James R. Payne M.D.
Aesthetic Plastic Surgery

1334 Nelson Avenue
Modesto, CA 95350
209.524.9904 T
209.524.4 1 0 1 F


Purpose of Procedure

The goal of rhinoplasty surgery is to improve the external appearance of the nose as well as to preserve or improve satisfactory nasal breathing.

This surgery is often combined with other facial surgery to optimally restore proportion and balance to the face.

Brief Description of the Procedure

This surgery may be performed under local anesthesia with intravenous sedation or under general anesthesia. All surgery is done at Dr. Payne’s MediCare and California State Certified Pueblo Nuevo Surgery Center located within his office.

All incisions are well hidden and mostly located within the interior of the nose. These scars typically become invisible within a few months after surgery. Rhinoplasty surgery may be done closed (no external nasal incision) or open (small incision across the columella on the underside of the nose). Through these incisions the internal nasal anatomy is accessed and corrected. Surgery on the inside of the nose is aimed at preserving or improving nasal breathing. This can include modification of the septum and the structures on the lateral nasal wall such as the inferior turbinates. It sometimes includes other surgical maneuvers designed to open up the nasal passages.

The external portion of the rhinoplasty includes modification of the bridge (dorsum) of the nose. Many patients have a significant dorsal hump they don’t like and which requires reduction. The nasal tip is often bulbous, large, asymmetric, and unattractive. The required work is aimed at providing a pleasing appearance of the nasal tip as well as fitting the tip to the bridge for proper balance between these two zones of the nose. The bony nasal pyramid is often narrowed in order to correct excess width of the nasal base or other problems. The length and projection of the nose can be changed. The nasal openings may be modified. Sometimes the use of cartilage, fascia, bone or other materials within the nose may be required in order to achieve the desired appearance. Big noses are reduced, small noses may be enlarged, and crooked noses straightened.

Likely Outcome and Longevity

Rhinoplasty surgery has the potential to dramatically change and improve the appearance of the nose and face. This is an operation that actually makes people look different than they used to as compared to other facial cosmetic procedures which try to turn the clock back to take years off the face. For women the postoperative rhinoplasty appearance often results in a softer, younger looking, more feminine, and friendlier look. For men, it tends to make them look more handsome and youthful.

It is always important to try to preserve or improve nasal breathing after a rhinoplasty. A good looking nose that fits a patient’s face and which is associated with good air exchange through both nostrils can be very satisfying to the patient and the plastic surgeon.

These operations tend to be fairly permanent. The human face including the nose continues to change as the rest of the body ages but the need for redo rhinoplasty after an initial successful operation is unlikely for the majority of patients.

Most patients tend to have two or three complaints about their noses. This includes the bridge or dorsum of the nose and the appearance of the nasal tip. Noses are complicated in terms of having a discussion about anatomy, appearance, surgical changes, and subsequent outcome. Dr. Payne is board certified not only in Plastic Surgery but also in Ears, Nose, and Throat. His unique combination of training and experience has helped him to become very adept at performing nasal surgery. He spends a lot of time preoperatively with each patient talking about their complaints as well as informing them as to what he thinks about their anatomy and what the surgical possibilities are. He begins by focusing on what it is the patient feels is most important but then fills in this initial analysis with a more detailed discussion of the overall picture. There are a lot of subtleties to nasal surgery that only an experienced plastic surgeon is able to recognize and communicate to his patients. Dr. Payne uses a computerized imaging system to help educate his patients about what their postoperative appearance may be and to show them different options. This helps patients to visualize their postoperative appearance ahead of time so they may feel more comfortable in making their decision to proceed with surgery. Patients can see Before and After images of other clients who have undergone similar previous surgery as well.

Please remember that the nose is only part of the face. Sometimes nasal surgery needs to be combined with other facial surgery for optimal facial cosmetic improvement. Occasionally rhinoplasty patients benefit from having their chins modified. This may include a chin reduction or augmentation. As the chin is changed (particularly as seen from the lateral or side view) this can dramatically change the appearance of the nose. The addition of a chin implant can also improve the appearance of the jaw line and neck. The point to be made here is that the nose and other surrounding facial features all contribute to our appearance and sometimes other surgery beyond the nose on other areas of the face is needed in order to obtain an optimal cosmetic outcome.

Recovery Issues

Rhinoplasty surgery is not particularly painful. The internal nose is sometimes packed for a few days after surgery along with a splint over the dorsum (outside) of the nose. If bone work is required as a part of the rhinoplasty procedure then most patients should anticipate some bruising and swelling particularly to the lower eyelids and cheeks. Camouflage makeup is provided for those patients interested in having it.

Dr. Payne suggests that most patients take one week off work following this surgery. It can be less or more depending on each person’s individual circumstances. Off duty medically excused absence notes are provided to those that need them. Each patient will be given detailed postoperative instructions prior to surgery. Appropriate medications are provided to the patient including antibiotics, narcotics, and other symptom relieving medications. Dr. Payne calls each patient the night of surgery and the morning after to check on them and make sure their caregivers are comfortable with their duties.

Patients are seen one to two times per week until they are well healed. By closely following the postoperative instructions most patients can look good by 2–4 weeks after surgery. Normal lifestyles may be resumed quickly after surgery. Exercise can begin within a week or so. Patients are cautioned not to drive or engage in other dangerous activity until they are off all narcotics and other mind influencing drugs.

Once full healing has taken place and patients are happy with their results then no further followup is required. Before and After fotos are provided to patients who request them.


Please contact our office for information regarding cost. You can get a ballpark non-binding quote over the phone for this surgical procedure. The cost of the consultation is $100 and will be applied to any surgical procedure that you have. Once you have had your consultation with Dr. Payne the final details of the operative game plan will be made. At that point you will be given a final fee quote. There are multiple options for each patient hence cost may vary from person to person.


Please contact our office if you wish to make an appointment to see Dr. Payne for a consultation. Our office will be happy to talk to you in detail about this procedure. Feel free to ask lots of questions.

Your initial consultation will be with Dr. Payne. This generally will take about 1 hour. You may visit the office prior to this consultation to have preoperative digital photographs taken or to simply come by and chat. If you would like you can view our Before and After album filled with multiple examples of this type of surgery. You will be given multiple brochures and other paperwork which will help to prepare you for your consultation. All your options will be discussed with you at the time you make your first appointment.

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