Rhinoplasty

What is Rhinoplasty?

Why it’s done

Rhinoplasty (RIE-no-plas-tee) is surgery that changes the shape of the nose. The motivation for rhinoplasty may be to change the appearance of the nose, improve breathing or both. In Other words, Rhinoplasty can change the size, shape or proportions of your nose. It may be done to repair deformities from an injury, correct a birth defect or improve some breathing difficulties.

Cosmetic surgical rhinoplasty can help address:

. Enlarged, bulbous, drooping, upturned or hooked nasal tip

. Large, wide or upturned nostrils

. Nasal asymmetry

. Removing a hump on the nose

. Straightening the bridge

. Reshaping the nose’s tip

. A broken nose

. Correcting the nose after an injury

. Opening breathing passages

. Making the nose bigger or smaller

Before Rhinoplasty Surgery

Before scheduling a rhinoplasty in iran, you should meet with your surgeon to discuss important factors that determine whether the surgery is likely to work well for you. This meeting generally includes the following:

Your medical history:

The most important question your doctor will ask about your motives for surgery and your goals. Your doctor will also ask questions about your medical history – including the history of nose obstruction, surgery, and any medications you take. If you have a bleeding disorder, such as hemophilia, you may not be a candidate for rhinoplasty.

Physical exam:

The doctor will perform a complete physical examination, including any laboratory tests, such as blood tests. He or she will also lose your skin and inside and outside the nose. Physical examination helps your doctor determine what changes need to be made and how your physical attributes – for example, your skin thickness or cartilage strength at the end of your nose – affect your results. Physical examination is also important to determine the effect of nose-nose surgery on your breathing.

Photography:

Someone from the doctor’s office may take pictures of your nose from different angles. The surgeon may use computer programs to simulate images to show you the kinds of possible results. Your doctor will use these images for previous, subsequent and referral evaluations during surgery and long-term reviews. More importantly, images allow for a specific discussion about the objectives of surgery.

Discuss your expectations:

You and your doctor should talk about your motives and expectations. You will be told what you can and cannot do for your nose and what your results might be. It is normal for people to feel self-conscious in discussing their appearance, but it is important to be open with your wounds about your wishes and goals in surgery.

Sometimes the surgeon may talk to you about surgery to increase your chin. This is because a small chin will create their nose bigger. Chin surgery is not required under these conditions, but it may better balance facial features. Once the procedure is determined, you will need to arrange someone to take you home if you have an outpatient procedure. In the first few days after anesthesia, you may have convulsions in memory, slow reaction time and reduce judgment. So arrange a meeting with a family member or a friend at night or two to help with personal care tasks while recovering from surgery.

Food and medicine

Avoid drugs containing aspirin or ibuprofen for 2 weeks prior to the procedure of nasal and nasal mobilization. These drugs may increase bleeding. Take only medicines that have been approved or prescribed by the surgeon. If you smoke, stop smoking. Smoking slows the healing process after surgery and makes you more susceptible to infection.

Rhinoplasty surgery Risks and Side effects

Rhinoplasty surgery risks include:

. Anesthesia risks

. Infection

. Poor wound healing or scarring

. Change in skin sensation (numbness or pain)

. Nasal septal perforation (a hole in the nasal septum) is rare. Additional surgical treatment may be necessary to repair the septum but it may be impossible to correct this complication.

. Difficulty breathing

. Unsatisfactory nasal appearance

. Skin discoloration and swelling

. Possibility of revision surgery

Who are and aren’t good candidates for rhinoplasty?

Rhinoplasty surgery is popular with both men and women, although more women choose to have nose surgery. The best candidates should meet these general qualifications:

. Good physical health with no serious medical conditions or illnesses

. Non-smoker

. Complete facial growth

. Positive outlook on life

. Patients who have realistic aesthetic goals and expectations

. They have a deformity which needs correcting.

. They have reached the right age, which means that younger people should wait until they reach physical maturity and then undergo this procedure. Females usually attain physical maturity earlier at the age 16 onwards while male teenagers have to wait until the age of 18 onwards. The reason for this is that the nose stops growing and changing significantly at this age.

However we may advise you not to undergo the procedure if:

. You have skin or nasal cartilage that is lacking in structural integrity.

. You have unrealistic expectations and you seek perfection, I mean if you are looking for something to transform you into another person.

. You suffer from depression or another psychological issue such as body dysmorphic disorder.

. You have high blood pressure, bleeding disorders, lung disease, diabetes, high cholesterol and severe allergies.

. You are a heavy drinker or smoker.

During Rhinoplasty Surgery

Steps of rhinoplasty

Rhinoplasty surgery includes the following steps:

. Step 1 – Anesthesia

. Step 2 – The incision

. Step 3 – Reshaping the nose structure

. Step 4 – Correcting a deviated septum

. Step 5 – Closing the incision

. Step 6 – See the results

During Procedure

Rhinoplasty surgery may be done inside your nose or through a small external cut (incision) at the base of your nose, between your nostrils. Your surgeon will likely adjust the bone and cartilage underneath your skin. Your rhinoplasty surgeon can change the shape of your nasal bones or cartilage in several ways, depending on how much needs to be removed or added, your nose’s structure, and available materials. For small changes, the surgeon may use cartilage taken from deeper inside your nose or from your ear. For larger changes, the surgeon can use cartilage from your rib, implants or bone from other parts of your body.

After these changes are made, the rhinoplasty surgeon places the nose’s skin and tissue back and stitches the incisions in your nose. If the wall between the two sides of the nose (septum) is bent or crooked (deviated), the surgeon can also correct it to improve breathing. After the rhinoplasty surgery, you’ll be in a recovery room, where the staff monitors your return to wakefulness. You might leave later that day or, if you have other health issues, you might stay overnight.

Type of Rhinoplasty

There are four types of rhinoplasty procedures.

1. Closed Rhinoplasty

A closed rhinoplasty is the most common type of rhinoplasty. All incisions are hidden inside the nose with no external scars. Lifting the soft tissue slightly upward, the bone and cartilage is accessible to perform the necessary changes. The technical methods, once the inside structure of the nose is visualized for an open or closed rhinoplasty, are similar. There are several advantages to having a closed rhinoplasty, due to its less-invasive nature:

. Reduced nasal tissue irritation (due to the lack of a columellar incision)

. Reduced likelihood of the nasal-tip support reduction

. Smaller likelihood of post-operative edema

. Lessened detectable scarring

. Less time spent in the operating room

. Faster post-operative patient recovery

2. Open Rhinoplasty

An open rhinoplasty has historically been the rhinoplasty for patients who need extensive work done to the nose. Your surgeon will make incisions in the skin between your nostrils underneath your nose. This area is called the columella. Next, the skin is lifted to reveal the inside of the nasal cavity, giving your rhinoplasty surgeon access to perform the necessary reshaping. Where extensive grafting or when revision surgery is needed, you may require an open rhinoplasty. Some surgeons will choose open rhinoplasty as their primary method of surgery depending on the training and skill of the physician. Open rhinoplasty procedures are best for patients with the following issues:

. Collapsed valves from previous hump removal

. Genetic, structural deformities in the nose (i.e. cleft lip palate)

. Acquired deformities in the nose (i.e. severe trauma requiring grafting)

. Dissatisfaction with the cosmetic appearance of the nose after previous nasal surgery

3. Filler Rhinoplasty

A filler rhinoplasty is a less common type of nose surgery. It is non-surgical in nature and can be done by dermatologists, cosmetic surgeons, physician assistants as well as general plastic surgeons. No incisions are made, but rather, the injectable filler is used to correct minor imperfections in the nose. For example, a filler rhinoplasty is an option for those who desire minimal change to the nose. The most common types of “fillers” are Juvederm and Restylane. A drawback to choosing a filler rhinoplasty is that the results are not permanent. Scarring from fillers can be permanent and vessels can be obstructed causing necrosis of the nasal skin. Over time, the filler eventually absorbs back into the skin, effectively erasing the changes and requiring an additional procedure.

4. Revision Rhinoplasty

Revision rhinoplasty is a subsequent surgery after a primary rhinoplasty (Read more about : Bad rhinoplasty). Typically patients opt for a revision rhinoplasty if they are unhappy with the results of the primary rhinoplasty or if they seek further changes not originally desired in the primary rhinoplasty. Breathing difficulties uncovered or created by the primary surgery are fairly common. For most, a revision rhinoplasty is an option for those who desire a “touch-up.” Most surgeons have a revision rate of around 10-15%. If a doctor has no revision rate the patients are likely having another physician perform subsequent surgeries. The main reason for revision surgery is breathing difficulty or a bump or irregularity of the bridge of the nose. Because the complexity and time involved are more than your first rhinoplasty, it also costs more. Generally, revision rhinoplasty costs 50-100% more than a primary rhinoplasty.

Does Rhinoplasty require General Anesthesia?

Rhinoplasty surgery requires local anesthesia with sedation or general anesthesia, depending on how complex your surgery is and what your surgeon prefers. Discuss with your rhinoplasty surgeon before rhinoplasty surgery which type of anesthesia is most appropriate for you.

Local anesthesia with sedation, this type of anesthesia is usually used in an outpatient setting and it’s limited to a specific area of your body. Your rhinoplasty surgeon injects a pain-numbing medication into your nasal tissues and sedates you with medication injected through an intravenous (IV) line. This makes you groggy but not fully asleep.

General anesthesia, you receive the drug (anesthetic) by inhaling it or through a small tube (IV line) placed in a vein in your hand, neck or chest. General anesthesia affects your entire body and causes you to be unconscious during surgery. General anesthesia requires a breathing tube.

After Rhinoplasty Surgery

Post-Operative Instructions for a Rhinoplasty

Nose job Surgery after Care

You may be eager to see the results of your rhinoplasty procedure right away, but the recovery process takes time, most patients will notice results when the swelling begins to go down, but it may be up to a full year before the final results become apparent.

Post-operative care is very important. Unnecessary pain and the complications of infection and swelling may be minimized if the instructions are followed carefully. Sometimes the after-effects of surgery are quite minimal, so not all these instructions may apply. Common sense will often dictate what you should do. However, when in doubt, follow these guidelines or call our office any time for clarification.

Rhinoplasty is a common surgery that not only can give a great cosmetic outcome but also can improve nasal breathing. The success of the surgery lies in the hands of the patient as well as the surgeon. The best surgeon on earth will not obtain satisfactory results if the patients do not properly care for themselves after surgery. In order to take advantage of all the positive changes associated with the nasal surgery, the patient must pay close attention to the recovery process.

Immediately Following Surgery:

. An adult should stay with you for at least the first 24 hours after surgery. Rest is absolutely necessary.

. You should rest with your head elevated in a recliner or with at least 2 pillows for at least the first week after surgery. Try not to sleep on the side of your face but rather sleep with the back of your head on the pillow. Some patients prefer an airline type pillow for comfort. Also popular is the common pillow called a “husband.” This is the large pillow that has extensions that go under the arms and supports the patient.

. Take the prescribed pain medications before you begin to feel discomfort. It is easier to prevent pain than control it.

. Restrict your activities the day of surgery and several days afterwards. It is not unusual to require 10 to 14 days before you are feeling back to normal, and before you can resume physical activity.

. Caution: If you suddenly sit up or stand from a lying position you may become dizzy. If you are lying down following surgery, make sure you sit for one minute before standing. Stand up slowly to provide time to steady yourself. If you feel dizzy when you sit or stand, you should lie back down immediately to minimize the possibility of fainting.

. Packing: A nasal packing is sometimes placed into the nostrils, especially if your surgery is also to relieve a nasal breathing obstruction. This packing is removed a few days following surgery. Our doctor usually sees you within a few days to assist in the removal of packing and to review instructions.

. A small bandage is placed between the bottom of the nose and the upper lip. This is changed as often as needed during the day. A small amount of oozing is ordinary and expected. It should not concern you. The bandage may be changed one or a dozen times. The loosely closed incision allows blood to escape rather than flow back up into the nasal tissue. Most of this oozing stops by the evening of surgery or by the following morning. The drip pad, placed below the nose, can ordinarily be discontinued the morning following your operation. A small amount of red-pink serum is to be expected. Just dab it away.

. A small silicone splint is placed atop the upper two-thirds of the nose at the completion of the rhinoplasty. This splint acts both as a protector for the freshly operated nose and helps to maintain the position of the newly sculpted nasal bones. The splint is removed in one week. Do not allow it to get wet or it may separate prematurely.

. After general anesthesia or I.V. sedation, clear liquids should be initially taken. Over the next several days a high calorie, high protein intake is very important. Nourishment should be taken regularly. You should prevent dehydration by taking fluids regularly. Keeping well hydrated also prevents nausea and vomiting. Try not to miss a single meal. You will feel better, have more strength, less discomfort, and heal faster if you continue to eat. Decreased activity may promote constipation so you may want to add more raw fruit to your diet and be sure to increase your fluid intake. Avoid straining when going to the restroom. Getting a laxative or a stool softener may be beneficial.

The First Week after Surgery:

. Ice: During the day and evening of surgery, cold compresses are used continuously over the nose and eyes to minimize swelling and control bruising. The ice packs should be used for the first 2 to 3 days as much as possible. A good way to do this is to crush up the ice and place it into a zip lock bag. Wrap a thin towel around the ice pack and place it over the nose and over the eyes.

. Puffiness: Puffiness or swelling of the eyelids is always most pronounced on the second morning following any facial plastic surgery (i.e., surgery on Monday, most swelling on Wednesday). It usually regresses quickly in the next few days. This normal and expected observation is no cause for concern.

. Bruising: Bruising and discoloration around the eyes is extremely variable. However, the majority of patients do experience minimal black and blue. Careful adherence to the recommended pre-operative medication instructions is imperative. A few patients, despite taking all precautions, will develop marked bruising in the eyelids. Even this bruising is usually resolved by the end of the first week.

. Nasal Stuffiness: Invariably, there is some nasal stuffiness during the week after surgery. The external edema (swelling) is reflected internally, but the mild blockage will improve steadily. The application, twice daily, of a small amount of prescription ointment just inside the nostrils, acts to lubricate the surgically sutured area and prevent crusting.

. Any crusting that does form can be gently removed with a peroxide dampened Q-tip. However, it is imperative to avoid extensive manipulation in this area. Do not blow the nose. Do not use nose drops.

. Nasal Discharge: For the first few post-operative days, you may expect a small amount pink-colored water nasal discharge. Usually, a facial tissue touched to the nostrils is all that is required. Occasionally, reapplication of a small gauze bandage beneath the nostrils may be more convenient. Any gauze that has continuous persistent show of bright red blood should be reported to me.

. Bleeding on the third, fourth, or fifth day occurs in less than one-percent of cases. First aid for such a rare occurrence is as follows: Lie down and elevate head. Place cold compress on the nose. If available, saturate a piece of cotton with nose drops or Visine, and place it in the bleeding nostril.

. Pain: Discomfort following rhinoplasty is usually limited to the first two or three days following the procedure. In most cases, it is moderate in nature. Severe pain is rarely a consequence of facial plastic surgery. The prescription for pain tablets that you have received should be used the 1st day after surgery and then on an as needed basis thereafter.

. Nasal Appearance with Cast: During the first week, you may notice that the nasal tip is slightly elevated. This is a constant, temporary factor following all rhinoplasties. The position of the nasal tip at this time has little relationship to the final result. The tip will slowly drop to its new lower position over several days or weeks. The nasal splint will be removed at the end of the first week.

. Exercise: Exercise must be limited during the first week. While relaxed ambulation about the home and local shopping, dining or visiting is encouraged: any lifting, pulling or straining must be avoided, as it may cause bleeding.

. Avoid Blood Thinners: Do not use Aspirin until after the first week. Please refer to blood thinner sheet. Alcohol is a potent blood vessel dilator and, in the post-operative condition, can promote swelling of the surgical area and even bleedings. It is best to avoid Alcohol intake for at least one week following surgery.

. Stiches will be removed at 1 week. After all stitches have been removed, the scar will appear a deep pink color. There will be varying amounts of swelling in and around the scars themselves. With the passage of time, the pink will become white, the firmness of the scar will soften, and they will become less noticeable. Each individual varies with respect to healing, but it takes approximately one year for these changes to occur in most scars. Beginning 6 weeks after the surgery, application and gentle massage with vitamin E, cocoa butter, or Mederma may promote softer, less conspicuous scar. Incisions can be covered with makeup 10 days after surgery.

After The First Week:

. Nasal Appearance: At the time of nasal splint removal, you will have your chance to see the new nose. It will appear quite swollen but, in most cases, even in this swollen condition, the improvement can be appreciated. It is not a time for critical evaluation since, over the next few weeks, daily changes progress toward the final result.

. In most cases, the appearance at six to eight weeks approximates the final shape. Many factors determine how quickly, or slowly, the nose assumes the final appearance. The most influential determinant is skin type. Skin that is thicker and oilier is certain to retain edema and swelling longer that skin that is drier and thinner. Individuals vary in healing potential. The nose will continue to heal over a long period of time with subtle changes occurring over years of surgery. Our goal is to provide a long term result which will last the person’s entire life.

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. Activity: During the second week the nose must not be bumped, (elbows, doors, etc.). Though the bones are firmly healing in place, even a slight blow could cause movement. Avoid any situation where a potential for ‘ nasal trauma exists. Exercise which increases the heart rate can begin at 14 days post-up. Exercise during the first week post-up can cause bleeding. During the second week post-up it will increase edema or swelling. At 14 days, you can begin fast walking and light weights. At 21 days, you can begin running and heavier weighty. At 30 days, full exercise can begin. A frequent question is “…when can sexual activity resume…” As a moderately exertional activity (caloric expenditure), sexual activity can safely be resumed at 12-14 days following facial plastic surgery.

. Wearing Glasses: You should not wear glasses for about one month. If glasses must be worn, taping the central bridge of the glasses to the forehead will allow as little pressure as possible on the nasal bones.

Sun Exposure: It is wise not to sunbathe for about 60 days. A sunburn will cause the nose to swell and delay the final result. Walking about between sun and shade or sitting with a hat, is permitted. It is always best to apply a waterproof factor 25 sunblock to the nose if strong sun exposure is anticipated.

. The nasal skin is somewhat insensitive following rhinoplasty. This can be appreciated by touching the skin which will seem slightly – numb. Full sensation always returns in three months time; the tip regains full sensation last. The advice concerning sun exposure also applies to the winter cold. It is possible to experience frost-bite if exposed for long periods to sub-freezing weather during activities such as skiing. Both sun and the winter cold are natural enemies to the skin and prolong the usual post-up course.

. Skin: A natural reaction of all types of nasal skin to this surgery is a pronounced increase in nasal oiliness. Even skin that is usually dry will need to be wiped with an astringent on a cotton pad once or twice a day for two weeks or more. Another universal observation is the presence of flaking or peeling of the skin, much like that caused by sunburn. This also abates in about two weeks. Most discoloration is resolved in 7-10 days. However, though unusual, this may persist longer as pigmentation beneath the eyes. Occasionally, olive-skinned patients may retain this pigment for several months.

. Small irregularities may be felt below the smooth skin, especially over the nasal bones. These irregularities are common. Most noses, even without surgery, have palpable bone irregularity beneath smooth skin.

Out of Town Patients: You must remain in the Phoenix metropolitan area for at least one week following surgery.

. Friends and Family: Whether you are contemplating or have decided to undergo plastic surgery, be prepared to hear all manner of stories and judgments friends from friends and relatives. If you ask an opinion about your surgery, most people: will not be supportive. Many will have some tale of difficulty to tell you; it is an unfortunate fact of human nature. Occasionally, relatives and friends who are told you have made a definite decision about facial surgery are more supportive. After surgery, almost everyone will forget their negative statements. They will admire the results and see, for the first time, what you were talking about.

. Improvement not Perfection: Observe, in yourself and in those around you, that the two sides of the human body are not the same. Aesthetic surgery can never make them exactly the same. Our purpose and goal in facial aesthetic surgery is improvement and not perfection.

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Additional Information:

. Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, notify the office. Tylenol should be taken to reduce the fever.

. In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least an hour including the prescribed medicine. You should then sip on flat coke, tea, or ginger ale. You can also purchase coke syrup over the counter which can have a soothing effect on the stomach. You should sip slowly over a fifteen-minute period. When the nausea subsides you can begin taking solid foods and the prescribed medicine. Please call if the nausea does not subside within 3 hours. There are medications we can call in to your pharmacy that work very well to control nausea and vomiting.

. If you have been placed on antibiotics, take the tablets or liquid as directed. Make sure you finish the antibiotic even if you feel like you are completely better and do not need it. Discontinue antibiotic use in the event of a rash or other unfavorable reaction, and notify the office of the reaction. Sometimes taking antibiotics with yogurt can help prevent diarrhea. If you take birth control pills, the birth control may become ineffective; use back up form of birth control.

. Do not drive an automobile or work around machinery until you are no longer taking any narcotic pain medications. Avoid alcoholic beverages as they will enhance the effect of the narcotic. This is a dangerous combination. Pain or discomfort following surgery should begin to subside after the first two to three days. If pain persists, it may require attention and you should call the office. Do not routinely take Tylenol with prescription pain medications. Many prescription pain medications already contain Tylenol.

. Your case is individual as no two people are alike. Do not accept well intended advice from friends. Discuss your questions and concerns with our Doctors.

. You should wear clothing that fastens either in the front or at the back rather than the type that must be pulled over the head for one week.

. It is not uncommon to have some mild post-operative depression. Most patients are shocked when they see their face swollen and, perhaps, discolored. Be realistic and realize that this is a very temporary condition which will subside shortly. The best “treatment” consists of busying one’s self with the details of post-operative care and trying to divert one’s attention to other thoughts. Just relax and rest and let your face heal.

. Do not smoke for at least 2 weeks post operatively as smoking significantly delays healing and increases the risk of complications.

Flying after Rhinoplasty

A patient must not fly for at least 5 days after the surgery. While unlikely, the possibility that you will have a nosebleed during the flight, which could be an emergency situation, is avoided. It is still not recommended to fly for an additional week (in total 2 weeks), but many patients cannot stay in town for that long of a period. If you must fly during the second week of your recovery, it is important to take Sudafed and spray a nasal decongestant (Afrin or other) prior to taking off. If not, the pressure changes during the flight may be very painful. It is also typical to have renewed swelling after the flight, which will last about 1-2 days. All of these issues are not concerning if you are planning to travel by car or train.

Out of town patients should plan to stay a few days after the surgery at a hotel. They can travel and fly back home after splint removal at 5-7 days. Physical activity should be limited for 10-14 days. It usually takes about 6 weeks before the patient can exercise again without discomfort. High-risk contact sports should be avoided for 3 months.