Why the Consultation Matters
For most patients, the rhinoplasty consultation is the moment that decides everything: whether to move forward, and with whom. Mariana (@justvisaa), a Bay Area creator, met Dr. Michael Macdonald at Aesthetic Surgery Center in San Francisco before her rhinoplasty and septoplasty. She described that first meeting in her own 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. Knowing I'm putting something so important to me in his hands gives me so much peace of mind."
Mariana shared her journey on Instagram in collaboration with our practice. Watch her reel, where she talks about her consultation and the lead-up to surgery.
Here is what happens at a rhinoplasty consultation in San Francisco with Dr. Macdonald, and how to make the most of yours.
Start With Your Goals
Mariana came in with two clear goals: to soften her features and to finally breathe properly after years with a deviated septum. Your goals may be different. You might want to smooth a bump on the bridge, refine a wide or drooping tip, correct asymmetry, or fix a breathing problem, or several of these at once.
The consultation starts with you explaining what bothers you and what you'd like to change. Photos of noses you like can help, but the aim is a result that fits your face, not a copy of someone else's.
What Happens During the Consultation
Dr. Macdonald looks at the nose in relation to the whole face: the forehead, eyes, lips and chin. Small changes to the nose can change the balance of the profile, so he considers proportion, not just the nose on its own.
He also reviews your health history, any previous nasal surgery or injury, medications, and anything that could affect surgery or healing. Then he explains which changes are realistic for your anatomy and skin, and which approach he recommends, open or closed, and why.
The Breathing Exam
This is the part many patients don't expect. Dr. Macdonald is double board-certified in facial plastic surgery and in otolaryngology–head and neck surgery (ENT), so every rhinoplasty consultation includes a look inside the nose.
He checks the septum, the turbinates and the nasal valves. A deviated septum, like Mariana's, can block airflow on one or both sides. If a structural problem is found, it can often be corrected during the same surgery with septoplasty or other breathing treatments.
Treating shape and breathing together matters. Reshaping the outside of the nose without considering the airway can leave breathing problems untreated, or even make them worse.
Reviewing Your Plan and Recovery
Once your goals and anatomy are clear, Dr. Macdonald explains the plan: what will be changed, how, and what recovery looks like. Most patients return to light daily activities within 7 to 14 days, and swelling continues to settle for months. He also discusses risks, follow-up visits, and how to prepare.
You can look through the rhinoplasty gallery together to talk about the kinds of changes you like. Every result is individual, so photos are a starting point for conversation, not a promise.
Questions to Ask
Bring a list. Useful questions include:
- What changes do you recommend for my nose, and why?
- Is there anything affecting my breathing?
- Will you use an open or closed approach?
- What will recovery look like for my job and lifestyle?
- When will I see my final result?
- Is any part of my surgery likely to be covered by insurance?
There's no pressure to decide on the day. Take the time you need.
What to Bring
- A list of your medications and supplements
- Any records from previous nasal surgery or injury
- Photos that show what you like or dislike (optional)
- Your insurance information if you have breathing symptoms
- Your list of questions
Frequently Asked Questions
How long does a rhinoplasty consultation take?
Plan for enough time to discuss your goals, have your face and nose examined inside and out, and ask all your questions. Our team will confirm timing when you book.
Do I need to know exactly what I want?
No. Many patients only know what bothers them. Part of the consultation is working out which changes would look natural on your face.
Will the breathing exam be uncomfortable?
The internal nasal exam is quick and usually well tolerated. It helps find problems like a deviated septum that could be treated during the same surgery.
Do I have to book surgery at the consultation?
No. You can take time to think, ask follow-up questions, and decide when you're ready.
Book Your Rhinoplasty Consultation
Like Mariana, your rhinoplasty journey starts with a conversation. Dr. Michael Macdonald sees patients at Aesthetic Surgery Center, 500 Sutter St, Suite 430, San Francisco. Learn more about rhinoplasty, then book a consultation or call (415) 956-3223.
Mariana shared her experience in collaboration with Aesthetic Surgery Center. Individual experiences and results vary.
