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Rhinoplasty: Frequently Asked Questions

Interested in rhinoplasty? Learn all about nose surgery from Seattle plastic surgeon Dr. Jonathan Grant. Visit http://cascadeface.com/

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Rhinoplasty: Frequently Asked Questions

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  1. Cascade Facial Surgery & Aesthetics Rhinoplasty: Frequently Asked Questions 1.What is Rhinoplasty? Rhinoplasty is literally plastic surgery on the nose. Rhinoplasty typically involves both the soft tissues and the structural elements (cartilage and bone) of the nose. Rhinoplasty can address nasal appearance or nasal function (breathing) specifically. However, Rhinoplasty should always at least consider both nasal appearance and function. The ability to breathe through the nose should not be compromised in addressing nasal appearance. 2.Is Rhinoplasty surgery painful? The surgery itself is typically not uncomfortable as it is usually done under general anesthesia. It is not uncommon for the nose tobe sore for two or three weeks beyond surgery and it may be sensitive to pressure for a few weeks beyond that. Some patients have more extensive manipulation of cartilage and bone in the nose than others. Those with more extensive or more involved procedures may experience a bit more discomfort than those with relatively minor procedures. 3.What are the risks of Rhinoplasty? Some of the risks of rhinoplasty are similar to the risks for other facial surgeries and some are unique to the nose. Revision rhinoplasty cases can have a number of unique risks that vary from

  2. patient to patient depending on what was done to the nose in prior surgery. Always be sure to discuss your unique considerations with your surgeon before your procedure. As in other facial procedures, prolonged bleeding can occur after surgery. Infections can also happen but in general they are uncommon after nose surgery. The scars may also be more conspicuous than desired.In most rhinoplasty casesmost of the incisions are inside of the nose. If there are external incisions the scars are generally inconspicuous as they are generally under the tip of the nose in between the opening of the nostrils. Scar issues after rhinoplasty surgery are uncommon. As most rhinoplasties involve removing some cartilage from the septum of the nose, there is some risk of a fluid collection, or hematoma, on the septum. A hole or perforation can develop in the septum if a septal hematoma goes untreated after surgery. Septal perforations can cause symptoms such as crusting or bleeding or they can make your nasal breathing noisier than before surgery. Large perforations can also cause a collapse of the outer nasal shape, a condition sometimes referred to as a “saddle nose” deformity. However, septal perforations are generally uncommon. If your surgery plan requires more cartilage than is available in the septum of your nose, some may need to be taken from your ear or even a rib. Cartilage grafting from these areas can cause discomfort for a few weeks where the cartilage was taken. Removal of cartilage from the ear or rib cage can result in an area on the rib can result in a pneumothorax, or collection of air inside the chest cavity, if the lining of the chest cavity is punctured. Otherwise, infection, bleeding, and fluid collections can occur at cartilage donor sites. To avoid donor site issues, some physicians will use cadaveric cartilage material in rhinoplasty cases.

  3. 4.How long after my surgery will I see the final results? Generally rhinoplasty patients can start to see the changes in their nasal appearance as soon as the splint is taken off around a week after surgery. There is some variability – more involved procedures may have more swelling. For most rhinoplasty cases, the swelling dissipates substantially in the first 2 or 3 weeks. However, some low grade soft tissue firmness or swelling persists for many months and the soft tissues of the nose can remodel and mature after a procedure for 12 months or even longer. For this reason, patients are usually counselled not to look at their post-operative nose as a final result until a year after the procedure or later. 5.How long does it take for bruising and swelling to go away? Most of the bruising and swelling is inconspicuous or concealable with makeup around 2 weeks, though low grade swelling will persist with gradual, continuous improvement for a few weeks more. There is a little more risk of bruising lasting longer than a couple of weeks if the nasal bones have to be manipulated. 6.How do I minimize bruising from Rhinoplasty? Cold compresses help in the first 24 to 48 hours. Make sure to rest with your head elevated for the week or two after the procedure and avoid rigorous physical activity for a couple of weeks as well. Additionally, arnica montana supplements with or without bromelain can help minimize bruising and speed up resolution of bruising in your early recovery period. Additionally, if you take medications such as motrin, ibuprofen, advil, aleve, or aspirin, these are usually held for 10- 14 days before your surgery. If you are taking these medications or prescription blood thinners at the time of your procedure then you will have increased risk for more severe and prolonged bruising, as well as a septal hematoma (discussed earlier in surgical risks question #3)

  4. 7.What are the risks and limitations of Rhinoplasty? See question #3 above regarding risks. The limitations of rhinoplasty are difficult to generalize as every person’s nose is unique. This is a question that is best answered on a case by case basis and this is why it is so important to meet with your surgeon before your procedure and go through the risks, anticipated benefits, and limitations of any nose procedures recommended. In most offices (and in our office) your surgeon will have imaging software which allows for a simulation of anticipated changes in your nasal appearance to be rendered during your consultation. Remember that these digital simulations, while they are based on your own photographs, are only simulations – the software cannot predict or represent with complete accuracy exactly how your nose will look after your surgery. 8.Is it common to have breathing problems after Rhinoplasty? In the first week or two after rhinoplasty, it is not uncommon to have some difficulty breathing through the nose because of soft tissue swelling within the nose. This typically improves steadily after the first post-operative week. Within a few weeks, you should have breathing that is at least as good as it was before surgery, if not better. If you have a deviated septum, enlarged turbinates, or a small nasal valve (an anatomic area in the nasal airway), these issues can be addressed at the same time as your rhinoplasty in an effort to improve you nasal breathing. It is important to discuss any nasal breathing issues you have with your surgeon before surgery so that a surgical plan can be develop with consideration of these issues. 9.How can I get a natural looking Rhinoplasty? This is a great question… there are a lot of different noses out there that people are born with naturally. What looks natural varies depending on each patient’s perspective. Generally, your

  5. nose needs to be proportionate to your face to look natural. Additionally, it needs to have characteristics that are shared by your other facial features. For example, if you have a thin face with high cheek bones then you don’t want to have a broad nose. If you have thicker skin and more full cheeks then a nose with a well-defined tip that is very narrow may not look right on your face. I think the key to getting a natural looking rhinoplasty is making sure that you have a clear understanding of how your upcoming procedure will likely change your nose. Imaging software used appropriately by your surgeon (in a conservative, realistic fashion) and an earnest, in depth discussion with your surgeon about anticipated outcomes is the best place to start. 10.What type of anesthesia is used? Usually general anesthesia is used. For minor rhinoplasty procedures( those that don’t really involve the nasal bones), IV sedation with an anesthesiologist or nurse anesthetist monitoring you during your procedure can be sufficient to keep you comfortable during your procedure. 11.How long do the results last? Unless you had filler or botox injections as part of your rhinoplasty, your results are considered permanent. However, the nose can be expected to change over time, with or without surgery. Gradually over the years, the tip of the nose can fall or droop as some of the cartilage that supports it can get weaker and less rigid. The soft tissue “envelope” of the nose can also thin over time. These changes can occur even if you never had surgery on your nose. Additionally cartilage grafts used in rhinoplasty can sometimes bend or get weaker over time, but this varies depending on the type of grafting cartilage used and measures can be taken to minimize the risk of this happening.

  6. 12.How much time will I need to take off from work after undergoing rhinoplasty surgery? In general, 2 weeks off from work is enough. If you do a lot of heavy lifting at work, you may want to take off a little longer or plan to return to work with activity restriction until 2 or 3 weeks after your procedure. 13.How soon will I be able to exercise after my Rhinoplasty surgery? 2 or 3 weeks after your rhinoplasty, assuming favorable healing. You should plan on having 2 or 3 follow up appointments within the first 2 or 3 weeks following your nose surgery to check on your healing progress. 14.What should I look for in a surgeon to perform my revision rhinoplasty procedure? You should be looking for someone who has been trained to do these procedures. Board certified or board eligible facial plastic Surgeons and general plastic surgeons have had specialized training in rhinoplasty procedures. Many board certified or board eligible otolaryngologists (ear, nose, and throat specialists) also have had sufficient training in rhinoplasty surgery. For revision rhinoplasty surgery, you typically should be looking for a surgeon with considerable rhinoplasty experience. Particularly if you have ethnic nasal features that have been altered in an undesirable fashion from a prior procedure, you should be looking for a rhinoplasty surgeon specifically with experience in treating or addressing revision nasal surgeries with similar ethnic features.

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