right? The the shape of the bones or the deviation of the bones from one side of the other, if they have you know bony ridges on there that distract from it, the tip, which is very complicated, multiple cartilages that you know function with each other, and the size of the tip and the shape of the tip. So when you are looking at the nose and analyzing the nose, it's in part of the whole entire face, right? Your nose should has very, you know, standard, you know, shapes, sizes, and angles of the nose. Like in a shorter woman, they have a little bit more of a rotation of the nose. So depending on what your height is, your rotation probably wants to be between like, you know, a hundred and a hundred and five degrees. If you're a really tall woman, you want to be probably more in the, you know, the 95 area. Why? Because if you're short, nobody's looking up your nose. If you're tall, people are looking up there, right? So you don't want to have a rotated nose if you're a female that's 5'11 and you want to do it. Men, like so then we talk about like a feminine versus a, you know, a masculine nose. Women tend to have a straight or a nasal scoop to their nose, tends to be a little bit more petite. Men tend to have a straight versus a humped nose in there. Their rotation is at 90 degrees. You do not want to have their nasal tip lip rotation over 90 degrees because that's a very feminine nose. So, unless you're doing like transgender surgery and trying to feminize a nose, there are feminine and mascular features. You have to take a look at your face and the balance of the face. You cannot take my nose and put it on your face because we have different facial features. So when somebody comes in and they talk about a rhinoplasty and they cosmetic and they don't like their nose, and they come in and they bring me pictures of other people. And I think that that's interesting, but I'm not gonna put somebody else's nose on your face. What I want to do is take your features of your nose and take those distracting features and kind of make them less distracting so your nose fits your face. And that's a really important concept when you're going through there. And of course, I'm always gonna analyze the functional component to it because if the if you take too much of the cartilage away, the nose will collapse and you can't breathe through the nose, right? So you want to make sure that you are not resecting too much cartilage, right? So if somebody comes in and they like, I want a smaller nose, but I can't breathe through your nose. The answer to helping you breathe through your nose may be a wider nose, right? Because if you open up the space inside the nose, you'll get more airflow. So when patients come in, and a lot of times they come in because they have a functional component in there. We discuss that. And we come up with a treatment pan and an expectation that manages both the functional component and the cosmetic component. So if I have to widen your nose to give you a better airway, some patients are like, I am fine with that. I just want to breathe better. Other patients are like, I don't want a wider nose. I'm like, okay, then we're gonna have to compromise a little bit of that function to keep your nose, you know, smaller in there. And there are things we can do to help with that, but that may not be the the widest, biggest airway I can give you.

SPEAKER_00 8:06

So you've done a lot of rhinoplasties.

SPEAKER_02 8:08

Probably over a thousand. Yeah, a lot of them.

SPEAKER_00 8:10

Been doing it for a long time. That's a lot of procedures.

SPEAKER_02 8:13

Yeah.

SPEAKER_00 8:14

Revisions. So you get you get a lot of revisions that come into the Yeah.

SPEAKER_02 8:18

So I would say probably for the bulk of my career, probably about 90% of my surgeries were rhinoplasties or nasal surgeries. I would probably say at one point, probably about 60% of those were revisions. Now, revision surgeries are a totally different surgery from a primary rhinoplasty. Um, when nobody's been in there before, the planes are very clear, the treatment options that we do are very predictable, right? There's a lot in the healing process of a nose. The nose heals and you can't necessarily predict how it's gonna heal. It's more reliable to predict it if nobody's been in there before. When you go into a rhino, a revision rhinoplasty, um, there's a lot of scar tissue, your results are gonna be less predictable and less reliable. A lot of times people have removed cartilage, so um, and they may have removed cartilage from the septum, so we have to start looking for other places to get that from. When you have a primary rhinoplasty, I typically will reconstruct the outer part of the nose or fix the outer part of the nose with cartilage that I take from the septum on the inside, which is deviated. So I'm kind of killing birds with one stone. I'm removing the crooked cartilage from inside the nose and then using that cartilage to rebuild the outside of the nose. When somebody's been in there before, I don't have any usable cartilage. So I have to go and take a cartilage source either from the ear or from a rib. So we go and harvest a piece of a rib and we rebuild the nose. And the goal is to have a functional nose that doesn't look bad, right? Or looks better, or depending on what we're going through. So your outcomes in a revision rhinoplasty are are less predictable. And so it's really important when you're selecting a surgeon, if you've had surgery on your nose before, that you definitely have a rhinoplasty surgeon, not somebody that does, you know, rhinoplasties here and there, because the healing process is long and complicated.

SPEAKER_00 10:11

Yeah. So talk talk about the healing process. You know, there I've I've heard rumors that it's like it can be, it can be years, right?

SPEAKER_02 10:17

And so absolutely. So I tell all of my patients when we do a rhinoplasty, it's at least a year of healing. And that doesn't mean you look bad for the whole year, but it means if I took pictures of you at two weeks after surgery, at three months, six months, and a year, your nose is gonna look different. And I've I I watched that for 20 years as I've gone through and look at it. We go to our academy meetings and we're doing, you know, lectures, and people like in famous rhinoplasty surgeons will show pictures from a, you know, a year after they've done a rhinoplasty and five years later and the nose is still changing. And that's because it's this very fragile, delicate, three-dimensional structure that is influenced by scarring. So scarring healing. So I can go in and I will put it where it's supposed to be, it will be straight on. But the bones will shift and move and they'll be scarring. So it's really important when you go in to do that that you can predict what's gonna happen. And so when I'm in there, I, you know, I, you know, I can go in there and I can move it, but I go, well, if I take cartilage from the upper part of the nose here to make a more petite, cute nose, I know that when the scarring happens, it's gonna rotate the nose upward because the tip is like a tripod. And so as you take out part of it, as it heals, it's gonna rotate up. So I predict that when I'm when I'm adjusting the rotation of my nose. So when I go in, I may not rotate it up as much as I think it needs to, knowing that when the scarring process comes in, it's gonna naturally pull it up a little bit. But the significant aspect of the swelling is probably in the first few weeks afterwards. So as far as um, you know, time you need off of work, if we're doing a lot of work and breaking the bones, then I'd probably say a week to two weeks off of work. So you don't, you know, you don't look bad in there. But when you come back and see me at a month, I'm gonna tell you you're still really swollen. And then when you come back at three months, you're gonna say everything is looking good except for this tip. The tip is really swollen. The tip takes a good year for that swelling process to be in there. So it's important that patients understand that because this is all about expectations. I want you to feel the best you can about it. But if you're expecting to look normal, you know, a week after surgery, that's not gonna happen and you're gonna be disappointed for the whole, you know, for the whole time afterwards. So setting reasonable expectations and goals is really important with your rhinoplasty surgeon.

SPEAKER_00 12:40

Yeah, just like making sure, and like after hearing this, I'm just sitting here, like making sure that the patients understand that their nose is gonna keep changing years. It is a procedure.

SPEAKER_02 12:49

And the more you do, the more the the more it's gonna change. So I again, these are the important things that I talk to about patients. Like some patients just want to breathe better. And we talk about, hey, we can do this and we can do like a basic down and dirty. I am going to go in there and give you wide open in there and not do a lot of work. If I do a lot of work, I do a lot of um breaking the bone, shifting the bones, adjusting that cosmetic things. The healing process and that, you know, that predictability, there's more variables in it. And those are important conversations to have because some people are like, I really don't want to have, you know, I don't really want any changes. I like my nose, it's who I am, it's what I look like. And then I have other people who are like, no, no, no, I really want to fix these things because it affects how I feel about myself and it's always really bothered me.

SPEAKER_00 13:39

And so getting those What's your thoughts on using fillers on the nose?

SPEAKER_02 13:43

Yeah, so I am not a fan of using fillers on the nose. So there's a lot of um risk to vascular accusation, occlusion, and damage and loss of skin when you're using fillers in the nose. I am not a fan of liquid rhinoplasties, right? Um, it's, you know, they're temporary, they'll eventually go away. Um, but if you need a rhinoplasty, you should go have a rhinoplasty because when you go in to get the rhinoplasty, you've now got scarring, filler, and problems in there. So as a rhinoplasty surgeon, I am totally against it. I've, you know, I'm not totally against it, but I am not a big fan of it because I feel like you need to do the definitive procedure. And again, going in the first time to do it when nobody has been in there, just wait, have the procedure done, and then you'll have the results that you want on there, as opposed to keep going back and injecting fillers. Now, I have used fillers very conservative in patients who have had multiple surgeries on the nose. This is a really high-risk area. But if they have a certain defect that really bothers them a lot and it's too risky to go in and do another um surgery, then I've used it very conservative, but that is very uncommon. I am capable of taking care of any complications that could potentially come from it. But I definitely don't think that um that the novice injector should be um putting fillers in the nose.

SPEAKER_00 15:05

Aaron Powell, I have not put fillers in the nose.

SPEAKER_02 15:07

Thank you very much. I appreciate that.

SPEAKER_00 15:09

Does um when you so does the does a cosmetic functional rhinoplasty you had to obviously repair fractured nose. Correct. People that have had injuries. Absolutely. Is there a big difference on how they're managed?

SPEAKER_02 15:21

Aaron Powell No, there's really not a there's not a big difference on how they're managed. And a lot of times, you know, you're going in and doing, you know, the same things and breaking the nose and, you know, like and going back in there. I think a lot of times when people have had prior surgeries or they've had trauma in there, you know, a lot of people will say, I want my old nose back. And I think that that's really hard to guarantee that you're going to give them the exact nose that they had back. I think a better approach is that like, I had my nose fractured and now I don't look like, I don't like that it's deviated here. I don't like this hump, or I don't like this thing. So, you know, when you're talking to your rhinoplasty surgeon, having specific things that you don't like. I don't like the width of my tip, I don't like this here. Saying something like, I want my old nose back, it's it's harder because then the expectations of disappointment, as opposed to saying something like, I don't like that it's crooked, I want it straighter. And those are um and that's something, okay, well, that's a tangible thing that we can work on to go through and get it.

unknown 16:22

Dr.

SPEAKER_00 16:22

Sanderson, great information. This has been fascinating. I want to go ahead and thank all of our listeners for following us today or listening to our show. If you like the episode and like the show, please follow us or click the subscribe button below. Thank you for joining us today, and we'll see you next time.

SPEAKER_01 16:37

Thanks for joining us on Vitality Unfiltered with David Bowder. Addressing norms, busting myths, and uncovering health realities for a more vibrant life today. For more expert insights and real talk, make sure to subscribe and join us next time.