Meet Mariana
Mariana (@justvisaa) is a Bay Area creator who had rhinoplasty and septoplasty with Dr. Michael Macdonald at Aesthetic Surgery Center in San Francisco. She had two goals, and she described them in her own words:
"I wanted to soften my features, but also FINALLY breathe properly after living with a deviated septum."
Mariana documented her journey on Instagram in collaboration with our practice, from the lead-up to surgery through her first days of recovery. You can watch her surgery day and her first days after surgery.
Her story shows something many patients don't realize at first: the shape of the nose and the way it breathes are connected. Below, we follow each stage of Mariana's journey and explain what any patient considering rhinoplasty in San Francisco can expect.
Her Consultation: Being Heard First
For Mariana, the consultation set the tone for everything that followed. In her words, translated from Spanish:
"From the very first consultation he made me feel super calm. He took the time to listen to absolutely everything I wanted, explained every detail and understood exactly what I was looking for."
A rhinoplasty consultation with Dr. Macdonald starts with a conversation about what you want to change and why. He then examines the outside of the nose in relation to the rest of the face, and the inside of the nose to check for breathing problems such as a deviated septum, enlarged turbinates or weak nasal valves.
From there, you discuss whether cosmetic surgery, functional surgery or a combination makes sense for you, what is realistic for your anatomy, and what recovery involves. There's no pressure to decide on the day.
Shape and Breathing, Planned Together
Mariana's plan combined two procedures. Rhinoplasty refines the shape of the nose. Septoplasty straightens the septum, the wall inside the nose, so air can flow freely. When both are done in one surgery, it is often called septorhinoplasty.
This is where a surgeon's training matters. Dr. Macdonald is double board-certified by the American Board of Facial Plastic and Reconstructive Surgery and the American Board of Otolaryngology–Head and Neck Surgery (ENT). That means he plans the look of the nose and the airway at the same time, so changing the outside doesn't come at the cost of breathing, and fixing breathing doesn't ignore appearance.
If breathing is your main concern, our functional and breathing solutions page explains the options.
Surgery Day
After years of thinking about it, Mariana's surgery day arrived, and she filmed it to share the whole process with her followers. Watch Mariana's surgery day on Instagram.
On surgery day, patients check in, meet with Dr. Macdonald to review the plan one more time, and receive anesthesia. Depending on the plan, the surgery may use an open or closed approach. Afterward, a splint protects the nose during early healing, and most patients go home the same day with a responsible adult. Your care team gives you specific instructions before and after surgery.
Recovery Happens in Stages
Mariana also shared her first days after surgery. Watch her early recovery on Instagram.
Every patient heals differently, but recovery generally follows a pattern:
- First days: swelling, some bruising and nasal congestion are common. Sleeping with your head elevated helps.
- About one week: the splint is usually removed at a follow-up visit.
- 7 to 14 days: most patients return to light daily activities and work.
- Following weeks: visible swelling and bruising continue to fade.
- Several months to a year: the final shape gradually refines, especially at the tip.
When septoplasty is part of the surgery, breathing may feel congested at first. That usually improves as the inside of the nose heals.
What Mariana's Story Means for You
Mariana's journey reflects what many of our patients want: a nose that looks more balanced and breathes better, without looking "done." Every plan at Aesthetic Surgery Center is built around the individual patient's anatomy and goals, so your plan may look different from hers.
You can see more examples of Dr. Macdonald's work in our rhinoplasty gallery.
Frequently Asked Questions
Can rhinoplasty and septoplasty be done in the same surgery?
Yes. When a patient wants to refine the shape of the nose and also has a deviated septum, both are often done together in one operation, as in Mariana's case.
Will rhinoplasty help me breathe better?
It can when a structural problem, such as a deviated septum or weak nasal valves, is causing the blockage. An exam with an ENT-trained surgeon identifies the cause and the right treatment.
How long is recovery?
Most patients return to light activities within 7 to 14 days. Swelling continues to settle for several months, and the final shape refines over about a year.
Does insurance cover any part of it?
The septoplasty portion may be covered when it is medically necessary to treat breathing problems. The cosmetic portion is not covered. Our team can help you understand your options.
How do I start?
Book a consultation with Dr. Macdonald to discuss your goals, have your nose and breathing examined, and get a personalized plan.
Start Your Own Rhinoplasty Journey
If you're thinking about changing the shape of your nose, breathing better, or both, the first step is a conversation. Dr. Michael Macdonald sees patients at Aesthetic Surgery Center, 500 Sutter St, Suite 430, in Union Square, San Francisco.
Book a consultation or call (415) 956-3223.
Mariana shared her experience in collaboration with Aesthetic Surgery Center. Individual experiences and results vary.
