RHINOPLASTY (NOSE SURGERY)
Rhinoplasty is the name of an operation to change the shape of the nose. The nose can be altered in a number of ways to address a patient’s aesthetic goals, so the first thing you want to do is decide what specific aspects of your nose you dislike rather than general descriptions like, “It is too big”. After listening to you and examining your facial features, Dr. Creasman is able to show you what is possible with rhinoplasty to make your nose look more attractive. He uses 3 dimensional photography and computer simulationsto show you a proposed “after” appearance to the best of his ability. This also allows him to analyze other features such as the chin and neck that may also play a role in facial —harmony and beauty.
Everything depends on what characteristics one is born with, and so it is important that you have a thorough, realistic, and informed consultation with Dr. Creasman. This will provide an accurate idea of what can be done surgically to make you feel better about your appearance.
Dr. Creasman will take a medical history and do a directed physical examination of your nose and other facial features during your visit. This will involve identifying functional issues as well as cosmetic issues of concern to you. It is important for you to provide us with any history of trauma or surgery that you have had to your nose. You should inform the doctor or any seasonal allergy problems that you have.
After examining you nose, inside and outside, Dr. Creasman will generally want to discuss your surgical options with you using Vectra 3D computer imaging, which can demonstrate for you the changes he would suggest for your nose. Though this is not to be implied as a warranty of the surgical result, it does provide a visual communication aid both for you to give feedback, and for him to convey to you the limitations as well as the possibilities of what can be done with nasal surgery. Though it is important and often reassuring to view before and after pictures of other patients, it is equally important to see how one actually looks with the nose they think they want. Looking at the photos on a screen side by side as if it were another person’s face also allows you to be more objective.
It is not uncommon that additional procedures are performed at the same time as the nose is altered, such as liposuction of the neck or a chin augmentation. You may wish to visit those sections of the website prior to your consultation to familiarize yourself with the effects achieved with these procedures. If Dr. Creasman feels that you would benefit from another minor procedure, he will tell you during the consultation as part of a comprehensive facial assessment.
Risks of Rhinoplasty
Complications of nasal surgery are infrequent and usually minor. However, possible complications include infection, bleeding, or a reaction to the anesthetic or sedative medications. There may or may not be a scar underneath your nose, but this is seldom prominent. There can be some numbness of the nose after surgery, on the inside or the outside of the nose. The nose may not appear perfectly straight, but almost all noses are a bit crooked. Some people find rhinoplasty has an adverse effect on their breathing, but this is rare. Seasonal allergies are usually not affected by nasal surgery. After surgery, small blood vessels may appear beneath the skin, which may require treatment. When grafts of cartilage are used, or in the case of a prosthetic implant, they can shift over time leading to visibility or crookedness, which may require surgical revision. An infected implant requires removal, and may not be replaceable. Secondary nasal procedures are more complicated and have a higher complication rate.
Before Your Procedure
You will need to refrain from ingesting any medications or other substances which could result in surgical complications. We will provide a list of medications that will need to be discontinued at least two weeks prior to operation. Patients are seen two weeks prior to their surgery date for a general physical examination to ensure that no underlying medical problems exist which may interfere with the safety of their surgery. Specifically, any infections which arise prior to operation should be reported to our office.
Antibiotics are administered intravenously just prior to surgery to reduce the risk of surgical wound infection. A prescription for pain medication is written for you at your preoperative visit, so that you have your pain pills when you return home from the operation.
Pre-operative photographs are taken so that you can see the improvement from your surgery afterwards. We generally take post-operative photographs at 3 – 6 months after your procedure.
You will be asked to sign a surgical consent which enumerates the risks of the procedure in detail. These risks will be explained herein and also at the consultation.
Rhinoplasties are performed either under a local anesthetic with intravenous sedation (semi-conscious) or a general anesthetic by an anesthesiologist (completely unconscious). Patients are always completely unconscious during the phase when the nose is being injected with local anesthetic. The nose is made completely numb inside and out. Though patients sometimes report remembering movement, you will feel no pain. If a general anesthetic is used, you will be asleep throughout the procedure. If a sedation is used, you may remember portions of the procedure, but not pain.
Rhinoplasty usually takes about two hours, but sometimes longer. After lifting the skin off the cartilage and bones of the nose, sculpting of that framework is carried out. The exact nature of that sculpting depends on your particular problem and will need to be discussed at the consultation. If the nose is being reduced in size, the nasal bones are carefully fractured to reshape it. Often, the tip of the nose is altered to make it more attractive and proportional. A splint is applied and the nose is not usually packed. Sometimes, only tapes support the nose while it is healing. The stitches dissolve on their own and do not require removal.
Following a brief monitoring period in our recovery room, you will be discharged into the company of an adult escort.
The Post-operative Period
You should anticipate that you will feel and look puffy and swollen during the first 2-3 days after your procedure. Though there is some pain in the first 24 hours, after this there is usually just a feeling of pressure and stuffiness. It is advisable to keep your head elevated above the level of your heart for the first few days to reduce swelling. Bruising around your eyes is to be expected, and usually peaks at 48 hours, quickly subsiding in 5-7 days. Ice compresses over your eyes will help to reduce this, but in all likelihood, you will look worse than you feel. You may have some oozing of blood from your nostrils, which is collected in a gauze bandage you will be asked to change every several hours during the first several days.
At 3-5 days the splint is taken off your nose and you will be able to see your new appearance, but the nose is still swollen and will get smaller. This takes many months, but most of the swelling is down in the first six weeks.
Though you should be able to return to most sedentary work in a couple of days, you will still not feel normal for several weeks to months after surgery. The nose might feel numb for months, especially if a lot of work is done on the tip. It is advisable to avoid strenuous activity such as exercise for about four weeks, as this will delay your healing and could lead to bleeding or prolonged swelling.
Some patients are unhappy with the appearance of the nose in the immediate post-operative period, as the tissues are still quite swollen and much of the detail still has yet to be seen and appreciated. It is not unusual for friends or family to offer unsolicited and often negative critique during this period, when you are particularly sensitive and vulnerable. It is wise to take a “wait and see” approach, as the appearance of the nose will change significantly during the first three months, and even up to the first year or two. It is important to be patient during this period of time. The majority of patients are thrilled with their results.