Planning for a rhinoplasty procedure is something that all patients seeking nose surgery should take seriously. Rhinoplasty, or nose job, surgery is the most difficult of all cosmetic surgery procedures. With revision rates as high as 30-50%, you must make sure to do all of your homework ahead of your visit with your plastic surgeon.
Researching the procedure before your visit
It is important that you take some time to read up on rhinoplasty surgery to familiarize yourself with the procedure and what it entails before you go and have a consultation with a board-certified plastic surgeon or facial plastic surgeon who specializes in rhinoplasty. The most obvious source for information on just about anything these days is the Internet. The problem with the Internet is that while there’s lots of great information about any subject you might care to learn more about, there’s also lots of junk information. Below is a list of reputable sources of information about rhinoplasty (besides this blog of course!):
Researching your plastic surgeon to make sure you pick a good one
Once you’ve familiarized yourself with the rhinoplasty procedure, it is time to choose one or a few surgeons to consult with, or interview, to both learn more about the procedure and to see if you like their style and temperament. There are basically two types of surgeons who perform rhinoplasty: board-certified plastic surgeons and board-certified facial plastic surgeons. Avoid anyone else who does not come from this medical training background as they either dabble in the procedure (do not truly specialize) or are wholly unqualified to perform this procedure! Below is a little tutorial I put together on how to choose a plastic surgeon:
What happens on the day of the consultation?
Once you’ve chosen the surgeon(s) you plan to consult with, go ahead and call their office(s) to get on the schedule to meet them. Be aware that many plastic surgeons charge a consultation fee to consult with them. Do not let something like a consultation fee scare you off from visiting the best surgeon for you. I say this because some surgeons don’t charge a consultation fee because they are afraid patients won’t pay to come see them if they do. Your face is nothing to mess with, so don’t let the fact, that a surgeon you are interested in charges a consultation fee, dissuade you from seeing them.
On the day of your consultation, make sure to bring a list of your questions for the doctor. Also bring any “wish pics” you have of noses that you like. This will help your surgeon better understand your aesthetic mindset.
The consultation typically starts with the surgeon or their patient coordinator evaluating your medical history. It is absolutely vital for you to tell the truth on your medical history forms. Concealing any pertinent health information could jeopardize your physical safety, especially on the day of surgery. Once the health review is completed, your surgeon will examine your nose and ask questions about your concerns.
Skilled rhinoplasty specialists will evaluate your face from several angles to see how your preoperative nose fits in with the rest of the face. They will check the skin of the nose, the cartilage strength and position, and the bony anatomy and contour. An internal exam of the nose will be performed to evaluate for a deviated septum, septal perforations, airway obstruction, nasal valve function, and to look for any nasal masses. Based on the starting anatomy and your aesthetic/functional concerns, your surgeon can develop an operative plan.
Most rhinoplasty specialists will typically take a series of photos of the nose after they’ve completed a physical exam of your nose. These pictures serve to educate the patient on their starting anatomy, including all the normal asymmetries of the face not typically recognized by the average person. With these photos your surgeon can perform rhinoplasty simulations. Simulations are used to educate a patient about realistic possible outcomes from surgery. Simulations are not, however, a warranty or guarantee, of a particular outcome. Remember that many patients need a little touchup procedure after the nose completely heals.
At this point it is time for you to ask questions of the surgeon to make sure you both are on the same page. Check out my blog article Top 10 Questions to Ask a Rhinoplasty Surgeon to see what I think makes a good list of questions to ask your surgeon.
How am I going to pay for my surgery?
Rhinoplasty surgery can be either elective cosmetic surgery or can be covered by your health insurance policy. If you don’t like the look of your nose and are wanting to improve it for the sake of it’s look, this is considered to be a cosmetic reason for the surgery. Health insurance companies will not pay for these types of surgeries. Your surgeon will often offer several forms of financing to cover the cost of the surgery, anesthesia, and facility charges. Of course cash, checks, and credit cards will always be welcomed.
If you have problems with nasal obstruction or other types of breathing problems due to anatomic problems with your nose, whether congenital or due to trauma, your health insurance will often cover the cost to fix these problems. Your surgeon, however, has to prove medical necessity first. To do this, they will often try to manage your nasal obstruction concerns using medication, and other nonsurgical methods, for 4-6 weeks. If this fails, it is often due to a fixed anatomic deformity that can only be improved upon with surgery.
I’ve arranged my form of payment for my surgery and have scheduled the surgery date
At this point you have made arrangements to pay for the surgery and have a surgery date scheduled on the calendar. Most patients will want to take 1 week off of work to have enough time for a successful recuperation period after surgery. To prepare for the surgery, your surgeon will typically schedule you for a preoperative appointment 2-4 weeks prior to surgery. During this appointment, your surgeon and their staff will finalize the surgical plan and go over your simulations to make sure that you still agree with the plan and the cosmetic goals. You will sign your surgical consent forms and the office staff will start the process of your medical clearance (if medically indicated). Medical clearance is a process in which you have blood work obtained and an EKG (electrocardiogram) performed to make sure that you have the best chance for a successful and safe surgery. If you have particular medical issues, your surgeon will also want to communicate with your general doctor to make sure you are truly safe to move forward with surgery. If it is safe to do so, you will typically stop all unnecessary medications and supplements that would increase your chances of bleeding during surgery. These might include aspirin, ibuprofen, fish oil, garlic, vitamin E, weight-loss supplements, etc. Your surgeon will have a list for you to read over. Also this would be a great time to stop smoking as well. Nicotine in tobacco cigarettes is a poison that effects the blood supply to the nose and continued smoking could cause tissue loss in your nose.
The day of your surgery
On the day of surgery, you come to the surgery center with someone who will be able to take care of you for 24 hours after surgery. Most patients will need general anesthesia to have their procedure performed. Sometimes the procedure can be performed using only local anesthesia, or IV sedation. Either way, you will want a responsible adult with you to help you in the first day after the procedure.
You will be greeted by the nursing staff and your belongings secured. You will change out of your street clothes and into one of those drafty patient gowns. The preoperative nurse will ask you some questions including when you ate last. It is important to have an empty stomach prior to IV sedation or general anesthesia procedures. If you are having surgery using only local anesthesia, you are typically allowed to eat something before the procedure. After the question, the nurses will go ahead and start an IV and get you situated on the bed with a warming blanket. If you are female of childbearing capability, you will have a pregnancy test administered. If you happen to be pregnant, your selective surgery will be cancelled for the safety of the fetus.
At this point, your anesthesiologist will come and speak with you. He/she will ask you pertinent questions about past anesthesia experiences, etc. They will examine your mouth and your neck to determine how easy or difficult of an airway you might have. They will then have you sign anesthesia consent forms after you’ve had a chance to ask any questions you might have about anesthesia.
Your surgeon will be the last person to see you before you go back to the operating room to have your procedure. This is a great time for you to ask any last minute questions. It is a great time to review the surgical goals and plan with you one last time. Make sure you get your desires across.
The operating room
At this point, you have been given a little IV cocktail of sedatives to relax you and help you drift off gently to sleep for surgery. The surgical team will wheel your gurney back into the operating room and place it next to the surgical table. While you will feel drunk, you are still able to move. The surgical nurse will help you move over onto the surgical table. The gurney is then removed from the room. You will be secured on the table and warm blankets will be placed over your body. Operating rooms are notoriously cold for sterility purposes. Special massaging socks will start squeezing your calves. These help prevent blood clots.
The anesthesiologist will then add more medications to your IV while making you breathe 100% oxygen to pre-oxygenate your lungs. One of the medications you are given is a short-acting paralytic drug that relaxes your muscles for a short period of time so that the anesthesiologist can go ahead and safely intubate you. Intubation consists of placing a tiny tube into your mouth, across your vocal cords, and into the upper part of your tracheal airway. A little cuff on the tube is inflated to avoid the loss of anesthetic gases used to keep you asleep during surgery. Your endotracheal tube is then secured to your face with special tape to keep it from dislodging.
Every surgeon will perform your surgery slightly differently. Issues like anatomy, medical history, and desired outcome play into the path a surgeon will take with your nose. It is always recommended that you discuss this in detail with your surgeon prior to surgery. There are commonalities for most patients, ever. Most patients will have sutures if they’ve had an open rhinoplasty procedure. Most surgeons prefer this procedure because it allows better visualization of the nasal anatomy. Many patient may have intranasal packing or airway splints to control postoperative bleeding and help shape the healing nasal airways. Finally, the majority of patients will have some type of splint/cast on the outside of their nose to smooth the skin back down and control swelling of the nose.
Bruising is to be expected and will last 7-10 days. In my practice, we use a Rapid Recovery Protocol to minimize the bruising and swelling my patients experience.
Rhinoplasty is the procedure that takes the longest to heal from. Primary rhinoplasty patients can expect their final results to take a year to manifest. Secondary or revision rhinoplasty patients may need 18-24 months to see their final results. The extra recovery time is due to the scarring and blood supply alteration created during the first rhinoplasty procedure.
The first week after your surgery, you will be taking it easy. You will sleep with the head of your bed elevated to decrease swelling and control blood pressure to your head to reduce bruising. Aggressive icing around the nose and eye will help this out tremendously. You might need a little cotton dressing at your nostril to catch any draining blood. Because your nose will feel stuffy, you will probably breath open mouthed, or even snore after surgery. I highly recommend the use of a cool mist humidifier to soothe your throat. Nasal packing is removed 2-3 days postoperatively.
You will keep the splint on your nose for about 6-7 days. At the time of external splint removal, your surgeon will remove any external stitches. Internal airway splints may be removed 7-21 days postoperatively, depending on the situation. In my practice, this is the time I provide a patient with their second phase of rhinoplasty recovery instructions. In my practice, I teach patients night time taping and daily soft tissue molding exercises. Your nose will definitely swell after the splint is removed, so I like to control this process.
The upper 2/3’s of your nose will stay swollen for 2-3 months before recovering. If your nasal bones were reshaped or narrowed, they will be fully healed by this time. You definitely want to protect your nose from any other trauma until this time. After this period, most patients don’t notice significant changes in the nose until the 9th month when the tip itself starts to soften. By 12 months, healing is typically complete.
If you are concerned with the pace of your healing, I highly recommend sticking close to your surgeon and their team. Aggressive swelling can be managed with taping and massage, but may occasionally require steroid injections to control. Besides, your surgeon has as much invested in the success of your rhinoplasty as you do. I can tell you that I have an extremely high satisfaction rate with both primary and revision rhinoplasty surgeries, and I believe it has to do with both my technical skills and the very close care we provide to each patient. While I want my patients to be happy, I also want to be happy with the noses I create or fix.
Check out this video I made regarding recovering from rhinoplasty:
Now that you have a better understanding of rhinoplasty surgery and the recovery process, you can confidently go forward with your own rhinoplasty journey. As always, I encourage you to do your homework and make sure you pick the best surgeon for you. If you have any questions for me or want to consult with me about rhinoplasty surgery, please call (303) 708-8234, or email me at my Contact Us page.