Primary Rhinoplasty

Primary rhinoplasty, also known as “nose” or “nasal” surgery, corrects the nasal shape, size, and/or function for a patient who has never undergone nasal surgery. Before the primary rhinoplasty procedure, Dr. Constantian takes the time to ensure that he and his patients understand each other in terms of aesthetic goals. He personally meets with his patients and listens to their concerns and desires regarding the specific changes in appearance and function that they would prefer. Appearance is very personal, and each patient deserves the degree of change or preservation of ethnic or family identity that he or she wishes. Dr. Constantian then thoroughly assesses the patient for airway problems, the skin’s ability to shrink or take on a new shape, and areas of the nose that are anatomically too large or too small. Based on his discussion with the patient and his physical examination, Dr. Constantian explains what he can accomplish with surgery, and what he cannot, and creates a surgical plan that will achieve the patient’s cosmetic changes, maximize safety, and create the best airway.

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  • Consultation fee: $250
  • Surgical fee: $6,800 to $10,500
  • Hospital and anesthesia fees (for cosmetic/self-pay patients): Approximately $3,100

Secondary Rhinoplasty

Secondary rhinoplasty, also known as revision rhinoplasty, corrects problems that resulted from a previous rhinoplasty procedure and constitutes 70% of Dr. Constantian’s practice. Dr. Constantian performs secondary rhinoplasty to help patients who have already undergone one or more nose surgeries and are now suffering from reduced airway function or serious cosmetic problems. The secondary rhinoplasty procedure is more difficult than primary rhinoplasty because the cartilage and bone that create the nasal shape have already been altered and may be scarred or deformed, the skin has become thicker and less pliable, and potential cartilage building materials have been used up. Dr. Constantian always considers safety, nasal balance, airway function, deformities of cartilage and bone, and areas that need additional support or reshaping to devise a safe plan that satisfies, to the greatest degree possible, the patient's aesthetic goals.

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  • Consultation fee: $350
  • Surgical fee: $7,800 to $15,500 ($9,500 to $14,500 or higher if rib cartilage or time-consuming procedures are needed)
  • Hospital and anesthesia fees (for cosmetic/self-pay patients): Approximately $3,500

Our Approach

While many surgeons use the open approach to rhinoplasty, there are significant and rarely-discussed problems and limitations with this technique. We provide our patients with higher safety, quicker recovery, and more precise results that can be achieved with the closed rhinoplasty approach.

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Incisions / Scars

Visible, permanent scar across the tissue between the nostrils (columella)

Columella often becomes irreparably wider or deformed

Scars hidden within the nose

Columella remains narrow and unscarred

Dissection / Alterations

Skin is lifted for access to underlying structures

Disrupts the interconnection of nasal parts so that shape and support have to be reestablished

Much more chance of creating new deformities

More disruptive to the circulation and, therefore, less safe in scarred or operated noses

Skin loss can occur

Alterations are made through the nostrils

Does not disrupt the normal support mechanisms

Only areas that will be changed are uncovered so that there is much less chance of creating new deformities

Little disruption of nasal circulation

Incisions are limited, so the closed approach is much safer in scarred or operated noses

The skin is much better protected

Surgeon’s Visibility

Better view of internal structures, but the final surface shape is only the surgeon’s educated guess

The skin imparts half of the nasal shape and cannot be accurately assessed with open rhinoplasty

Better view of how changes to internal structures affect the nasal surface, details of shape, and nasal proportion

Much better capacity for the surgeon to make subtle changes and to assess the nuances of the surface and skin so that the patient’s goals are achieved

Framework Supports

Artificial: internal struts often uphold the new nasal tip

Permanent internal sutures are often used, which can cause late infections

Natural: anatomical reconstruction of the new external shape and airway support

No internal structures are used to create shape


Longer surgery

More extensive

More swelling

Higher chance of new deformities or asymmetries

Shorter operating time

Less extensive

Less swelling

Much less chance of creating new deformities


Take longer to become visible

Airway improvement is immediate when dressings are removed

Surface shape appears more quickly

Why Choose Dr. Constantian

Mark B. Constantian, MD, FACS has been a board-certified plastic surgeon since 1979 and is an expert in the field of rhinoplasty. He is a past president of the New England Society of Plastic and Reconstructive Surgeons, the Northeastern Society of Plastic Surgeons and The Rhinoplasty Society and is also an active member of The American Society for Aesthetic Plastic Surgery and other prestigious plastic surgery societies. Dr. Constantian is Clinical Adjunct Professor of Surgery (Plastic Surgery) at the University of Wisconsin Medical Center and Visiting Professor of Plastic Surgery at the University of Virginia.
He has published many journal articles and textbook chapters on rhinoplasty and is the author of a recent two-volume textbook on rhinoplasty. Dr. Constantian teaches regularly at regional, national, and international plastic surgery meetings, and his outcome study on airway repair is the most cited article on nasal function since 1970. Dr. Constantian understands that rhinoplasty is as much an art as it is a science, and his years of extensive training and experience provide him with the skills needed to successfully execute difficult techniques with both accuracy and efficacy.


Rhinoplasty is a complex surgery, so people naturally have many questions about the procedure. The following are some of the most common questions that patients ask Dr. Constantian during their initial consultations.

I have spent my career teaching surgeons how to achieve specific changes by understanding nasal structure. Many patients, especially those who fly here from Europe or the Middle East for surgery or have a strong ethnic identity, do not want obvious changes or want to retain certain nasal characteristics--tip or bridge shape, for example. This is all possible and is a routine part of my preoperative discussion with every patient.

Featured Procedure

Closed Rhinoplasty
Please contact us, if you are considering rhinoplasty or another plastic surgery procedure.