reshaping), nasal cosmetic surgery, is performed to improve
the nose aesthetically - making it harmonize better with the
other facial features - while maintaining or improving
function. Because it is the most defining feature of the
face, the size and shape of the nose has a significant
impact on a person's appearance.
Some patients want
their nose to be straight, others want the nostrils
narrowed, others say their nose sticks out to far from their
face. Because the nasal tip loses support as we age, some
patients are surprised to realize how significantly
rhinoplasty contributes to a more youthful appearance. Once
thought a beauty procedure sought by only wealthy women, men
in today's competitive corporate workplace are increasingly
seeking rhinoplasty to improve self-confidence and restore a
When discussing rhinoplasty the best place to start is by
looking at before and after photos to see just what can be
accomplished. As you will see in the photos, patients often
ask to combine a rhinoplasty with a brow lift for correction
of frown lines between the eyes or blepharoplasty for
improvements in bags under the eyes. Chin implants, cheek
implants, otoplasty (ear surgery), lip surgery and facelifts
can also be performed in conjunction with rhinoplasty. Many
patients seek information about improving superficial skin
wrinkles with a chemical peel, laser surgery or similar skin
When patients come
to our office seeking facial plastic surgery, it's not
uncommon for them to focus on a single aspect of their
appearance rather than the overall picture. A board
certified facial plastic surgeon, trained to perform
cosmetic and reconstructive surgery exclusively on faces and
necks, knows that his responsibility is to evaluate not only
the areas of concern but also the motivation behind the
requests. It goes without saying a rhinoplasty won't save a
failing marriage. Similarly some patients not ready for
cosmetic surgery are better served with conservative
measures, such as Botox for fine lines and wrinkles or
Collagen for crows feet. Patients who educate themselves
know when and if the time is right to proceed.
At your initial consultation, we will evaluate the soft
tissue and bony architecture as well as the form and
function of your nose. An overall assessment of the face
provides the basis for what one may expect from rhinoplasty.
Skin type, ethnic background and age, along with the degree
of deformity and function are important factors influencing
the outcome of surgery. As with all facial plastic surgery,
a thorough health assessment and realistic expectations are
of procedures and routines is essential to a successful
final result. Before we proceed to preoperative routines, we
want to take a moment to include those patients who are
referred to us for revision rhinoplasty. Revision
rhinoplasty - a term no one wants to hear! Whether due to
trauma following original rhinoplasty, disease, pre-existing
conditions or surgeon error, revision rhinoplasty occurs
from 2-5% in any surgeon's practice.
Although the preoperative and postoperative instructions for
revision rhinoplasty are the same as for the primary
(first-time) rhinoplasty patient, revision rhinoplasty has
it's own set of special considerations. If you are a patient
seeking revision rhinoplasty, please a moment to scroll to
review special considerations for revision rhinoplasty.
Including revision rhinoplasty in our procedure instructions
also brings up a very important point.
Facial plastic surgeons (board certified reconstructive and
cosmetic surgeons that concentrate exclusively on the face
and neck) are specialty trained to perform rhinoplasty, the
most challenging of all cosmetic surgery. Not every cosmetic
surgeon is trained in rhinoplasty and not all surgeons have
the skill to perform rhinoplasty. More than any other
cosmetic surgery, we highly recommend that you do your
homework in selecting a surgeon that specializes in
rhinoplasty. And if you are seeking revision surgery, your
thorough investigation before selecting a surgeon is
critical. How do you do this? Start with our how to Select a
preoperative appointment our nurse will provide all the
instructions for you to follow before and after surgery. On
the business day prior to the operation we ask you to call
to confirm your arrival time for surgery. Upon arrival for
your surgery, you will talk with a nurse (who will start an
IV), discuss anesthesia (local anesthesia with IV sedation
keeps you asleep and comfortable) and meet with your doctor
before going to the operating room. Rhinoplasty takes about
an hour depending on the structure and amount of change you
are seeking. Revision rhinoplasty generally takes longer,
especially if you need grafts as we previously discussed.
Also, if you are having a combination of procedures your
surgery will take longer. Recovery time from the anesthetic
takes about an hour and you will be discharged about four to
five hours from the time of admission.
any aspirin, aspirin-containing products, or ibuprofen
(Advil, Aleve, etc.) for one week prior to and two weeks
following your surgery. See our "Medication List" for
products to avoid prior to and immediately following
surgery. If you are on any medications that affects
bleeding (such as coumadin or warfarin) please notify
the office immediately.
us of all routine medications and significant health
history. We ask that you remain on your daily
medications unless instructed otherwise. At the
preoperative appointment, our nurse will tell you which
daily medications to take with just a sip of water on
the morning of surgery.
preoperative appointment you will be given prescriptions
for use following surgery including an oral antibiotic,
swelling and pain medications. You will be instructed to
take Vitamin C (ascorbic acid), which helps promote
healing, one week before and two weeks following
surgery. Please take Arnica, a natural herb that
significantly decreases bruising, as instructed before
and after surgery. We will also ask you to obtain an
antibiotic ointment and saline spray for use following
surgery. Please obtain these prescription medications
and items before your surgery so you will have them
ready for use when you return home after your surgery
has been completed.
Please call the
Lindsay House Surgery Center at (585) 244-1135 before
noon on the business day prior to your procedure to
confirm your arrival time.
You may not eat
or drink after midnight the evening before the procedure
unless instructed otherwise. This includes all food,
liquids, water, candy, mints or gum. You may brush your
teeth. Your procedure will be cancelled if you do not
follow these instructions.
Do not bring
valuables (cash, credit cards, watches, jewelry, etc.)
to the Lindsay House on the day of surgery. Remove all
make-up and nail polish before arriving for your
It is not
required that a family member or friend stay at the
Lindsay House during your surgery. However, someone must
be available at all times while you are here at the
Lindsay House for surgery. Someone will need to drive
you home after your surgery and stay with you that
evening. Transportation to the office for packing
removal the day following surgery is also required.
After surgery your
nose will be packed with soft nasal packing. There will be
soft silastic splints along each side of your septum
(divider of the inside of the nose). Splints reinforce the
newly shaped cartilage. You may notice that tears run down
your cheeks. This is due to swelling and will subside during
the first week following surgery.
The nasal packing will prevent breathing through your nose
so you will have to breathe through your mouth. Your mouth
will become very dry. Please drink as much fluid as you can
which will help you from becoming dehydrated. Drinks at the
bedside along with a humidifier (cool or warm) may help.
Following nasal surgery, mucous membranes can produce extra
mucous. Draining of red-tinged mucous through your packs
onto your drip pad is normal. Many people ask, "How much
drainage is too much?" If you are completely saturating the
drip pad with bright red blood every five minutes by the
clock for an hour, notify us at the telephone numbers
provided below. This is uncommon and can routinely be
treated over the telephone or with a visit to our office.
Following your procedure the nurses will ask assist you to
meet the discharge criteria: to drink liquids, walk with a
steady gait, void, manage your discomfort, and to have your
nasal drainage under control. The nurses will teach you how
to change the drip pad under your nose, which you will need
for about 24-48 hours.
You will be asked to come to our Lindsay House office (not
the Surgery Center) the following day for packing removal.
Although removal of nasal packing has been described by most
patients as discomfort rather than pain, you are encouraged
to take your pain medication about an hour prior to packing
removal. Packing removal will help relieve some of the
pressure. However, due to swelling, you will not be able to
breathe well through your nose for one week.
Sleep with head of the bed elevated or use two to three
pillows. Sneeze with your mouth open and do not blow your
nose of sniff for seven days. Absolutely no bending, lifting
or straining. If you have little children, bend at the knees
or sit on the floor and let them climb on to your lap. One
week off work is recommended following rhinoplasty. Avoid
long steamy showers for one week postoperatively or the cast
may become loose. Taking care to keep the cast dry while
bathing is important.
Advance diet from liquids to soft food to your regular diet
as tolerated. In the immediate postoperative period, avoid
extremely hot liquids or foods if you experience temporary
numbness on the roof of the mouth.
soaked pads on eyes until bedtime, changing pads every
20-30 minutes. Pads should be soaking wet - do not wring
out completely. It is the weight of the water as well as
the temperature that helps minimize bruising. A small
bag of frozen peas or corn may also be used on top of
the eye pads. Make sure the bag is not placed directly
on the skin. Use a washcloth or towel between the bag
and your skin.
You will have a
gauze drip pad placed beneath your nose. Change this as
needed for the first 24 hours following surgery. It is
not uncommon to change this every 15 minutes for the
first several hours following rhinoplasty. If you
completely saturate the pad with bright red blood every
five minutes for one hour by the clock, please call your
surgeon at the numbers provided. Ice packs to the
forehead and/or back of the neck may help decrease
bleeding. Do not place ice packs directly on your skin.
Do not swallow any drainage from your nose as it may
make you nauseated. Cough it up and spit it out.
removal of the packing, the drainage will eventually
subside and the drip pad will no longer be required. Do
not use saline nasal spray until the night following
The cast must
remain on your nose for one week. It must be kept dry or
it could become loose. Notify your surgeon immediately
if the cast falls off.
Most patients complain of pressure from swelling and
congestion more than pain. Use pain medication (most
commonly Vicodin/hydrocodone) as directed/as needed.
Vicodin contains Tylenol. Do not take additional Tylenol
or acetaminophen while taking Vicodin. Do not drive or
drink alcohol while taking pain medication. Side effects
of pain medications can include nausea and constipation.
Taking pain medication with food can minimize nausea.
Over-the-counter laxatives are indicated if constipation
packing removal has been described as pressure rather
than pain, we recommend taking pain medication about one
hour before coming to the office for packing removal.
antibiotic (Keflex/Cephalexin) when you arrive home
following the procedure. During your surgery you
received antibiotics through your IV. Take antibiotics
as directed until gone. It is not uncommon to have a
low-grade fever for 24 hours following surgery.
prescription for swelling medication (most commonly
Medrol Dosepak/methyl prednisolone) when you arrive home
following surgery. At your preoperative appointment, our
nurse will provide specific directions for use of this
medication following surgery.
following packing removal, start using the ointment
(most commonly polysporin/bacitracin) two times a day
(morning and evening) inside the base of each nostril.
Insert only the cotton part of the Q-tip into your nose.
Ointment is applied after the morning and evening saline
rinse and ointment
packing removal, start your saltwater rinses in the
evening. Salt water rinsing is very important for your
postoperative healing. The salt water moisturizes,
cleanses and facilitates healing.
You can make your own salt water by mixing one
tablespoon of sea salt (not table salt) and 12-16 oz.
lukewarm water in a small plant mister bottle. Place the
tip of the mister gently near the opening of the nose
and spray your nose. If you prefer you can purchase
saline spray in your drugstore without a prescription.
Please rinse your nose with salt water five to six times
per day until your splints are removed. You may then
decrease your rinsing to three times per day.
Nasal congestion, facial fullness, headache and
disrupted sleep are very normal postoperative symptoms
and will decrease as the healing process occurs. It is
not uncommon to have numbness on the roof of the mouth
(palate) behind the front teeth. Therefore avoid
extremely hot liquids or food in the immediate
Following rhinoplasty, it takes time for the swelling of
the mucus membranes to subside and for the skin to
adhere to the new framework. Most patients return to
work one to two weeks following surgery, depending on
temporary bruising and swelling. At that time, swelling
is still apparent to you but not to many of your
coworkers and closest friends.
Final results following rhinoplasty are not apparent for
one full year following surgery. After three months, the
changes are ever so subtle, although still important.
Being perfectionists about our work, you may tell us you
are pleased long before the one year anniversary.
However, we request that you follow-up with us at that
time for postoperative photographs and so that we can
enjoy your final result.
Revision Rhinoplasty (Nasal Reshaping)
Revision rhinoplasty is more challenging than primary
rhinoplasty for several reasons. First is the altered
"geography" of the nose. At the time of the primary
rhinoplasty, distorted cartilage was removed to make the
nose straight and restore function. Therefore, in
revision rhinoplasty, the cartilage needed for
reconstruction is no longer available. Depending on the
amount of cartilage that remains, the need to borrow
cartilage from behind one ear (an auricular graft) to
restore nasal form and function is not uncommon.
Although the ear incision is camouflaged well and does
not change the shape, size, form or function of the
donor ear, the need to borrow neighboring cartilage
means an extra incision.
Nasal lining that has undergone surgery is now subject
to scar tissue, which also increases the complexity of
revision surgery. Therefore, amount of surgical time
required to perform revision rhinoplasty typically is
longer than primary rhinoplasty.
One risk of primary rhinoplasty is the appearance of
telangectasias - little spider like veins that are
typically present prior to surgery but become more
noticeable after rhinoplasty. This is not commonly an
issue and the overall improvements far outweigh the
appearance of these. However, in revision rhinoplasty,
the appearance of telangectasias can be more pronounced.
This point should be discussed prior to revision surgery
so your doctor can provide his opinion depending on your
individual skin type, texture and thickness.
Revision rhinoplasty may have its own set of special
considerations but it also can be the most rewarding. If
you are considering revision rhinoplasty (regardless of
where you elect to have the surgery performed) it is
essential that you consider a board certified facial
plastic surgeon. Why? Because facial plastic surgeons
have unique board certifications in both head and neck
surgery and cosmetic and reconstructive surgery. Please
ask to see before and after pictures of patients who
have been referred to Lindsay House for revision