Rhinoplasty is considered by many surgeons to be the most challenging plastic surgery procedure. Chiefly this is due to: complex anatomy, changes in the tissue over a lifetime, and the delicate balance between airway function and appearance. The most important factors in performing rhinoplasty are creating a natural, un-operated appearance, providing an improved nasal airway, and creating a nasal shape that is well balanced with the rest of the face.

Why Do Patients Seek Out Rhinoplasty?

Many of our Fairfield County area patients worry that they are being vain to discuss the possibility of rhinoplasty or even feel guilt for its consideration. Sometimes this feeling comes from a well-meaning spouse or parent who is concerned about risk. In reality, it is not unreasonable at all, if done for appropriate reasons with appropriate goals, using appropriate techniques. For example, as much as our research has shown (see sub-pages), the over-sized and deviated nose is simply due to the supportive nasal cartilage (the front end of the septum) being out of balance with the skeletal structure of the midface. This results in many cases asymmetry, encroachment of the nose into the lip (particularly with smiling), an overly long and high bridged nose, and importantly interference with breathing and sleep quality.

These qualities are extremely common and are found at variable degrees in many individuals, causing stress, insecurity, and even poor health due to poor sleep and exercise tolerance. Most of these problems can be addressed with a limited rhinoplasty that simply resizes the nose to match your facial skeleton. This procedure, done inside the nostrils (as opposed to the common open procedure) not only restores your airway in an effective manner by opening the area around the nostrils, but allows one to retain their signature appearance or look, just with a proportionally smaller and balanced nose. Thus, there is no risk of ski-slopes, pointy tips, bulky or “scooped-out” bridges, or turned up tips that people fear from rhinoplasty thanks to the ever-present, pervasive exposure to bad celebrity “nose-jobs”.

Using Fillers

Radiesse™ can be a minimally invasive filler for minor contour anomalies after rhinoplasty, as demonstrated in our 2008 study.

Dr. Howard Stupak: Rhinoplasty and Revision Rhinoplasty Expert

Dr. Stupak is well known both as a Fairfield County rhinoplasty expert and nationally in the academic community for his contributions to the field of rhinoplasty through research endeavors, surgical innovation, and education. Dr. Stupak is a site director and Associate Professor in the Department of Otolaryngology/Head and Neck Surgery at the Albert Einstein College of Medicine, and won the teacher of the year award in 2013. He has published important articles in the field of rhinoplasty, recently identifying that functional rhinoplasty may be critical in the management of sleep apnea, and describing a new understanding of, and technique for the “tension nose deformity.” He conceived, developed and patented the Alar ™ nasal airway device, now being sold by Medtronic.

Dr. Stupak has a unique perspective on rhinoplasty: Using evolutionary and unconventional techniques, where grafting is minimized, he instead re-positions and re-sizes existing nasal elements for a more natural and individualized improvement. Thus, the improved nose is designed to exist in better harmony with the upper lip and maxilla or cheek structures.


The bulk of recovery is completed within a week or two, but it takes months to years for the final drops of below-the-skin healing to be completed. This does not mean you will look swollen for a year, but that your body will be continuing to heal and improve over that time. Sometimes, long-term follow-up visits can be helpful to assist patients through this process. There is some discomfort for the first week (or two), controllable with rest, preparation and pain medication too. We do NOT use packing, so there can be a little bit of ooziness too for a few days, but this is manageable if one is prepared. Finally, tape and splints are removed at about a week from surgery, and then most people feel a lot better. The breathing starts to get better soon, but can be months to see the final airway result.


Septo-rhinoplasty is also an excellent procedure to improve nasal breathing, or the nasal airway. More evidence, even from studies conducted in this practice demonstrates the importance of adequate nasal breathing in promoting maximal athletic performance, preventing snoring and sleep apnea, and in maintaining overall health.

Can Rhinoplasty Treat Sleep Apnea?

Well, no…and yes! As we showed in our 2015 study, many people can have sleep apnea treated with rhinoplasty. Especially if the main reason for mouth breathing is severe nostril narrowing and deviated septum. However, if one has sleep apnea due to obesity, age, large tongue, small jaw, or a combination of these factors, then as logic would predict, rhinoplasty is much less effective and other treatments like CPAP are required.

Our Rhinoplasty Research

I wanted to give you some insight into the research we do into rhinoplasty…here is a list of our recent publications from PubMed:
These articles and our ongoing research into rhinoplasty not only help advance the field of aesthetics and breathing, but help me provide better care to my patients. Our techniques, and knowledge about the procedure are getting better every day, making the operation even more reliable and effective. Essentially, the research aims to identify better ways to do the procedure, find the right candidates, and understand how the physiology works. Here is a summary of a recent article:

2018 New Research

A team at the Albert Einstein College of Medicine led by Howard Stupak MD performed a radiologic investigation into the origin of over-sized noses and septal deviation. Instead of what is conventionally believed that nasal-septal cartilage is intrinsically overgrown and deviated, the authors found that the nasal-septal cartilage is relatively conserved amongst individuals, but that the bony nasal opening in the midface (or maxilla) is too small for the cartilage in pathologic cases. This small bony “chamber” causes the cartilage to extrude externally creating a dorsal hump (or bump), and downward into the lip creating distortion known as the “tension nose deformity”. Internally, the septum buckles and bends creating the commonly seen “septal deviation”. This new understanding gives surgeons a new perspective to address these common problems that normally manifest as nasal breathing, aesthetic and sleep disorders: Instead of the conventional technique of attempting to remove the most deviated portions, and trying to use grafts to overwhelm the forces of deviation, surgeons can shorten the nose from the bridge (dorsum) and lip (caudal end), and the re-sized cartilage now matches the midface opening, and the elastic cartilage literally springs back to the midline. The article is found in the February 2018 edition of the renowned journal Plastic and Reconstructive Surgery, and features a video of the new surgical technique.

The future of Rhinoplasty Research

In addition to the published research, our team is working on Albert Einstein College of Medicine approved projects to use new technology to measure nasal breathing using a simple app and new techniques to permit minimally invasive facial fracture repair. Finally, we are using Computational Flow Dynamics to measure 3-Dimensional Nasal Airflow before and after rhinoplasty with changes in shape at the nostril and nasal valve. Feel free to contact us if you have questions about our research , are interested in collaboration or device licensing, or are a member of the media.

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