Rhinoplasty procedure steps in the operating room

"I'm scared because I don't know what is being done while I'm under" is something we hear often in consultations. TIANA Plastic Surgery operates only on noses, rhinoplasty and revision rhinoplasty, and Dr. Choi Hang-seok handles each patient 1:1 from consultation through surgery, anesthesia and aftercare. This post walks through the operating room in order.

If you want to know which of these steps your own nose needs, send 5 photos (front, 45-degree and side) on WhatsApp with one line about what bothers you most. We reply in English.

Rhinoplasty procedure steps: six stages in the operating room

On rhinoplasty surgery day, the operating room usually runs in this order. Depending on your nose and the scope of surgery, a step may be skipped or added.

Order	Step	What it decides
1	Final design check	What changes, and by how much
2	Anesthesia	Safety and pain control during surgery
3	Incision and dissection	Whether bone and cartilage can be seen directly
4	Cartilage harvest	Whether there is enough material to support the tip
5	Shaping the bridge and tip	Balance of height, angle and length
6	Closing and splint	Holding the new shape while it settles

If you would rather watch the flow, see the video that shows the rhinoplasty steps in order (a simulated surgery, in Korean with auto-translated captions). The trip from arrival to flying home is laid out in how long to stay for Korean rhinoplasty, and more posts are in the Korean rhinoplasty guide.

Before surgery: the final design and material check

The design agreed at the consultation is checked once more right before surgery. Using the 3D-CT images of your bone structure and nasal passages, plus front and profile photos, the surgeon confirms the bridge height, the tip angle and the angle between nose and lip, one by one.

The materials are confirmed at this stage too. TIANA works with silicone, ear cartilage, septal cartilage, rib cartilage or donor rib cartilage, your own dermis and fascia. Which one is used depends on skin thickness, how much support is needed and any previous surgery, not on preference. Rib cartilage is covered in more detail in rib cartilage rhinoplasty recovery.

A note from Dr. Choi

If doubts remain before surgery, I think it is better not to operate that day. A design should be settled before you walk into the operating room. If there is anything you forgot to ask, this final check is the time to say it.

Who manages rhinoplasty anesthesia?

At TIANA, rhinoplasty anesthesia is managed by the director personally. The doctor who consulted with you, the doctor who operates and the doctor who manages anesthesia are the same person, so the health and medication details you shared at the consultation carry straight into decisions in the operating room.

The method is chosen for your nose and the scope of surgery, and it is explained before the operation. Tell us at the consultation about any medical conditions, medicines you take, or past bad reactions to anesthesia.

Incision and dissection: seeing the bone and cartilage directly

The incision is usually made inside the nostrils or across the columella, the small pillar between the nostrils. Where it goes depends on how finely the tip needs to be reshaped.

The skin is then lifted carefully off the cartilage, so the nasal bone and cartilage can be seen directly. Whether a bend or asymmetry comes from the shape of the cartilage, its position or the bone can be checked at this point.

Septal cartilage harvest: taking the material that supports the tip

Raising the tip or changing its angle or length needs cartilage for support. Septal cartilage harvest means taking what is needed from the cartilage inside the wall that divides the two nostrils.

The surgeon leaves the part of the septum the nose needs for support. How much can be taken differs between people, and ear or rib cartilage is added when it is not enough. If the septum is bent, it may be straightened during this step as well.

Shaping the bridge and tip: height, angle and length

The harvested cartilage or an implant is used to set the bridge height, the tip height and angle, and the length of the nose. A raised tip alone can look stuck on, so the surgeon keeps checking how it joins the bridge, the width from the front and the nose-lip angle in profile.

There are several ways to support the tip, including septal extension and a columellar strut. What tip work involves on its own is explained in what tip plasty involves.

This profile shows one patient one month after the bridge and tip were shaped together. Results vary between people, depending on skin thickness, cartilage and the scope of surgery.

Closing, the splint, and after surgery

Once the shape is set, the incisions are closed and a splint holds the nose in place. From the next day, the surgeon checks how you are doing and explains aftercare and medication.

Plan on 7 to 14 nights in Seoul, with 7 nights as the minimum. The splint and outer stitches usually come off around day 7, and the inner stitches around day 14. If you fly home around day 7, you receive a referral letter and a surgery certificate so the inner stitches can be removed at home. Timing varies between people and is confirmed again at surgery.

Risks to know about

The American Society of Plastic Surgeons lists risks of rhinoplasty such as infection, bleeding, asymmetry, difficulty breathing and revision surgery when the result is not what you hoped. Swelling and bruising are common for a while after surgery, and how fast they fade varies. Whether you are a candidate is decided after an exam.

Clinic address: TIANA Plastic Surgery, 108 Bongeunsa-ro, Gangnam-gu, Seoul (closed on Sundays and public holidays). You can read more about the surgeon on Dr. Choi's profile or the English home page.

Summary

• The rhinoplasty procedure steps are design check, anesthesia, incision and dissection, cartilage harvest, shaping, and closing with a splint
• The design and materials are checked once more right before surgery
• At TIANA, the director also manages anesthesia personally
• Septal cartilage is taken while keeping what the nose needs for support; ear or rib cartilage is added if needed
• Stitches come out around day 7 and day 14, and patients flying home get a referral letter and a surgery certificate

To find out which steps your nose needs, send 5 photos (front, 45-degree and side) on WhatsApp with the one thing you most want to know, such as "what does my tip need for support?". We reply in English with the likely scope of surgery.