Rhinoplasty

Rhinoplasty (also known as a Nose Job) is a very popular cosmetic surgery where nose surgery involving restructuring the nose is performed to improve its appearance. Statistically, every year 500,000+ people seek consultations with Los Angeles Plastic Surgeons and Beverly Hills Plastic Surgeons for Rhinoplasty surgery.

Why nose surgery is sought after:

• Some people may not like the appearance of the nose they were born with
• Aging may have changed a nose’s appearance which people are no longer happy with
• While others may a distorted nose following an injury which can cause breathing problems

A slight alteration of the nose through Rhinoplasty can help resolve these concerns and greatly improve one’s appearance.

Facial aesthetics can improve by reshaping the nose which in turn can improve self-confidence or health.

The Goal of Rhinoplasty:

To improve the nose aesthetically (without creating a “surgical” look) and to create harmony with other facial features.

Rhinoplasty is usually performed under general anesthesia. In some cases, it may be performed using local injections of anesthesia with intravenous sedation.

In both rhinoplasty and revision rhinoplasty, the majority of incisions are made inside the nose, where they are not visible on the exterior of the nose. Sometimes a small incision is made in the area of skin separating the nostrils. Cartilage and bone are then strategically removed or rearranged to produce a newly shaped nose. A septoplasty is sometimes simultaneously performed if the patient has a deviated septum (cartilage and/or bone causing obstruction inside the nose). Oftentimes to create a better balance of features, many patients will have chin augmentation surgery in conjunction with rhinoplasty.

With a septoplasty, all incisions are placed entirely inside the nose. Portions of cartilage and/or bone that are causing the obstruction are then removed. The incisions are closed with fine sutures and a splint is placed on the outside of the nose. The splint helps retain the new shape of the nose while the nose heals. Nasal packing can be uncomfortable so Beverly Hills plastic surgeon Dr. Donald B. Yoo prefers to use thin silastic splints inside of the nose. Typically 7 days after surgery the nasal splints are removed. The majority of the bruising is resolved approximately 2 weeks after surgery. After the first 3 months the swelling is 70% resolved, and the remainder goes down over time. The final result will usually be evident 18-24 months following surgery. To help reduce bruising and discomfort, cold compresses can be used. A short course of post-operative antibiotics and steroids are given to help prevent infection and excess swelling. Although discomfort is usually minimal, pain medication is available if required. Vigorous activity is to be avoided for 4 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. As with all facial plastic surgery, good health and realistic expectations are prerequisites.

During the first week following Beverly Hills rhinoplasty surgery, limit your activity sharply. You are encouraged to walk about the house, but avoid bending at the waist or picking up heavy objects. Bleeding may result if you overexert yourself. When you rest or sleep, keep your head elevated on 2-3 pillows and try to avoid turning on your side. It is not unusual to feel a bit depressed for a few days after surgery so it helps to recognize your feelings and keep your emotions under control. 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 easily chewable foods and drink plenty of fluids. Hard to chew foods (like steak) should be avoided for one week.

To clean, use a Q-tip dipped in hydrogen peroxide and carefully clean around the nostrils 3 times a day. Immediately afterwards, place a bit of pure Vaseline or antibiotic ointment around the nostrils to keep them from drying out. For at least 2 weeks, swelling will obstruct your nasal passages. You can use a humidifier which 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.

You may bathe in a tub with some assistance. Showering is allowed on the second post-operative day. Make sure to cover the nasal cast so that it remains dry. If the cast becomes wet, use a blow dryer to help dry it. You may 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.

Pain, Swelling, Bruising

Most patients feel more 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 around the eyes and cheeks is variable. Swelling maximizes at about 2 days then subsides over the next week. An ice pack to the eyes during the first 48 hours may help decrease the swelling around the eyes and cheeks. This will eventually 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

Mild bleeding is normal during the first 12 hours after surgery. It may be necessary to change the gauze a dozen or so times over this period. In the first day or two, you may experience some minor bleeding. Do not swallow the blood, as it will make you nauseated. It is also 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 placed 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.