Who is a candidate?
The nose is at the center of one’s face, and therefore is not in a position to be ignored.
The structure of the nose can either make breathing easier or harder, and the appearance of the nose can contribute to facial harmony and beauty, or detract from the face and become a focal point for all the wrong reasons.
Dr. Patel is very experienced in Rhinoplasty and Revision Rhinoplasty, including repair of fractures and reconstruction of the airway utilizing advanced techniques.
There are both reconstructive and cosmetic reasons for rhinoplasty.
Common reasons for having rhinoplasty include:
- Reducing a dorsal hump
- Refining a large, bulbous, or boxy tip
- Correcting a drooping tip
- Narrowing the base of the nose
- Narrowing the overall width of the nose
- Reducing the overall size of the nose
- Building a bridge in Asian, African-American, or other “ethnic” noses
- Changing the overall shape of the nose
- Increasing the length or projection of the nose
- Correcting deformity that resulted from fracture or injury
- Improving breathing (septoplasty, spreader grafts, etc)
- Correcting deviated septum
How to Choose a Rhinoplasty Surgeon
In rhinoplasty or revision rhinoplasty, a crucial thing to figure out before surgery is if you and your surgeon have the same idea of what is beautiful.
Often when patients come in for a revision, it is not that the surgeon did not do the surgery that was discussed. Rather, it is that the patient does not like the results.
Your surgeon may build what he or she thinks is a gorgeous nose, and what you think is beautiful is entirely different and you end up unhappy.
To avoid this, first be as clear as possible about what you want to achieve, and second make sure your surgeon has the experience required to get you that result and a similar idea on what is beautiful.
Do not rush into surgery if you are not confident the surgeon understands what your goals are. Doing your research and taking your time upfront will could save you from a second surgery.
When you go in for a consultation, be prepared to discuss what bothers you about your nose, and how important each of those things are.
Dr. Patel will often ask you to list the top 3 things about your nose that you dislike or would like to change. (It is okay if you do not have 3 things, or have more than 3.)
She will also go over a full history regarding any breathing difficulties you may have, including prior surgery, fractures or trauma, history of allergies, etc.
It is very important to disclose any and all surgery and trauma to your nose, because this has a big impact on the surgical plan.
Finding out in the middle of surgery that a patient has already had surgery on the nose can really limit what can be done, since you may not have been consented for the more extensive procedure that you may need.
Not disclosing information can thus backfire and you may not get the best result that was possible. After discussing your history and goals, if you have any photographs of yourself or others that help describe what you want, you can present the photos to Dr. Patel and point out specific details you like or dislike.
Next, you will go to an exam room where Dr. Patel will look inside the nose to assess your airway, and also look and feel the outside of the nose.
Photographs will then be taken in six different views, and may be used to show you the analysis of your nose and how different areas can be improved.
Open versus Closed Rhinoplasty
There are 2 approaches when performing rhinoplasty or revision rhinoplasty procedures. The first is an “open” approach, where a small inverted V shaped incision is placed on the columella of the nose, and the remaining incisions are inside the nostrils.
The second is a “closed” approach, where there are no external skin incisions, and everything is done through incisions inside the nostrils.
Dr. Patel prefers open rhinoplasty in most cases as it allows the best visualization and exposure without distortion, allowing the placement of very precise grafts and suture techniques.
In smaller cases, or those not involving much tip work, a closed approach may be utilized instead. Dr. Patel assesses each nose individually to determine the best approach for that particular patient and uses the one that she feels will allow her to achieve the best possible long-term result.
Risks of rhinoplasty and revision rhinoplasty
The standard surgical risks include pain; bleeding; infection; scarring; painful or hypertrophic scarring; injury to vessels, nerves, surrounding structures; change in sensation; asymmetry; poor cosmetic result; visibility, malposition, warping, or other problems with grafts; difficulty breathing; prolonged edema, numbness, parasthesias; loss of skin; need for further procedure and out of pocket costs; and risks of anesthesia.
Please note that when it comes to rhinoplasty surgery, there is always a chance of needing a revision, and this may result in additional out-of-pocket costs. Even in the best of hands, revisions are a possibility.
They are an even bigger possibility in the case of revision rhinoplasty.
Can I have my septum fixed or airway fixed at the same time as cosmetic rhinoplasty?
Yes. Your airway and breathing are of utmost importance, and should be addressed at the time of your surgery.
Some patients do not recognize any difficulty in breathing, and if they go for rhinoplasty where parts of the nose are made smaller and nothing was done to add support for breathing from the inside, they are now set up for breathing problems they did not have to begin with.
Any evaluation by a plastic surgeon for rhinoplasty must include an internal exam to look at your septum and turbinates, and also check for internal and external valve collapse. All of these things can be addressed at the time of your surgery.
Will insurance cover my rhinoplasty?
Insurance providers will cover procedures they deem to be medically necessary. Regarding the nose, portions that may be covered by insurance are correcting a deviated septum (or septoplasty), repairing a nasal fracture or deformity from a nasal fracture, correcting breathing problems by reconstructing the nasal airway (including at times fascia grafts or cartilage grafts taken from the ear or rib), and treating hypertrophy of the inferior turbinates.
If any of these things apply to your case, our office can submit for pre-authorization on your behalf. If approved, it may result in lower out-of-pocket costs since if portions are covered by insurance.
Where do you get cartilage from to make the internal support grafts?
Cartilage used for grafts can be harvested from the nasal septum, ear, or rib. Another option is also cadaver rib cartilage.
What to expect after surgery
When you wake up from surgery, you will have a splint on the outside of your nose, soft silicone splints inside the nose (that have openings to breathe through), and a piece of gauze above your upper lip (“mustache dressing”) to catch any blood or mucus draining from the nose.
If you needed rib cartilage during the surgery, you will spend one night in an aftercare facility or hotel with private duty nursing. This is to make sure you have monitoring after surgery and also injectable pain medication if needed.
Dr. Patel will see you on the day following surgery to change the mustache dressing, gently clean any dried blood or mucus from around the nares, and check the donor sites for any bleeding, fluid collection, or other overnight concerns. Your next visit is one week after surgery, at which time typically the internal and external splints are removed.
In select cases, they may be removed at a later date. Stitches at the columella are also removed at 1 week. The nose is then taped with brown paper tape. You will be instructed how to tape, and should keep the tape on at all times for the first 2 weeks. Dr. Patel will see you again the following week to remove any staples (if you had a fascia graft harvested from the scalp), and then 2 weeks later.
At that time typically you may transition to night-time taping only. The visits are then spread out less frequently thereafter. The schedule is adjusted based on doctor/patient preferences and needs.
Walking the day of surgery is recommended. You must keep the nasal splint dry at all times. You may sponge bath, or shower 24 hours after surgery (* You must keep splint away from water and also away from steam, since both will loosen the splint). You may want to sleep with the head of your bed elevated to minimize swelling.
No baths, soaking in tubs, hot tubs, or swimming pools until incisions are fully healed. Gentle soap (non-perfumed, non-irritating soap preferred) and water over the incision is okay once the splint has been removed. Scar gel may be used starting 2 weeks after surgery or once incisions have no open areas, crusting, or scabs.
In general, Dr. Patel recommends avoiding exercise for 6 weeks following surgery, at which time you can ease back into your workouts. Light activity may be okay around 3 weeks after surgery. You may return to work 2 weeks after surgery, depending on your pain level, stamina, and activities required in your occupation.
You may drive once you are no longer taking pain medications or muscle relaxers, and allow a 24 hour minimum window between your last pain medication or muscle relaxant dose and driving. Bruising and swelling is normal after surgery. The initial swelling will get much better in the first 2-3 weeks, but you will still have swelling present for months.
The final result after a primary rhinoplasty is not seen until 1 year out from surgery or more. If you are having a revision rhinoplasty, your early swelling may be more intense, and it may take even longer than 1 year to really resolve. All recovery processes and recommendations vary patient to patient, so these general guidelines may not apply to every patient.