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Plastic Surgery - Nose


Rhinoplasty Iowa | Nose Job IowaMany patients who desire cosmetic surgery of the nose feel that their nose simply does not fit the overall look or balance of their face. They may have inherited a family trait that they wish to change. They may perceive that their nose is too large, crooked, or have an arch or bump that is unappealing to them. These patients feel that having surgery on their nose will vastly improve their appearance and create a more beautiful or handsome facial palette. Other patients who fall into this group include those whose nose is overly wide from the front, or has an unusual depression, or enlarged nostrils. Rhinoplasty (cosmetic reshaping of the nose) can be performed at almost any age, but it is recommended that the patient wait until his or her teenage years to ensure full adult facial and bone growth. Men and women of all ages elect nose surgery every year and are thrilled with the outcome.

The Rhinoplasty Patient

An initial consultation with our staff at Iowa City Plastic Surgery is the first step to every surgical procedure. When we sit down with you, we will ask you about your surgical goals and what results you hope to achieve through your nasal surgery. We will discuss treatment options, your overall health, medical conditions and any medications you may be taking. At Iowa City Plastic Surgery, we view each patient as a unique and individualized person. Therefore, our staff, from Claudette to Dr. Cram will handle your nasal surgery as it best fits your health and emotional needs. Please let us know if you have any conditions that will affect your surgery, including any diseases, such as high blood pressure, diabetes or thyroidism, that may effect your abilities to accept anesthesia, and heal properly. Please let us know if you are currently taking any medications, over-the-counter or prescription. Dr. Cram will discuss all aspects of the nasal surgery, including the surgical procedure, anesthesia, the risks and costs involved, the Mercy Hospital facility and the expected recovery time.


Nasal surgeries are performed under local anesthesia with sedation, or can be done under general anesthesia. In either case, rhinoplasty is performed on an out-patient basis. The choice of anesthetic technique will be discussed during your consultation. Patient safety and comfort are our primary concern, and the anesthetic will be chosen with these two parameters in mind.


Dr. Cram will explain the specific surgical technique prior to your scheduled treatment. Your surgery will be performed at Mercy Hospital of Iowa City. A comprehensive team, including Dr. Cram who will perform the surgery, will monitor your vitals before, during and after surgery. Mercy Hospital nurses and anesthesiologists are caring, professional and dedicated staff with your comfort and safety as their first priority. The surgical techniques that are useful in rhinoplasty, all depend on changing the underlying cartilaginous and bony structure to obtain the desired changes in the external nose appearance. In some cases, it is desirable to remove some of the bony dorsum and some of the cartilage that forms the bridge of the nose in order to make the line either straight rather than humped, or even in some patients, slightly concave if that is what is highly desirable to that patient. In other cases, it may be necessary to add either bone or cartilaginous structure to the dorsum if the nose is already too small or is too scooped in appearance. In the tip of the nose, it may be desirable to remove some of the cartilage to decrease the bulbous appearance of the nasal tip, or in some cases, it may be necessary to add cartilage to provide better definition and support. In all cases, we must preserve as much of the supporting architecture of the nose to ensure that the nose will not collapse with each breath. In most cases today, this type of surgery is done through an “open” approach in which the skin of the nose is lifted via a small incision across the skin dividing the nasal passages into left and right sides. The rest of the incisions are made internally in the nose and the skin is lifted off the cartilaginous and bony support as needed to provide direct vision and the ability to altar either by adding or subtracting structure in order to achieve the goals of the operation. In some cases, this can be done with only the internal incisions if changes to be made are less drastic and/or are easily visualized without lifting the skin off of some structures. This is generally referred to as a “closed” approach. Each technique has advantages and disadvantages and the proper technique will be chosen after discussing your goals for the operative procedure and then establishing what changes will be necessary to achieve those goals. Dr. Cram will explain these maneuvers in detail to help you understand the procedure to be performed. Most surgeries on the nose will take between 2 ½ - 6 hours, depending on your age and complexity of the procedure.


Most patients who have had nose surgery experience slight pain, bruising and swelling immediately following surgery. You will be given pain medications to help you deal with the discomfort. We ask that for the first 24 hours after surgery you:

  • Ensure there is a responsible adult with you at home to help care for you.
  • Keep your head elevated and limit physical activity
  • Monitor your swelling and bleeding and let the ICPS staff know of any persistent pain or increased bleeding

Our staff will monitor your recovery closely after your procedure. Many patients are shocked at how they look immediately following nose surgery, but in a few weeks, when the packing and splint has been removed, and swelling and bruising has eased, patients are delighted with the results. Most patients resume normal activities 10 -14 days after nasal surgery. Your scarring (if any) will be minimal. Most patients feel they have a new outlook on life and feel a heightened sense of self-confidence after their rhinoplasty procedure.

Risks And Results

With any surgical procedure there are risks and potential complications. Bleeding and infection are two risks of any operation and could occur in nasal surgery as well. There is a possibility of numbness of the area as it is healing, though this is not common. Sudden swelling, increased pain or excessive bleeding should be reported to Iowa City Plastic Surgery immediately. Despite our best efforts, there is always the possibility that one of these complications could occur. In that event, the patient and the surgeon must remain a team, and work together to obtain the best outcome possible under the circumstances.


The cost of the procedure will depend on the complexity of your nasal surgery as well as the cost of the operating room and the anesthesiologist fees. The patient is usually given the information on cost at the time of the first consultation. It is important to understand what the price quote includes so that the total cost of surgery is determined.

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Plastic Surgery Iowa Dr Albert E Cram | Plastic Surgeon | Iowa