Rhinoplasty

Reshape and improve the appearance of your nose.

RECOVERY TIME: ~2 weeks

Every year, over half a million people who are interested in improving the appearance of their nose seek consultations with Los Angeles Plastic Surgeons and Beverly Hills Plastic Surgeons. Some are unhappy with the nose they were born with, and some with the way aging has changed their nose. For others, breathing may be a problem, or an injury may have distorted the nose. A slight alteration of the nose can greatly improve one?s appearance. Rhinoplasty (reshaping the nose), can improve one?s looks, self-confidence or health. As with all facial plastic surgery, good health and realistic expectations are prerequisites. The goal of rhinoplasty is to improve the nose aesthetically (without creating a ?surgical? look) in order to create harmony with other facial features. Additionally, many patients have a chin augmentation in conjunction with rhinoplasty to create a better balance of features. Rhinoplasty is usually performed under general anesthesia. In some cases, it may be performed using local injections of anesthesia with intravenous sedation.

In rhinoplasty and revision rhinoplasty, the majority of incisions are made inside the nose, where they are invisible. In some cases, a small incision is made in the area of skin separating the nostrils. Certain amounts of bone and cartilage are then removed or rearranged to provide a newly shaped nose. If the patient has a deviated septum (cartilage and/or bone causing obstruction inside the nose), a septoplasty may be simultaneously performed.

With a septoplasty, all incisions are placed entirely inside the nose. The septoplasty removes portions of cartilage and/or bone that are causing the obstruction. The incisions are then closed with fine sutures, followed by placement of a splint to the outside of the nose. The splint helps retain the new shape while the nose heals. Inside the nose, Beverly Hills plastic surgeon Dr. Donald B. Yoo prefers to use thin silastic splints instead of uncomfortable nasal packing. The nasal splints are typically removed seven days after surgery. The majority of the bruising is resolved two weeks after surgery. The swelling is 70% resolved after the first three months, and the remainder goes down over time. The final result will be evident 18-24 months following surgery. Cold compresses are used to help reduce the bruising and discomfort. A short course of post-operative antibiotics and steroids are given to help prevent infection and excess swelling. Although discomfort is minimal, pain medication is available if required. Vigorous activity is to be avoided for four weeks following surgery. Sun exposure and trauma must be avoided.

During your consultation, Dr. Yoo will discuss factors that may influence the outcome of the surgery, such as skin type, ethnicity, age, and degree of nasal deformity.

Beverly Hills Elite Rhinoplasty Surgeon

Patient Indications

  • A nose which does not “fit the face” whether due to birth, trauma or disease.
  • Breathing problems associated with cartilage and/or bone obstruction inside the nose (deviated septum).
  • A chin implant may be needed to bring the nose and chin into proportion to facial features.

Procedure

  • Rhinoplasty is performed under general anesthesia or local anesthesia with sedation in our outpatient state licenced surgery center in Beverly Hills. No overnight stay is required.
  • Most incisions are made inside the nose. In some cases, a small external excision is required. Cartilage and bone are removed or rearranged to alter the appearance of the nose.

Recovery

  • The head needs to be elevated for several days following nose surgery to minimize swelling.
  • Recuperation time is approximately 7-14 days during which time some bruising and swelling may be present.
  • A nasal splint, applied to hold bone and cartilage in the new shape while the nose heals, is removed in seven days.
  • Following nose surgery, discomfort is minimal and easily controlled by oral medication.
  • A natural and aesthetically improved nose (without a “surgical” look) in proper proportion to your other facial features.
  • Improved breathing with septoplasty.
  • Ideal candidates for any facial plastic surgery are those seeking improvement rather than perfection.

POST-OPERATIVE INSTRUCTIONS RHINOPLASTY

These instructions should be carefully read and followed. They are designed to answer the most commonly asked questions regarding post-operative care for rhinoplasty, revision rhinoplasty, Asian rhinoplasty and Korean rhinoplasty.

Activity: The First Week

Limit your activity sharply during the first week following Beverly Hills plastic surgery. You are encouraged to walk about the house, but avoid bending at the waist or picking up heavy objects. If you overexert yourself, bleeding may result. When you rest or sleep, keep your head elevated on 2-3 pillows and try to avoid turning on your side. Keep your emotions under control. It is not unusual to feel a bit depressed for a few days after surgery. This quickly passes as you begin to look and feel better. Anger or crying will only add to the swelling or initiate bleeding. Restrict your diet to plenty of fluids and easily chewable foods. Hard to chew foods (like steak) should be avoided for one week.

You may carefully clean around the nostrils with a Q - tip and hydrogen peroxide three times a day. Immediately afterwards, place a bit of pure Vaseline or antibiotic ointment around the nostrils to keep them from drying out. Swelling for at least two weeks will obstruct your nasal passages. A humidifier may help you sleep by allowing you to breathe through your mouth more comfortably.

Do not blow your nose or sniff excessively as this will only irritate the healing tissues. If you must sneeze, open your mouth. Also, avoid picking up babies, small children or pets; a flailing little arm may strike your nose. You probably will hit your nose one or more times during the first week. This will hurt, but will cause no problem unless the force is excessive.

With assistance, you may bathe in a tub, showering is allowed on the second post-operative day. Cover the nasal cast so that it remains dry. If the cast becomes wet, use a blow dryer to help dry it. It is all right to carefully wash your face with a mild soap and a clean washcloth or cotton balls.

Avoid cigarette smoking or even being in an area of excessive smoke as this irritates the nasal tissue and impedes healing. Also, avoid alcoholic beverages the first two weeks following surgery as this may increase your chances of bleeding.

Activity: The Second Week

It takes six weeks for the nasal bones to fully heal. Slowly resume your activity. After the first week, let your body tell you how much to do. Strenuous exercise may be resumed in 5-6 weeks. Build up to this level slowly. Semi-contact sports are to be avoided for four to six months. Swimming is allowed after six weeks.

Do not let your nose become sunburned for six months after surgery. This may result in prolonged swelling and erythema (redness). When outside, wear sunscreen with a SPF of 30 or greater.

Pain, Swelling, Bruising, or Bleeding

The first day or two, you may have some minor bleeding. Do not swallow the blood, as it will make you nauseated. Most patients complain more of discomfort from nasal and sinus congestion than from pain. Any pain should be controlled with the prescribed medication. After the first day, the pain may subside enough so that plain Tylenol or Extra Strength Tylenol may be sufficient. If not, call our office and we will prescribe a stronger medication. Swelling and bruising about the eyes and cheeks is variable. Swelling maximizes at about two days then subsides over the next week. An ice pack to the eyes for the first 48 hours may help decrease the swelling about the eyes and cheeks. This will clear completely and will not adversely affect the result. Bruising (discoloration) may persist a few days longer. Remember, this will all subside in time and has no bearing on your final result.

Bleeding

It is normal to have mild bleeding over the first 12 hours after surgery. It may be necessary to change the gauze a dozen or so times over this period. It is normal to have a pinkish-reddish discharge from your nose and throat for the first 3-4 days. This will gradually subside. If you have profuse nasal bleeding after this time, immediately lie down with your head elevated on 3-4 pillows. Iced washcloths on the back of the neck and over the eyes may help. Using nasal decongestants (such as Afrin) as directed will often help with bleeding. Please call Dr. Yoo or our Beverly HIlls office if these measures do not suffice.

Medications

Avoid medications such as Vitamin E, aspirin or ibuprofen for 2-3 weeks. Pain medication will be prescribed. Take it as needed. Please remember that pain medication may impair your reactions. Avoid driving or performing hazardous activities while taking this medication. If the prescribed medication does not control your symptoms, please let us know. Nausea may occasionally be related to the above medication. Taking the medication with food may help alleviate the nausea. After the first 24 hours, Extra-Strength or regular Tylenol may be sufficient.

Infections

Infection in unusual after rhinoplasty, but occasionally occurs. Fever over 100° F, excessive pain and swelling with redness may signify a developing nasal infection and should be reported. Infections generally clear up quickly with appropriate antibiotic treatment.

Post-Operative Visits

The nasal packs will be removed on the next morning after surgery. The cast and any sutures will be removed after one week. Brown paper tape will then be applied to your nose. Dr. Yoo will remove the tape in one week. When the cast is removed, the nose will be quite swollen and the nasal tip may be slightly turned up. This will settle down over the next few weeks, then more gradually thereafter. Remember that the nose does not assume its final shape until many months after surgery, depending upon the type of nasal skin you have. It will probably look better than prior to the operation within two or three weeks, but the final result takes longer. Be patient. Occasionally, an injection is necessary to reduce the swelling in one area. Any touch up surgery that may be necessary is not preformed for at least six months.

WHAT TO EXPECT FOLLOWING NASAL SURGERY

Certain physical changes are expected following nasal surgery. Some individuals experience all of the following and others only some. The degree to which each person is affected is variable and unpredictable. You may experience changes that are not included in this list.

Bleeding

Bloody drainage is common in the first 48 hours after surgery. Blood-tinged nasal discharge may persist for 1-2 weeks following surgery. Profuse bleeding is unusual. Should this occur, pinch your nostrils together firmly for 10 minutes without interruptions. If this does not stop the bleeding, call our office immediately.

Swelling

Nasal swelling is expected and may not be readily noticeable until after the splint is removed. Most of the swelling subsides in 4-6 weeks, but subtle swelling may persist for 6-12 months. In certain situations, the doctor may inject a small amount of steroid into your nose to help reduce the swelling.

Bruising

Bruises following nasal surgery usually manifests as ?black eyes?. Most bruising will resolve in 2-3 weeks and may be concealed with makeup if desired.

Breathing

Nasal breathing may be difficult for 2-3 weeks after surgery due to swelling inside the nose. This “stuffiness” will subside gradually and IS NOT improved with nasal sprays. Decongestive nasal sprays may actually cause damage to the nose and impair healing.

Discharge

As noted above, blood-tinged nasal discharge is common following surgery and may persists for 1-2 weeks.

Itching/Numbness

Itching, numbness and a “wooden feeling” to the nose are common. All of these do subside, although, it may take months for your nose to feel completely “normal”.