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I
usually recommend that patients wait
until they are at least 14 or 15,
and possibly older for boys, before
undergoing rhinoplasty. This is because
the nose may not be fully developed
at a younger age. If you are a teen,
I would like to be certain that you
have thought carefully about surgery
and that the desire to change your
appearance is based on your own feelings
rather than those of your parents
or friends.
Assuming you are in good health, there
is no upper age limit for having your
nose reshaped.
Rhinoplasty
is sometimes performed in conjunction
with a facelift or other rejuvenate
surgery to correct aging changes of
the nose such as a drooping tip. Sometimes
certain breathing |
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Problems related to the internal nasal structures
can be corrected at the same time as nose
reshaping is performed. I will be able to
help you determine whether these structures
should be modified along with reshaping
your nose.
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Are
you a good candidate for rhinoplasty?
Some
of the indications that you may be a good
candidate for rhinoplasty are: |
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·
Your nose appears too large for your face
· There is a bump on the nasal bridge
when viewed in profile
· Your nose seems too wide when viewed
from the front
· The nasal tip droops or plunges
· The tip is thickened or enlarged
· Your nostrils are excessively flared
· Your nose is off-center or crooked
· Previous injury has made your nose
asymmetrical
It
is important that you have a clear idea
of how you would like your nose to look
and, at the same time, realize that there
are limitations to the procedure. Patients
with sufficient physical and emotional
maturity who undergo rhinoplasty because
they want to enhance their self-image
are usually very satisfied with their
decision.
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1.Rhinoplasty
can be performed to meet aesthetic
goals or for reconstructive purposes
- to correct birth defects or breathing
problems. |
| 2.Incisions
are made inside the nostrils
or at the base of the nose,
providing access to the cartilage
ad bone which can then be sculpted
into shape. |
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3.The
surgeon removes a hump using a chisel
or a rasp, then brings the nasal bones
together to form a narrower bridge.
Cartilage is trimmed to reshape the
tip of the nose. |
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| 4.
Trimming the septum improves the angle
between the nose and upper lip |
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5.
If the nostrils are too wide, the
surgeon can remove small wedges of
skin from their base, bringing them
close together. |
| 6.
A splint made of tape and an overlay
of plastic, metal or plaster is applied
to help the bone and cartilage of
the nose maintain their new shape. |
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Your
Personal Consultation
During
the initial consultation, you may be asked
to look in a mirror and point out exactly
what you would like to see improved. This
will help me to understand your expectations
and determine whether they can realistically
be achieved. How
will I evaluate you for rhinoplasty?
You
should come to the consultation prepared
to discuss your medical history. This
will include information about any medical
conditions you may have, medical treatments
you have received, previous surgeries
including repair of nasal injuries, and
medications that you currently take. I
may also ask whether you have difficulty
breathing through your nose, suffer from
any allergies that may cause nasal stuffiness.
It is important for you to provide complete
information.
In
evaluating you for rhinoplasty, I will
conduct a routine and painless examination
of your internal nasal structures. Your
skin quality as well as the size and shape
of your nose and its relationship to your
other facial features will be carefully
studied.
When
will I learn about the cost of surgery?
It
is understandable that you would like
to have information about the cost of
surgery as soon as possible. I must first
complete a thorough evaluation before
your individualized surgical plan can
be developed. Following this, the fees
required for your surgery will be discussed
with you
. How
Rhinoplasty is Performed
Because
of individual factors, not everyone will
achieve the same results from rhinoplasty.
My goal is to obtain the best possible
results for you.
Where
are the rhinoplasty incisions placed?
Alterations
may be made to increase or decrease the
nasal bridge, reduce the size or width
of the nose, narrow the nostrils, change
the angle between the nose and upper lip,
or reshape the tip. The surgical techniques
employed will depend primarily on the
goals established by you and myself. In
many instances, all of the incisions will
be placed inside your nose, where they
will not be visible. If the base of the
nose is narrowed or the nostrils reduced,
small wedges of skin at the base of the
nostrils will be removed. Incisions are
hidden in the natural crease where the
nostril joins the cheek. Most of the times
a very short incision is made across the
vertical strip of tissue that separates
the nostrils, called the columella. This
technique is called an "open rhinoplasty."
Whatever incisions are used to reshape
your nose, they will ultimately be very
inconspicuous.
How
is my plastic surgeon able to reshape
my nose?
Through
the small incisions, work is done on the
cartilage and bone that form the framework
of your nose. Sometimes, the position
of certain bones may need to be altered
slightly in order to make your nose look
narrower and straighter. If your nose
needs to be built up in some areas, this
can be done using nasal cartilage, or
perhaps bone or cartilage from another
site. The skin and soft tissues then redrape
themselves over this new "scaffolding."
Understanding
Risks
Fortunately,
significant complications from rhinoplasty
are infrequent. Every year, many thousands
of people have their noses reshaped, experience
no major problems and are pleased with
the results. Anyone considering surgery,
however, should be aware of both the benefits
and risks.
The
subject of risks and potential complications
of surgery is best discussed on a personal
basis between you and myself.
Some
of the potential complications that may
be discussed with you include hematoma
(an accumulation of blood under the skin
that may require removal), infection and
reactions to anesthesia. Numbness of the
skin following rhinoplasty may occur but
is usually temporary. Occasionally, if
the surgical outcome needs further improvement,
additional surgery may be necessary.
You
can help minimize certain risks by following
the advice and instructions of your plastic
surgeon, both before and after your surgery.
How
should I prepare for surgery?
If
you are a smoker, you will be asked to
stop smoking well in advance of surgery.
Aspirin and certain anti-inflammatory
drugs can cause increased bleeding, so
you should avoid taking these medications
for a period of time before surgery. Your
surgeon will provide you with additional
preoperative instructions. If your rhinoplasty
will be performed on an outpatient basis,
be sure to arrange for someone to drive
you home after surgery and to stay with
you at least the first night following
surgery
.What
will the day of surgery be like?
Medications
are administered for your comfort during
the surgical procedure. Frequently, local
anesthesia and intravenous sedation are
used for patients undergoing surgery,
although general anesthesia may be desirable
in most instances. For your safety during
the operation, various monitors are used
to check your heart, blood pressure, pulse
and the amount of oxygen circulating in
your blood.
When
surgery is completed, you will be taken
into a recovery area where you will continue
to be closely monitored. There may be
some discomfort, but this can be controlled
by medication which you may continue taking
at home. Depending on the surgical technique
used, a splint may have been placed on
the bridge of your nose for the purpose
of holding the tissues in place until
they have stabilized. The splint will
protect your nose while you sleep and
shield it from accidental bumps. Frequently,
you may also have a small triangular bandage
beneath the tip of your nose. Packing
or soft internal splints are sometimes
used inside the nostrils, especially if
work has been done to improve your breathing.
You probably will be permitted to go home
after a few hours, although some patients
may stay overnight in the hospital or
surgical facility.
How
will I look initially?
It
is important to realize that the amount
of time it takes for recovery varies greatly
among individuals. The first couple of
days after surgery, you should restrict
your activities and sleep with your head
elevated. This will help to minimize swelling
and reduce the possibility of minor bleeding,
which is not uncommon. Remember, you must
not take aspirin. Use ice packs to reduce
swelling. Generally, bruising around the
eyes and cheeks is most apparent during
the first three days following surgery.
Most discoloration will disappear within
a week. A few days after surgery, you
can begin to use makeup as a concealer,
if desired. Noticeable swelling may last
for several weeks. Minor residual swelling,
most frequently affecting the nasal tip,
may continue for many months, but generally
this should not be apparent to others.
If packing was used, it will either dissolve
by itself or be removed three to seven
days after surgery. Stitches may also
be removed at that time. You may need
to continue wearing the nasal splint for
up to a week, during which time you should
avoid getting it wet.
When can I resume my normal activities?
Straining,
bending and lifting should be avoided
during the early
postoperative period. In many instances,
you may be able to return to work within
a week or ten days after surgery. Most
normal activities including exercise can
usually be resumed within three weeks.
It will be a few months before you can
expose your reshaped nose to direct sunlight.
Your nose will be sensitive during this
time, and you must be conscientious about
using a sunblock to protect your skin.
If the bones of your nose were altered,
it may be a number of weeks before you
can wear glasses without special support
such as tape.
Results
of Your Rhinoplasty
The
goal of rhinoplasty is a nose that looks
natural and blends harmoniously with your
other facial features. Since the healing
process is gradual, you should expect
to wait up to one year to see the final
results of your rhinoplasty. You are likely,
however, to begin enjoying your new look
within weeks of your surgery. Occasionally,
a touchup may be desired to further improve
the results. If this is the case, the
additional procedure is usually less extensive
than the original operation.
How
long will the results last?
In
most instances, the results of rhinoplasty
are permanent, except for possible changes
associated with the normal aging process.
Maintaining
a Relationship with Your Plastic Surgeon
You
will return to my office for follow-up
care at prescribed intervals, at which
time your progress will be evaluated.
Please remember that the relationship
with your plastic surgeon does not end
when you leave the operating room. If
you have questions or concerns during
your recovery, or need additional information
at a later time, you should contact me.
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