16 year old before and after a closed rhinoplasty
Rhinoplasty, colloquially known as a nose job, is one of the leading cosmetic procedures for both men and women. You may have considered corrective nasal surgery (a rhinoplasty) if your nose is misshapen, disproportionately large or small for your face, or if you have had an injury, which makes breathing difficult. The following information has been prepared to familiarize you with facts about the surgical procedure known as rhinoplasty in Newport Beach. You are requested to read this information thoroughly and to discuss any questions which might arise with your surgeon or Newport Beach Plastic Surgeon Dr. Juris Bunkis before you proceed with nasal surgery. You are also requested to keep this information as a reference during your post-operative period.
A rhinoplasty operation may be designed to:
1. Improve the general cosmetic appearance of the patient by reducing, recontouring or reshaping the external nose;
2. Straighten a previously injured nose, and/or;
3. Improve the patient's ability to breathe.
It is important that you understand that no nose is perfectly symmetrical. Every attempt will be made to decrease your side-to-side dissimilarities, but such differences always persist to some degree, even after the most successful rhinoplasty operation! There are many irregularities beneath the skin of a nose before and after rhinoplasty surgery, but these may become more noticeable after surgery, especially in individuals with very thin skin and minimal, underlying fatty layers. It is unnatural for a nose to be exactly in the center of the face, before or after a rhinoplasty operation. The two nostrils are never exactly the same shape or size. These irregularities and asymmetries will persist after a corrective rhinoplasty operation.
These facts are stressed as many patients are not aware of preoperative nasal irregularities and may be more critical of their appearance following rhinoplasty surgery than preoperatively. Many patients have a fear that the nasal change will be so great as to create a subject of discussion among family members and friends. Actually, rarely do the patient's friends and relatives ever remember the shape of the patient's original nose a few weeks following rhinoplasty surgery. The patient is also warned that there may be individuals who will not wish to acknowledge that the patient's appearance has improved and may disappoint the patient by making an unrestrained comment such as, “I liked your nose better the way it was before” or, “I didn't see anything wrong with your nose in the first place.”
The cosmetic procedure of recontouring the nose (rhinoplasty) is one of the more popular operations performed by plastic surgeons today. The patient's input is always sought regarding the desired nasal change, but the patient must accept the judgment of the plastic surgeon as to the type, shape, and contour of the nose, as he is more acquainted with limitations imposed by the patient's tissues and facial features.
Since no two people are alike, a patient should not expect to "select a nose" by studying other people's noses or photographs, but such input is helpful to the surgeon as it gives some idea of the patient's general expectations. Your surgeon may be able to give you a good idea of what can be expected to your profile following rhinoplasty surgery by working with our office digital imaging system.
A surgeon must consider the patient's entire facial profile when planning nasal surgery. Patients with moderate sized noses, but weak chins, will appear to have much larger noses than they actually possess. In such cases, it may be impossible to reduce the nose sufficiently to provide a profile that is satisfactory to the patient, but facial balance may be achieved by simultaneously performing a simultaneous chin augmentation.
Occasionally, if in addition to a weak chin, severe malpositioning of the jaws and teeth is present, an evaluation of the dental abnormalities by an oral surgeon will be recommended before making a final decision about the nose. Conversely, it may occasionally be necessary to reduce the size of an excessively large chin in conjunction with the rhinoplasty surgery if the ideal profile is to be obtained for the patient.
Less frequently, patients will present with a collapsed nose, or a very low nasal dorsum. Such patients may be interested in increasing the height of their nose. This is traditionally done with bone or cartilage grafts, or with a silicone rubber implant. Your surgeon will discuss the pros and cons of each method and will help you make the appropriate decision.
16 year old before and after a closed rhinoplasty
38 year old before and after a closed rhinoplasty
You may visit your surgeon or Newport Beach Plastic Surgeon Dr. Juris Bunkis as many times as you wish, to have all of your questions answered. At your final preoperative visit, your final questions will be answered and you will confirm that you have understand the rhinoplasty procedure to be performed, that this material has been explained to you, that you have read and understand these information sheets, and that you accept the risks by signing the informed consent forms. You will be given prescriptions for pain pills and nasal sprays, along with instructions for their use. Certain laboratory tests will also be required within two months of surgery. If you are over the age of 50, you will have to obtain a cardiogram at your doctor’s office or any licensed laboratory.
You may have blood drawn by our office nurse during your final preoperative visit, or, if you prefer, at your family doctor's office or any laboratory (e.g. Kaiser Hospital, etc.).
As with all other elective procedures, the patient should avoid ibuprofen (Advil®), all Aspirin® products and excessive amounts of vitamin E (the small amount contained in most multi-vitamin preparations is not harmful) for two weeks before surgery, as these inhibit the clotting mechanism and increase your chances of unnecessary operative bleeding. All patients will be asked to stop smoking at least a month prior to surgery in an effort to maximize your body's ability to heal the rhinoplasty incisions following the operation.
Usually, your anesthesiologist will call you the night before surgery to discuss the anesthetic care plan with you. But if you miss the call or your anesthesiologist does not call you, do not worry as you will be able to discuss your anesthesia and have all your questions answered in the morning, at the Surgery Center prior to your surgery (Orange County Surgery Center in Newport Beach, Southern California or Tracy Surgery Center in Northern California). It is imperative that the patient make prior arrangements for transportation to and from the Orange County Surgery Center in Newport Beach, Southern California or the Center in Northern California and to have a responsible adult stay with you for the first 24 hours after the rhinoplasty operation. Patients may elect to spend the first night with a registered nurse at an additional fee.
Most of the rhinoplasty incisions for reducing or recontouring the external nose are made inside the nose. Occasionally, an incision will be made across the base of the columella, the strut between the two nostrils. The nasal skin is lifted away from the cartilage and bone and the excess tissue is removed or repositioned. Instead of resecting tissue, occasionally it will be necessary to place grafts or implants into depressed areas to reshape the nose satisfactorily. Such grafts may be taken from the septum, the ear, or occasionally, from a rib. As mentioned, most nasal implants are made from silicone rubber. The nasal tip cartilage will be refined and the nose shortened if necessary. The excessive skin left by the reduction of the underlying bone and cartilage is elastic and usually readapts
itself to the new framework quite well.
An important aspect to the predictability of a desired result is the thickness of the patient's skin and underlying tissues; thick skin will not drape out as well post-operatively over the new framework as will thinner skin. Conversely, while minor irregularities of the cartilage or bone can be expected to be hidden by thicker skin, they may become clearly visible in the thin-skinned individual.
A chin augmentation or reduction may be performed either through an external (beneath the chin) or internal (inside the lower lip) incision. Your surgeon will discuss the various methods, which may be used to enlarge or reduce the chin.
The operative time is approximately one and a half hours in length. The operation is usually performed under a light general or deep sedation. An anesthesiologist will be present to administer the general anesthesia and to assist with monitoring to ensure your safety. The procedure is performed in an ambulatory surgery center or hospital.
After rhinoplasty surgery, a conforming splint is usually applied to the nose. The patient must place ice packs over the eyes for the first two days to reduce swelling and minor discomfort. Suitable pain medication and nasal sprays will be available.One of the sprays is plain salt water and can be used as often as desirable to wash mucous or crusts out of your nose, or simple to moisten the inside surfaces. You can use this spray as often as you would like, and conversely, if your nose feels fine, you do not have to use this spray. The other spray, Afrin®, is an over-the-counter nasal spray which can be used to decongest the nose. This is a powerful medication and should not be used more than twice a day. Afrin® may be used for the first two weeks, and its use should then be discontinued.
During the initial period after rhinoplasty surgery, every patient will experience a trickle of blood and mucous at the back of the throat. Make every effort to spit these fluids out and not to swallow them. Blood is irritating to the stomach and may induce nausea.
The nasal protective splint will be removed by your surgeon, at the time of the first rhinoplasty post-operative visit, approximately a week after the rhinoplasty operation. The majority of patients do not require nasal packing. However, a packing in the nose is occasionally required to help control the bleeding or to help held tissues in place. During the period that the nose is packed, the patient will have to breathe through the mouth. The patient may have the feeling of a minor cold anywhere from one to twelve weeks after rhinoplasty surgery due to the attendant congestion of the nasal passageways. Patients undergoing correction of an impaired airway will feel an improvement, but cannot expect air to flow as well through the reconstructed nose as through an open mouth. The eyelids will be discolored and swollen for a period of approximately seven to fourteen days after rhinoplasty surgery. Residual bruising may be covered with cosmetics. The office aesthetician can assist you with makeup application if requested. Occasionally, the whites of the eyes will become temporarily bloodshot-this could last for many weeks, but always resolves spontaneously.
The upper lip may feel stiff and unnatural for a varied period of time. Some numbness may be noted in the upper lip and over the tip of the nose for a period of up to six months. If a chin augmentation or reduction is also performed, varying degrees of lower lip numbness or asymmetry may also occur, although permanent changes are extremely rare.
Although the major effect of the nasal operation will be evident in a week, subtle improvements continue to occur over a period of six to twelve months. These changes will occur so gradually that the patient will not be aware of them.
The final outcome depends upon the age of the patient, the type of skin and the patient's healing ability. The older the patient, the thicker the nasal skin, and the broader the nose, the longer the residual swelling will remain. In such cases, it will be more impossible to achieve a thin, chiseled nasal appearance.
18 year old before and after a closed septorhinoplasty and chin augmentation
29 year old female before and after a rhinoplasty, septoplasty, inferior turbinectomies and a chin augmentation
Although most patients have very satisfactory results, complications may occur following nasal surgery. Dripping blood from the nostrils is expected after rhinoplasty surgery. If there are any questions regarding excessive or persistent post-operative bleeding or discomfort in excess of that controlled by pain pills, the surgeon should be contacted. Some bleeding may occur for up to four weeks after the rhinoplasty operation. The rhinoplasty patient must resist every urge to pick the nose with fingers or Q-tips to minimize the possibility of dislodging a crust and causing more bleeding. Other complications of rhinoplasty can include a narrowed passageway with difficulty breathing, nasal asymmetry or thickening over the top of the nose due to internal scarring and possible leaning of the nose to
one side due to drift or displacement of the fractured bones. There may be areas of permanent numbness of the nose and/or lip. The rhinoplasty operation to recontour the nose can be associated with a significant incidence of dissatisfaction. In a significant percentage of patients, a second operation may be necessary to reduce scarring beneath the skin, to reposition the nasal fragments or to remove a persistent dorsal bump. On rare occasions, it may be necessary to perform a secondary rhinoplasty procedure to correct a chin asymmetry or to remove an implant. Such additional operations will result in additional fees to the rhinoplasty patient.
It is not possible to advise you of every conceivable complication. The foregoing was not intended to frighten or upset you, but to insure that your decision to have this rhinoplasty operation is made with your awareness of the risks.
Coiffure procedures can be carried out while the splint is still in place, but it is essential that the splint be kept dry. It is very important to stress that the bandages must be kept dry. The patient must avoid warm, steamy environments (hot baths, showers, hot tubs, saunas, etc.), which may cause the nasal dressings to fall off prematurely. The nasal splint will be removed one week after rhinoplasty surgery, following which normal bathing may be resumed.
The nose is an extremely delicate structure and adequate time must be allowed post-operatively to ensure proper healing. Social activity and exercise should be limited for the first week following surgery. Swimming (requiring submerging of the nose) should be avoided for two to four weeks. Contact sports should be avoided for six weeks. Exercise such as running may be resumed whenever the rhinoplasty patient is comfortable doing so.
All fees will be discussed freely in advance by the office staff. Financing may be arranged if desired. Your insurance company may cover a part of the fee if the operation is designed to correct a deformity caused by an accident or to improve your airway. Payment of all fees, however, is the patient's responsibility; all fees are due prior to surgery and the proceeds of the insurance check will go to you when the check arrives (minus a 6% billing fee if you chose to use our billing service). If requested, the office staff will assist you with forms, but recovery of any insurance benefits is between you and your insurance company. Insurance companies never pay for the entire fee and never pay for nasal operations which are solely designed to improve your appearance. In compliance with
suggestions adopted by the American Society of Plastic Surgeons®, it is customary for the patient to pay all fees for cosmetic surgery prior to the desired operation. This insures that the patient is sincere in her motivation and can afford the surgery, thus creating a better patient/physician relationship. A non-refundable deposit will be required to secure your desired surgery date. The remainder of the fees must be paid prior to the surgery, usually at the time of the preoperative visit, but no more than two weeks before surgery. Additional fees are also required for laboratory tests, surgical facility fees, and the anesthesiologist. If additional surgical procedures become necessary, additional facility, laboratory, anesthesia, implant costs and professional fees will be incurred. The surgical facility and anesthesiologist fees quoted will be based on our best faith estimate; the final fee may vary as these fees are based on surgical time, and it is not always possible to predict exactly how long a procedure will take to complete.
It is important that you understand that the patient is responsible for all costs associated with all secondary surgical procedures or for the treatment of any complications that may arise as a result of this elective surgery.
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Except with the ThermiTight™ procedures, pre and post-op photos will be taken of the treatment site for record purposes.
Individual results may vary