RHINOPLASTY - QUESTIONS AND ANSWERS
Because informed patients are so important to the success of any plastic surgery, Dr. Robert H. Stubbs, a Canadian and American Board Certified Plastic Surgeon has prepared this web info for you. The web info will give you a basic understanding of the procedure - when it can help, how it is performed and what results you can expect. It can not answer all your questions, since a lot depends on the individual patient and the surgeon. Please ask a certified Plastic Surgeon about anything you do not understand.
A: Rhinoplasty is a plastic surgical procedure performed to improve the appearance of the nose and thereby achieve better harmony and balance of the facial elements. Because this procedure is done for both purely cosmetic and also reconstructive reasons, it is probably the commonest facial plastic procedure performed.
A: There is no such thing as a "standard nose job." Rhinoplasty varies with each patient, depending upon the type and degree of change determined by both the patient and the surgeon after appropriate consultation. The operation can enhance your appearance and your self-confidence, but it won't necessarily change your looks to match your ideal, or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations - they must be realistic. The goal of rhinoplasty is an improvement, not perfection, in the way you look. You should be physically healthy, psychologically stable, and realistic in your expectations. Smokers always heal more poorly than non-smokers!
Also, age may be a consideration. Although changes occur in the nose throughout life, the major growth is completed by the time a person reaches puberty. Rhinoplasty may be performed as early as 13 or 14 years of age. This helps avoid psychological trauma during early teenage years.
A: All surgery carries some uncertainty and risk. Rhinoplasty is normally safe, as long as patients are carefully selected, the operating facility is properly equipped and the physician is a certified Plastic Surgeon. Nevertheless, there is always a possibility of complications. See the Special Consent to Rhinoplasty.
A: Most patients are seen at least twice before surgery. At your initial consultation, we ask what you would like your nose to look like, evaluate the structure of your nose and face, assess any breathing problems and discuss the various surgical options with you. Certain factors may influence the procedure and the results. These factors include the nasal framework (bone and cartilage), the nasal coverage (the skin) and the nasal lining (skin and mucosa), the shape of your face, chin balance and your age.
Be honest in discussing your expectations. We will be frank with you, describing the procedure in detail and explaining its risks and limitations. We will also explain the anesthesia used, the location where surgery will be performed and the total costs involved. During this consultation, be sure to tell us about any medications (especially aspirin or other pills that affect clotting), vitamins or other drugs you are taking. Also, we must know if you have ever injured your nose or had previous nasal surgery. Allergies and/or breathing difficulties should be recorded. Smokers should consider giving up the habit before and after surgery. Then, a complete physical along with blood and urine analysis is arranged.
At the next consultation, or informed consent visit, the patient who is a suitable candidate has a chance to discuss the risks again or other details prior to the actual day of surgery.
A: The patient should not have had anything to eat or drink after midnight prior to surgery. Pre-op medications should have been taken. Also, transportation and post-op care arrangements should have been made.
Most rhinoplasty procedures are performed under deep sedation and local anesthesia in an out-patient private facility. Complex procedures or those that include a radical septoplasty (to correct nasal obstruction) are usually done under general anesthesia in a public hospital. Rhinoplasty usually takes a couple of hours, but the time required may vary considerably depending on the type of surgery (the external technique takes longer) and amount of work being done. During this time, the patient is carefully monitored. At surgery, some or all of the nasal elements are sculpted to the desired shape. The nature of the sculpting depends on your specific problem.
When the surgery is done, a splint will be applied to help your nose maintain its new shape. Nasal packs which dissolve after a week may be placed in your nostrils to stabilize the septum (the dividing wall between the air passages). The patient is then monitored in the recovery area for a few hours prior to discharge. It is mandatory for a patient who has had deep sedation to have someone stay with them the first night after surgery. The medications may affect judgment and co-ordination for 24 hours.
A: Follow-up visits vary according to the patient and the procedure. Most patients are seen again within one week. Early post-op instructions usually include taking prescribed medications, keeping your head elevated to reduce swelling and keeping the splint dry to avoid ulcerating the underlying nasal skin. After surgery, the face is bruised and swollen. You can control any discomfort with mild pain medication. Everyone looks a lot worse than they feel!
Most of the swelling and bruising is gone in two weeks. The splint is removed about 7 days after surgery and at that time women are able to apply make-up to hide residual discoloration. A little bleeding from the nostrils is common during the first few days following surgery. A watery mucous discharge can also occur. A light "mustache" dressing will make you more socially acceptable - especially at mealtime. All external sutures are removed about 7 days post-op. Internal ones just dissolve, but this may take a few weeks.
Most patients are quite active a few days after surgery and many are back to work or school within a week. The healing process is gradual. While most of the swelling and discoloration will be gone a few weeks after surgery, some subtle swelling can remain for six months or more. Further follow-up is usually scheduled for six weeks and then six months after surgery. If you have any unusual symptoms between visits or any questions about what you can or can not do, do not hesitate to call us. Strenuous activities are best avoided for at least 4-6 weeks post-op.
Strong direct sunlight can burn the healing nasal skin. Therefore, sun block and a hat with a brim are recommended in the early months after surgery. Common sense is often your best guide.
A: Rhinoplasty is a highly effective and very common technique for balancing facial features. Most patients are very satisfied with the results of their surgery. As long as your expectations are realistic, you should be very happy with your new nose. See the Surgical Art Gallery for some examples of this procedure.
