What is it?

Rhinoplasty is an operation that shapes the nose and may be used to improve your ability to breath.

Who is a candidate for this operation?

Any individual that is not satisfied with the shape of his or her nose. Apart from a purely cosmetic reason, there are individuals who may have a medical reason for Rhinoplasty. In such individuals, Rhinoplasty can improve a person's ability to breath. Most individuals seek this operation after the nose is fully developed.   This occurs in the mid-teens.   In older individuals the only deterrent to surgery may be their general health. Of course like any surgery the most suitable patients are those who have reasonable expectations about the results.

Who is not a good candidate for this operation?

There are no real contraindications to surgery unless your health precludes an elective operation. People who have unrealistic goals are not good candidates. Having very thick or very thin skin can be a relative deterrent to surgery. Your surgeon can tell you if he or she think that a good result is possible in your case.

What does it accomplish?

The shape of the nose is altered in such a way as to make a nose that is more suited to your face. If you have breathing problems the blockage inside the nose is corrected so that you can breath more easily.

Will Rhinoplasty cure my allergies?

Not usually. Allergies and chronic sinus problem are not commonly changed by a simple Rhinoplasty. You may need to see an allergy specialist or an Ear Nose and Throat doctor to treat your sinus problems.

What happens during the first consultation?

In the first consultation you will get a chance to discuss your concerns with our patient care coordinators and Dr, Marefat. We will tell you what you need to know about your procedure and will help you determine what is best for you.   You will receive information booklets and pricing on the procedures.

How is it done?

In Rhinoplasty the incisions are placed within the nostrils and are therefore not seen.   Occasionally a small incision may be placed on the outside, between the nostrils or in the base of the nostrils.   These incisions usually heal very well and the scars are barely visible after a while. The nose may be reduced or built up in order to create the form that can harmonize with the other facial structures.   To do this it may be necessary to place small pieces of bone or cartilage under the skin to adjust the underlying architecture of the nose.   The skin is then redraped over this new framework.

What are the goals of surgery?

  Our objective is to improve the shape of your nose so that it is more suited to your face. If you have problems breathing we would remove the cause of the obstructed airflow. This will enable you to breath better.

What kind of anesthesia will I have?  

Generally speaking I like to perform this operation under general anesthesia. In certain, less complicated case it may be possible to do this surgery under straight local or local sedation.

Procedure: Rhinoplasty continued

What can I expect after surgery?

Recovery time: After surgery you will have a minimal to moderate amount of drainage from the nose. You will need to rest for the first two or three days, but most people are up and about shortly after surgery. We generally recommend our patients to take off 7 days from work. Heavy lifting and exercising should be avoided in the first two weeks. You body will tell you when you are ready to get back into your regular exercise routine. You will have a nasal splint in place for a week.   This helps in the attachment of the skin back to the underlying tissues after surgery and reduces the chances of fluid collections under the skin or movement of the nasal bones and cartilage grafts during the critical early days after surgery.   During this interval you can shower but you cannot get your head wet. Once the splint is off you can shower normally. There will be some numbness associated with the surgery.   This numbness usually persists for about four to six weeks. A moderate degree of swelling is normal after this operation.   This swelling is related to accumulations of fluid in skin and subcutaneous tissues.   Most of the swelling resides in the first two or three weeks after the surgery.   Minor asymmetry between the two sides of the nose can be seen after the rhinoplasty.   No one has completely symmetrical nostrils for example and you have to accept these minor differences.

Will it be natural?

Unnaturalness and imperfection in the result of rhinoplasty is still the most common aesthetic complication of this surgery. The nose is one of the most visible parts of your face and unfortunately even small irregularities in the contours of your nose could be visible. Most surgeons are well aware of this and try as best as they can to avoid such visible signs of surgery.   However even when everything is done right that there is still a chance that you may develop some irregularity and if this does occur you may need to fix this problem in a touch up procedure.   This touch up procedure is done approximately 9-12 months after the initial procedure.

What are some of the complications of Rhinoplasty?

Before I tell you about the complications of rhinoplasty let me tell a little bit about how to digest these bits and pieces of information. Reading about complications can be quite scary. Many people cannot comfortably sit through a consultation session without having some real doubts about surgery. But it is different when you have these complications explained to you by a Doctor. He or she can put it in perspective for you and tell you the likelihood of such complications occurring. Most complications are very rare. Some are less rare and need to be explained to you in more detail so that you know how we would tackle these problems if they occurred. The purpose of explaining risks and complications is for you to know what steps we take to treat you and put you back on the road to recovery. Remember that every surgeon has his or her own way of treating problems. You must go over these potential risks with your surgeon to gain better insight and understanding.

When and where are touchup procedures done?
Touchups are done after three months. These procedures are usually much simpler than the first procedure and are not as painful.   I can do them in the office with a small amount of local anesthetic solution if it is a minor deformity or problem. However if the problem or irregularity were more complicated or difficult to anesthetize, I would do it in the outpatient surgery center under general anesthesia.

When are the sutures removed?

There are very few sutures in rhinoplasty procedures in general. These usually come out in the first week. Sometimes you may have absorbable sutures that do not need to come out.

How many visits do I have after surgery?

  We like to see our patients frequently after surgery. You are seen by the Doctor or nurse within 2-3 days of surgery. Then our normal postoperative routine is: 1 week, 1month, 3 months, 6months, and 12 months. Of course if there is a need you may be seen more. After a year we encourage our patients to come for routine follow-up visits every 3-5 years.

When can I wear make-up?

Yes. You should be able to wear makeup if you have had rhinoplasty. We do not recommend your putting makeup on your incisions however, because this may result in tattooing of the skin by the pigments of the makeup.

Am I a good candidate?

You are a good candidate for rhinoplasty if you have a correctable deformity, normal skin thickness, good general health, and realistic expectations. This does not mean that you cannot perform rhinoplasty if you do not meet these criteria. However, the best results are seen in individuals who have moderate skeletal deformities of the nose with a good quality skin cover. Generally the younger you are the better a candidate you are for surgery. But the physiologic age of person is more important than the chronological age. That is to say you may be 60 years old, but your skin and general health could be better than most who are 50 years old.

Procedure: Rhinoplasty continued

What does the surgery cost?

The cost of surgery varies but here are some guidelines that will help you determine roughly what you could expect. Remember that these are only rough estimates . These estimations include the cost of the operating room and the anesthesia. The fee may be subject to change without notice. The best way for you get an accurate cost analysis is to see a doctor.

Primary Rhinoplasty:      $4,775

Secondary Rhinoplasty:      $6,275

Septoplasty:             $4,000

Tip Rhinoplasty:    $4,000

You may be able to get insurance coverage for correction of your breathing problems. Ask our financial advisor about this possibility if you are having the inside of your nose operated on at the same time as the out appearance of the nose.

How do I pay for surgery?

You can pay for surgery by certified check, Credit card, or cash. Payments for cosmetic surgery are expected prior to the procedure. If you are scheduling several weeks in advance of surgery you can pay by personal check.

Are there scars?

Yes. However most of the scars are inside the nostrils and therefore not seen. The only external scar is located between the two nostrils.   This scar is very small (about 1/4 th of an inch) and is usually not seen. After several months this scar fades and is hardly visible.

Does it hurt?

The pain involved in rhinoplasty is very tolerable. We have heard our patients describe it as 'heaviness of the head' or just 'having a badly stuffed nose'. Many patients do not finish the pain medications prescribed to them for pain relief. But having said that remember that pain is very subjective, and it is not easy to predict what degree of pain you will have.

Will I be awake during surgery?

If you are having just a small area of your nose corrected and this can be done in the office then you will be awake. However if you are having a normal rhinoplasty you will most likely be done in an outpatient facility under general anesthesia. Rhinoplasty is an operation of subtleties and finesse. If you want a good result it is better to let the surgeon concentrate on you nose and not on your level of discomfort during the case.

Where is the surgery performed? (i.e. office suite or hospital)

The surgery can be done either in the office or the outpatient facility depending on the nature of the problem. For example if you have a minor amount of excess cartilage in the tip of your nose it may be feasible to do this in the office under local anesthesia. On the other hand, if you want to have you entire nose corrected with removal of a high hump and narrowing of the nose, then you are much more likely to be done in the outpatient facility. Only in rare situations in which the patient may have other risk factors does Dr.Marefat suggest the hospital environment for surgery.

Are medical photographs taken?  

Yes. In all cosmetic and reconstructive cases medical photos are taken. Photographs are mandatory because this is the only way for us to compare you before and after results. Photographs in plastic surgery serve much the same role that x-rays serve for orthopedic surgery.

Date Revised: 1/23/07

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