Rhinoplasty
Artistry as a surgical principle
The best rhinoplasty is one that is never noticed as such. The goal is not to replace the nose with a different one, but to resolve what bothers a patient while preserving, and often enhancing, what makes them distinctly themselves.
The existing structure is worked with, not overridden. This is a disciplined approach: precise about what to change, and equally precise about what to leave alone.
"The most successful outcomes appear effortless and enduring. Not like something was done, but like something was always there."
Every case is planned individually. The planning process begins in the consultation room, where photo morphs are created together, agreed upon by surgeon and patient, and serve as the visual reference point for surgical planning.
Both cosmetic and functional rhinoplasty are offered, and more often than not the two are addressed together. Breathing and aesthetics are not competing goals. They are deeply interconnected, and treating them as such produces the most complete results.
Trained to operate at the highest level
A background spanning both cosmetic refinement and complex reconstructive surgery informs every procedure performed here. Rhinoplasty at its most nuanced requires both artistic judgment and structural mastery.
American Board of Otolaryngology – Head & Neck Surgery
American Board of Facial Plastic & Reconstructive Surgery
Facial Plastic & Reconstructive Surgery
University of
Toronto
Advanced training in primary, functional, revision, and
reconstructive rhinoplasty.
Piezoelectric (Ultrasonic) Rhinoplasty enables precise bone work with reduced trauma, less bruising, and faster recovery compared to conventional instruments.
Is rhinoplasty right for you?
Candidacy is nuanced and something determined together in consultation. These are the considerations weighed most carefully.
Cosmetic concerns
Dorsal hump, width, tip definition, asymmetry, or overall proportion. Good candidates have specific, articulable goals and realistic expectations of outcome.
Functional concerns
Nasal obstruction from a deviated septum, valve collapse, or turbinate hypertrophy. Many patients present primarily for breathing and leave with a nose that looks better too, because the anatomy often dictates both.
Facial balance
The nose is assessed in the context of the full face. Chin projection, facial thirds, skin thickness, and skeletal structure all bear on what an ideal result looks like for a given patient.
Readiness & timing
Facial growth should be complete, typically mid-to-late teens for cosmetic surgery. Emotional readiness and settled, non-pressured motivation matter as much as physical candidacy.
A conversation, not a sales pitch
Consultations here are unhurried. The approach is to listen first, ask questions, and offer an honest clinical perspective second. Nasal anatomy is reviewed in detail, goals are discussed, and a clear picture is given of what is surgically achievable and what is realistically expected in each specific case.
A key part of every consultation is collaborative photo morphing: creating imaging together, iterating until both surgeon and patient agree it represents a realistic and desirable target. These morphs serve as the visual reference for surgical planning. They are a communication tool, not a guarantee.
Breathing function is reviewed at every rhinoplasty evaluation. Cosmetic and functional concerns are frequently intertwined, and addressing both in a single operation is often in the patient's best interest.
If a procedure would not meaningfully serve a patient's goals, or if expectations exceed what surgery can reliably deliver, that will be stated directly. That honesty is a feature of this practice.
Complexity is where your surgeon's skills show
Rhinoplasty is among the most technically demanding procedures in all of surgery, and despite meticulous planning, the operating room has a way of presenting surprises. Ridges or divots, paucity of bone or cartilage, and anatomical or post-traumatic features that are not apparent until surgery can dramatically change the appearance of the nose if not appropriately handled in the moment. These findings shift the direction of the operation and can begin pulling the surgery down a path that deviates from the plan, sometimes subtly, sometimes significantly.
This is not a failure of planning. It is the nature of rhinoplasty. What separates a good outcome from a compromised one in these moments is not the plan, it is the surgeon.
"The goal is to take command of the nose. Not to let the nose take command of you."
It is to your benefit to select a surgeon with tested experience in rhinoplasty, someone who can adapt in real time to unexpected anatomy. This means reconstructing with bone or cartilage grafts, using ultrasonic tools for precise contouring and fixation, and performing careful excision or repositioning of cartilage and bone as the situation demands. This toolbox of maneuvers represents the full vocabulary of an experienced rhinoplasty surgeon. It is not a fallback. It is required in many surgeries, deployed as needed to keep your result on course.
This is why surgeon selection in rhinoplasty matters beyond before-and-after photographs. It is the capacity to navigate complexity, not just to execute a plan when everything goes as expected, that ultimately determines your result.
From consultation to operating room
Once a surgical plan is agreed upon, the pathway to the procedure is organized and well-supported.
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Medical clearance
Rhinoplasty is a low-stress, low-risk procedure and routine pre-operative testing is generally not required. For patients over 50, clearance depends on individual health status; for patients over 60, it is required. Any specific requirements will be reviewed and coordinated in advance.
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Medications & lifestyle
Aspirin, ibuprofen, fish oil, vitamin E, and turmeric must be paused one week before surgery. Nicotine and vaping should be stopped as early as possible, at minimum one month before surgery, and remain stopped for four weeks after. All prescriptions should be filled before surgery day.
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Arranging support
A trusted adult is needed to drive home and stay the first night. Plan for approximately one week away from a desk-based role. Prescriptions should be filled before the day of surgery.
What to expect when you arrive
Rhinoplasty is performed under general anesthesia in an accredited surgical facility. Nothing to eat after midnight; small sips of water only for approved medications. Wear comfortable clothing and avoid makeup, lotion, and jewelry.
Arrival & preparation
Arrival approximately one hour before surgery for check-in, nursing assessment, IV placement, and anesthesia consultation.
The procedure
An open approach is used in most cases, providing direct visualization of the nasal framework. Septal cartilage is harvested for grafting as needed. For bone reshaping, piezoelectric (ultrasonic) instrumentation is used, which allows sculpting with exceptional accuracy and minimal tissue disruption, resulting in less bruising and a faster recovery.
Who is in the room
Throughout the entire procedure, the surgical team consists of a board-certified anesthesiologist dedicated solely to monitoring and managing your anesthesia and safety, a circulating nurse present at all times, and a scrub technician assisting directly with instruments. Before surgery begins, the anesthesiologist and nursing staff will each introduce themselves and speak with you personally, so you know exactly who is caring for you during your surgery.
Closure & dressing
A small external cast is applied at the close of surgery to support the nasal bones. Internal dissolvable sutures are used whenever possible. External sutures may be placed along the columella or nostrils depending on the approach, and in cases involving septoplasty, internal splints may be placed. All are removed comfortably in the office at the one-week visit.
Discharge
Most patients spend one to two hours in recovery before discharge the same day. That evening, Dr. Hashemi will personally reach out to check in, a reflection of the hands-on, engaged care that defines this practice.
Engaged care, directly from the surgeon
Recovery is not a period of uncertainty. Patients here have direct access to Dr. Hashemi throughout the healing process, not through a general inbox.
Evening of surgery
Dr. Hashemi personally reaches out the evening after surgery to check in, review how you are feeling, and address any questions before the first night.
Throughout recovery
Questions and concerns during the recovery period are met with direct, timely responses. An after-hours line is available for urgent needs outside of office hours.
Follow-up visits
The one-week post-operative visit, two-month follow-up, and one-year milestone are all conducted personally by Dr. Hashemi, ensuring continuity from first consultation through final result.
Healing in three phases
Rhinoplasty recovery is explained to every patient in terms of three general phases. Understanding this framework sets realistic expectations and removes much of the anxiety from the process.
Surgery through one week
The first phase encompasses the surgery itself and the subsequent week. Swelling peaks within the first week. The cast and sutures are removed at the one-week post-operative visit. Home care during this phase is active: medications, wound care, cold therapy to the cheeks, and rest.
The first month
After cast removal, residual swelling and bruising dissipate over the following weeks. Activity is kept lower during this time. Nasal taping continues daily for the first week after cast removal, then at night for the rest of the month. The nose should be treated gently and protected from pressure.
Months two through twelve
The third phase extends through the full first year. Month-by-month improvements occur in both visible appearance and breathing. Rhinoplasty changes the nasal skeleton, not the skin, and in select cases minor filler refinements may be considered later in the healing course to optimize contour.
The first days at home
The following reflects the exact instructions given to every patient: specific, practical, and designed to optimize recovery from day one.
Activity & sleep
The majority of awake time should be spent out of bed. Walking is encouraged. Avoid heavy lifting, bending, or strenuous activity. Sleep with the head elevated 30 degrees for two weeks, not on the side or face. A neck or travel pillow helps maintain position.
Cold therapy
Cool packs should be applied to the cheeks only, never directly on the nasal cast, for the first 72 hours. Use 15 minutes on, 15 minutes off, every two to three hours while awake. This is more effective than continuous cold for reducing early swelling and bruising.
Nose care
Do not blow the nose. Sneeze with the mouth open. Avoid touching, bumping, or pressing on the nose. Keep the cast dry; shower from the shoulders down only. Gently clean the front of the nose with wet Q-tips and use saline nasal spray several times daily.
Diet
Soft, easy-to-chew foods. Avoid salt for the first week, as it promotes swelling. Good options include protein shakes, broth, mashed avocado, eggs, chicken, fish, berries, and pineapple. Staying well-nourished actively supports healing.
Every patient receives a care kit from the practice containing everything needed for the first phase of recovery: gauze, nasal drip pads, Q-tips, saline spray, peroxide, and, for later in healing, silicone scar gel and nasal tape. There is no need to source these separately.
What you will be prescribed
All prescriptions should be filled before surgery day. The regimen below is designed for effective pain control, swelling reduction, and a smooth first week.
- Tylenol: up to 4,000 mg/day. First-line pain control throughout recovery.
- Celebrex: morning and evening. Do not combine with ibuprofen or aspirin.
- Medrol (steroid pack): begin the morning after surgery. Significantly reduces early swelling.
- Zofran: as needed for nausea in the first 24 hours.
- Oral antibiotic: prescribed and begun the evening of surgery.
- Antibiotic ointment: applied to nasal incisions three times daily during the first week, then transitioned to silicone scar gel.
- Rapid or persistent nose bleeding
- Foul-smelling drainage from incision sites
- Severe or worsening pain not controlled with medication
- The cast has come off
Office: 650-313-2338
All surgery patients have direct after-hours access to Dr. Hashemi.
The cast comes off. The healing continues.
The one-week post-operative visit is a significant milestone. The cast and sutures are removed, and the nose is seen for the first time since surgery. It will still be swollen; what is seen at week one is not the final result at six months. What is visible at this stage is a work in progress.
Nasal taping: Continue taping continuously for one additional week, removing and replacing daily with the shower. After that, tape only at night or when at home for the rest of the month. Wetting the tape in the shower helps it release without pulling on healing tissues.
Activity: Moderate lifting is permitted. Light cardio may begin two weeks after cast removal, keeping the heart rate near 100 bpm and avoiding exertion to the point of breathlessness. Full activity resumes three weeks after cast removal.
Scar care: Continue antibiotic ointment twice daily for one additional week, then transition to a silicone scar gel applied in a thin layer to the incision twice daily for two months.
Pressure & glasses: No glasses or sunglasses resting on the nasal bridge until one month post-operatively. Avoid masks or goggles that place pressure on the nose.
Swelling resolves on its own schedule
It is important to understand that the final result of rhinoplasty is not visible at three months. The nose continues to change and improve over a full year, and patients should expect a gradual process rather than an immediate outcome. Skin thickness plays a significant role in how quickly definition emerges, and this is discussed explicitly in consultation so that expectations are well-calibrated from the start.
Cast off. Sutures removed. Mild swelling, usually no bruising. Socially presentable for most.
Most swelling resolved. Nose essentially healed for activity and glasses. Some residual swelling remains and the process continues.
Nose is actively refining. Breathing is usually back to normal. Subtle improvements ongoing.
Essentially at final result. Tip natural and soft. Breathing stable. Scars fully matured.
Expected long-term changes include reduced tip pliability, altered sensation around the tip, and small ledges within the nostrils from scar and cartilage. These are all normal sequelae of rhinoplasty and are reviewed in detail during consultation.
Your face. Your identity. Your result.
Rhinoplasty done well is invisible. It is the version of you that people notice looks somehow more balanced, more rested, more like yourself, without being able to say precisely why. That is the outcome aimed for with every patient.
For those considering rhinoplasty in Palo Alto or the Silicon Valley area and looking for a thoughtful, honest conversation about what it can achieve, a consultation is the right first step.
Schedule a Consultation