Rhinoplasty Specialist

Who rhinoplasty is for

Most of the patients I see fall into one of three groups.

The first wants a change in appearance: a bump on the bridge, a tip that droops or looks wide, nostrils that flare, a nose that seems too large for the face. Breathing is fine. The goal is a nose that fits the face and does not announce that it was operated on.

The second has both a breathing problem and something about the shape they would change. Often they have lived with a blocked nose for years and only recently learned that both can be addressed in one operation.

The third has had rhinoplasty elsewhere and is unhappy with the result, or has developed a new problem since: a collapsed bridge, a pinched tip, or worse breathing. Revision rhinoplasty is a different operation from a first rhinoplasty, and I discuss it honestly, including when I advise waiting or not operating at all.

What a head and neck surgeon brings to this operation

I am board certified in otolaryngology, which is head and neck surgery, and in facial plastic and reconstructive surgery. My fellowship was in head and neck oncologic and reconstructive surgery, where much of the work was rebuilding faces and noses after cancer removal and trauma.

Three parts of that training show up in every cosmetic rhinoplasty I do. The airway: head and neck surgeons spend years operating inside the nose, on the septum, the turbinates, and the nasal valve, and cosmetic changes to the outside can narrow any of them. Grafting: most rhinoplasties need at least one cartilage graft to hold the new shape as the nose heals, and I harvest and shape septal, ear, and rib cartilage routinely. The septum as a resource: it is the first-choice source of graft material and also the structure most often deviated in patients who cannot breathe, so straightening it and harvesting from it in one step is second nature.

Reconstructive training changed the way I plan a cosmetic rhinoplasty because it forced me to balance form with function on every case. Nobody wants a nose that looks good but cannot breathe. What I am after is a strong functional result inside a face that is in harmony, and I plan both at the same time rather than one after the other.

None of this makes one type of surgeon better than another. It makes my approach specific, and you should choose a surgeon whose approach matches what your nose needs.

The consultation

A rhinoplasty consultation at my office takes about 30 minutes, in person in Roswell. We talk first: what bothers you about your nose, in your own words, plus breathing, allergies, injuries, and any previous nasal surgery. Then I examine the nose inside and out, including skin thickness, which matters a great deal.

Standardized photographs are taken at the visit. I do not use computer imaging or morphing. Projected images vary with whoever produces them and tend to set expectations that surgery cannot meet. Every nose is different, just as every face is, and my goal is a nose that fits your face within reasonable limits.

You leave with a written plan, a complete quote covering the surgeon fee and the separately quoted anesthesia and facility fees, and my honest opinion about what surgery can and cannot do. There is a consultation fee, credited toward surgery if you proceed.

Techniques I use

Every rhinoplasty is planned for the specific nose. These are the techniques I perform.

Open and closed approaches. Closed keeps every incision inside the nostrils and suits smaller changes to the bridge. Open adds a short incision across the columella, the skin between the nostrils, and gives direct access for tip work, grafting, and revision. The scar heals to a fine line.

Dorsal hump reduction and preservation rhinoplasty. A hump on the bridge is lowered in measured steps and the bridge is then supported, usually with spreader grafts, so the middle of the nose does not pinch inward over time. For some noses the bridge can instead be lowered by adjusting the framework beneath it, which preserves the natural lines. I will tell you which applies to you.

Tip refinement. Fine sutures reshape the tip cartilages, conservative trimming narrows them, and small grafts add definition or support. Removing too much tip cartilage is the most common cause of a pinched look years later. I leave more than I take.

Cartilage grafting. Grafts come from your own cartilage: septum first, ear for many tip grafts, rib for rebuilding a collapsed bridge. I do not use synthetic implants in the nose.

Alar base reduction and osteotomies. Wide or flared nostrils are narrowed through incisions in the natural crease. Wide nasal bones are moved inward through controlled cuts.

I do not offer non-surgical or filler rhinoplasty, and I do not use ultrasonic instruments. They are not part of my practice.

Functional rhinoplasty and septorhinoplasty

Surgery to fix nasal breathing is called functional rhinoplasty. Combined with straightening the septum, it is septorhinoplasty. Both can be done in the same operation as cosmetic changes, under one anesthetic and one recovery. The common causes of obstruction are a deviated septum, enlarged turbinates, and nasal valve collapse, and identifying which apply to you is part of the examination.

Insurance may cover the functional portion when there is documented obstruction and the repair is medically necessary. It never covers changes made for appearance. My office checks your benefits before surgery so there are no surprises. I do not help patients present cosmetic surgery as functional, and I would advise caution with any practice that does.

Ethnic rhinoplasty

A large part of my practice is patients of African, Asian, Middle Eastern, Hispanic, and mixed heritage. The goal is refinement that keeps the nose in harmony with the face and the patient's background, not a nose modeled on a single ideal. Thicker skin and softer tip cartilage call for building support and definition rather than removing tissue; a lower bridge may call for augmentation with your own cartilage. Read more on the ethnic rhinoplasty page.

What rhinoplasty costs

My surgeon fee for cosmetic rhinoplasty is $8,000 to $15,000. Anesthesia and facility fees are quoted separately and depend on how long the operation takes. A straightforward first rhinoplasty sits at the lower end. Revision surgery, rib cartilage harvest, and extensive structural work move it toward the upper end. A functional component may be partly covered by insurance. You receive the complete figure in writing at your consultation. CareCredit financing is available.

Recovery at a glance

• Day 1 to 3. Home the same day. Swelling and bruising peak around day two or three. Discomfort is mild to moderate and controlled with oral medication.
• Day 5 to 7. External and internal splints come off in the office. Breathing improves noticeably.
• Week 2. Most bruising has faded. Most patients are back at work or school within one to two weeks.
• Week 3. Strenuous exercise, heavy lifting, and straining wait until at least this point. Glasses stay off the bridge for about a month.
• One year. The final shape. The bridge settles first, the tip last.

Two things a brochure usually leaves out: in the early weeks the nose looks wider and the tip more upturned than the final result because of swelling, and that resolves. Sun protection matters for six months, because unprotected sun can leave lasting redness in the skin of the nose.

Risks and honest limits

Rhinoplasty is safe in experienced hands, and it is still surgery. Bleeding, infection, and anesthesia reactions are uncommon but possible. Specific to the nose: temporary numbness of the tip or upper teeth, a period of altered smell, small irregularities that may need a touch-up, and in a small number of cases a change in breathing.

Rhinoplasty cannot make thick skin thin, which limits fine definition at the tip. It cannot deliver a nose from a photograph of someone else, because your nose has to fit your face. And it cannot fix a problem that is not in the nose: a chin that sits far back can make a normal nose look large, and the honest advice is sometimes to address the chin or do nothing. Tell me before surgery if you have taken isotretinoin (Accutane), had radiation to the head or neck, or take steroids or immune-suppressing medication.

Where the surgery happens

Rhinoplasty is performed in an operating room under general anesthesia, with anesthesia provided by a board-certified anesthesiologist or a certified registered nurse anesthetist. A typical rhinoplasty takes two to three hours. You go home the same day with a responsible adult.

Frequently asked questions

How much does rhinoplasty cost in Atlanta?

At my practice, the surgeon fee for cosmetic rhinoplasty is $8,000 to $15,000. Anesthesia and facility fees are quoted separately and depend on the length of the operation. First-time surgery with limited structural work falls at the lower end; revision surgery and rib grafting fall at the upper end.

Does insurance ever cover rhinoplasty?

Not for changes to the appearance of the nose. It may cover the functional part of an operation, such as septoplasty or nasal valve repair, when obstruction is documented and the repair is medically necessary. My office verifies your benefits before surgery.

How long is recovery? When can I go back to work?

The splint comes off at about one week. Most patients return to work or school within one to two weeks. Strenuous exercise waits at least three weeks. The final shape is seen at about one year.

Open vs closed: which will I need?

Closed rhinoplasty keeps every incision inside the nose and suits smaller changes to the bridge. Open adds a short incision between the nostrils and gives direct access for tip work, grafting, and revision. I recommend one or the other at the consultation based on what your nose needs.

Will my results look natural?

That is the goal of every rhinoplasty I perform. A natural result comes from preserving structure, leaving more cartilage than I remove, and planning the nose in proportion to your face. Noses that look operated on are usually noses that had too much taken away.

When will I see final results?

Most patients see a clear change when the splint comes off at one week, but the nose is swollen then and looks wider than it will. Most swelling resolves over two to three months. The tip refines more slowly. The final result is judged at one year.

How painful is recovery?

Most patients describe pressure and congestion rather than pain. Discomfort is mild to moderate for the first two to three days and controlled with oral medication. A stuffy nose in the first week is the most bothersome symptom, and it improves once the internal splints come out.

What age can you have rhinoplasty?

The nose needs to have finished growing, usually around age 15 to 16 in girls and 16 to 17 in boys. There is no upper age limit as long as you are in good health.

What makes a head and neck surgeon different for this operation?

A head and neck surgeon trains for years on the inside of the nose and the airway, then adds facial plastic surgery training on top. In practice, I plan every rhinoplasty around breathing as well as appearance, I am comfortable with the cartilage grafting most noses need, and I can correct a deviated septum or a collapsed nasal valve in the same operation.

Request a consultation

I see rhinoplasty patients at my office at 1360 Upper Hembree Road, Suite 201B, in Roswell, serving Roswell, Alpharetta, Johns Creek, Sandy Springs, and the greater Atlanta area. Call 770-415-2554 or request a consultation online.

Related: Ethnic rhinoplasty | About Dr. Sokoya