Primary Rhinoplasty – What Can You Expect?

SocialMediajpegs.004

The term Primary Rhinoplasty is used to describe a nose surgery procedure which is done purely for cosmetic reasons.  In essence, it is a first time nose operation.  It is typically not performed to correct functional issues in the nose or reconstructive issues resulting from trauma. There are many reasons a person may choose to undergo a Primary Rhinoplasty in Denver, Colorado. Some of the issues that people use rhinoplasty surgery to correct or improve are to change the shape of the tip of the nose, to improve the nasal profile by removing bumps or indentations, to change the angle of the nose as it relates to the mouth, to change the shape or size of the nostrils and to improve overall facial harmony.

A Primary Rhinoplasty procedure is most ideal for patients who’ve completed their mid facial growth period, generally considered to be after 14 years of age in females and after 17 years of age in males. Patients should be in good health and should only be considering rhinoplasty for their own personal benefit and not to please anyone else. Patients should also have realistic goals and expectations. Rhinoplasty procedures can affect a great deal of improvement in a nose, but it is generally not recommended to try to change the nose drastically.  Consulting with a skilled board-certified plastic surgeon who specializes in facial plastic surgery procedures, such as Dr. Manish H. Shah, is the best way to determine if your goals are achievable.

Your consultation with Dr. Shah will allow for a physical examination of your nose after discussing your relevant pre-history.  Dr. Shah will then typically take multiple pictures of your nose from various angles.  He then takes these digital photos and puts them into Rhinoplasty simulation software.  With this software he can simulate various changes to your nose to give you an approximate idea about your possible outcomes.  It is important to note that Rhinoplasty simulations are not a guarantee or warranty of any particular outcome.  Dr. Shah uses the simulations to help educate you, the patient, about what is possible and what is not possible.  Complications from rhinoplasty surgery are quite rare but they can include the following: bleeding, infection, scarring, wound healing problems, asymmetry, numbness, soft tissue loss, breathing problems, septal perforation, dorsal saddle nose deformity, stiffness, need for revision surgery, dissatisfaction with the cosmetic outcome, reactions to medications and anesthesia, heart problems, lung problems, brain problems, and death.  While this might sound scary, rest assured that actual risks are quite rare.  Safety should always be a priority!

Primary Rhinoplasty procedures are typically performed in fully-accredited outpatient surgery centers, and in certain situations, in hospital.  Dr. Shah uses board-certified M.D. Anesthesiologists.  Dr. Shah prefers to use full general anesthesia because he believes it allows for better control of the patient’s airway.  This maximizes safety!  No one, but Dr. Shah, touches the patient.  Dr. Shah, though he loves to teach, is the only person who will be operating on your nose.  Most patients typically experience very little bleeding or post-operative bruising.  Postoperative nausea and vomiting are also fairly rare.  Pain control is fairly easily established, and most patients stop their narcotics by post-operative day # 2. A patient will rarely wake up with nasal packing.  If extensive work is done to straighten a deviated nose, Dr. Shah will often leave temporary internal splints to help mold the airway and insure that breathing will ultimately be improved.  All patients have an external molding splint left on for at least seven days after surgery.  This helps stabilize the skin and keep any surgically fractured nasal bones in place.

The first week is typically the hardest week for the patient.  They will be sleeping with their head elevated.  They will be applying ice packs to reduce bruising and swelling.  They are not allowed to get their faces wet, so hair washing is a bit difficult to do.  Dr. Shah recommends bathing during this first week.  A cool mist humidifier at the bedside is very soothing for the face and throat.  After this week, you will typically have your external splint and any external sutures removed.  External sutures are used only if you are having an open rhinoplasty and/or you are having your nostrils narrowed.  If the rhinoplasty is a closed procedure (endonasal approach) then all the incisions are hidden inside the nose and there will be no sutures to remove.

At this point, you will be taught the second phase of your care.  You will be allowed to rinse out your nose with saline spray and use oral decongestants to unclog your airways.  You will be taught night-time taping techniques and soft tissue massage to help mold your nose.  You will not be able to use eyeglasses, sunglasses, or ski goggles for two months to avoid shifting fractured nasal bones.  Your nose may swell after the splint is removed, but with time it will decongest.  The upper part of the nose settles in after about three months. The bones are at their hardest at this point.  For the next five to six months after this, most patients don’t notice big changes.  Finally, around months ten to twelve after surgery, the tip of the nose finalizes its cosmetic outcome.  Patients must realize that patience is mandatory because it will be at least one year before they see how their Rhinoplasty surgery turned out!

Top 10 Questions to Ask a Rhinoplasty Surgeon

The questionnaire

Rhinoplasty is the most difficult cosmetic surgery procedure to perform.  For this reason, it is essential that someone looking to have this surgery performed be well-educated and armed with the information they need to make a good decision.  As a board-certified plastic surgeon specializing in rhinoplasty surgery here in Denver, I feel that it is important for patients to ask questions of me when they consult with me about their choice for rhinoplasty.

Here are my Top 10 Questions to Ask a Rhinoplasty Surgeon…

1. “Are you board-certified?”

Board certification by the American Board of Plastic Surgery and/or the American Board of Facial Plastic and Reconstructive Surgery shows that your surgeon has completed accredited training in an ACGME accredited residency program and has passed both a rigorous written exam and an oral exam that tests them on their actual patients clinical care and outcomes.  Maintenance of Certification status further acknowledges that your surgeon continues to stay at the forefront of knowledge in their specialty.

2. “Is rhinoplasty a significant part of your cosmetic surgery practice?”

There are lots of different procedures that a plastic surgeon can perform.  While every surgeon claims that they perform rhinoplasty, the fact is that this procedure is not all that common in most practices.  Breast surgery and liposuction are more common procedures to ask for, and so surgeons are more commonly performing those procedures.  Rhinoplasty is not something you dabble in.  For the greatest chance of success with your rhinoplasty, I always recommend that you consult with a rhinoplasty specialist.  Rhinoplasty makes up roughly 25-30% of my practice.

3. “How many rhinoplasty procedures do you perform each year?”

In the U.S. the average ASAPS (American Society of Aesthetic Plastic Surgery) member performs between 6-12 rhinoplasty procedures/year.  I am an ASAPS member and I average around 50 rhinoplasty procedures/year.

4. “What is your revision rate?”

Rhinoplasty surgery is a very complex operation.  Some patients have more difficult noses than others.  For this reason, there is always a chance that a revision operation might be necessary after a nose heals from an initial surgery.  Most patients getting revision surgery really are getting touch-up or finesse surgery to get the best result possible.  A smaller percentage of patients have revision surgery because the initial procedure did not turn out well.  Nationally, in the U.S., you can expect a 30-50% revision rate in primary rhinoplasty. Amongst rhinoplasty specialists, the average revision rate is closer to 10%.  My primary revision rate is in line with this.

5. “What is your preferred technique for performing rhinoplasty?”

Rhinoplasty surgery can be performed either as a closed or an open operation.  A closed rhinoplasty operation only has incisions inside the nose.  It tends to be a method that reduces trauma to the nose and lends itself to a quicker recovery.  However, in less experienced hands, this technique doesn’t allow for as much visualization of the surgical field making the risk of a suboptimal outcome higher.  That being said, those surgeons who prefer this method and have a lot of experience using it make beautiful noses.

An open rhinoplasty operation involves intranasal incisions and an incision across the columella (the fleshy divider of the nostrils). This technique allows for better visualization of the surgical field but does cause more trauma to the tissues and takes longer to recover from.  In modern rhinoplasty, more surgeons are adopting the open technique.

In my practice over 80% of rhinoplasty procedures use the open technique.  I reserve the closed technique for more minor rhinoplasty cases and some revision rhinoplasty procedures.

6. “What happens if I need a revision after one year?”

Luckily for you, your chances for revision surgery in the hands of a skilled rhinoplasty specialist are fairly low.  Most surgeons stand by their work.  If a patient isn’t happy and has reasonable expectations, a reputable surgeon will often not charge for touch-up surgery.  Patients may be required to cover the costs of anesthesia and facility charges.  It is best to enquire about your surgeon’s revision policy before you have surgery.  The same goes for having realistic expectations.

7. “Do you perform rhinoplasty  simulations?”

Rhinoplasty simulations are computer generated morphs of the pictures of your nose taken by a rhinoplasty surgeon at consultation.  They are used to help educate patients about possible changes that might be expected after rhinoplasty.  They aren’t a guarantee or warranty for a particular outcome, but they are helping in guiding your surgeon to the best outcome possible.  It is important that you remain realistic about your outcomes as simulations can be made to look like anything.

8. “Can I see before and after pictures of patients of yours?”

A surgeon’s before and after gallery is a portfolio of their work.  It should have a cross section of patient types to show that the surgeon has a broad range of rhinoplasty skills.  Though it is rare to see a patient matching your description, you might see someone who looks like you.  That being said, individual results will vary.  Don’t expect that your nose after surgery will look like anyone else’s, especially celebrity noses.

9. “What societies do you belong to?”

Medical society membership shows that a surgeon is interested in staying at the cutting edge of their field.  Continuing medical education is necessary to learn advanced techniques and apply evidenced based data to the practice of rhinoplasty surgery.  I am a member of the ASPS (American Society of Plastic Surgeons), ASAPS, ISAPS (International Society of Aesthetic Plastic Surgery), the Rhinoplasty Society, and the Royal Society of Medicine.  I have published in peer-reviewed journals, been interviewed for television and for online publications, and lectured nationally and internationally.

Other important societies include the AAFPRS (American Academy of Facial Plastic and Reconstructive Surgery) and the AACS (American Academy of Cosmetic Surgery).

Make sure that your rhinoplasty surgeon has similar qualifications.

10. “Doctor, are my goals realistic?”

This is a loaded question but an extremely important one.  The first rule of the Hippocratic Oath is “Do no harm.”  Patient safety, both from a medical and an outcomes-based point of view, requires that a surgeon be realistic when counseling a patient, especially with cosmetic surgery.  There is a lot of money to be made in cosmetic surgery so there has been a sharp rise in non-qualified practitioners offering cosmetic surgery procedures.  Patients get lured into having surgery often with devastating consequences.  I have no problem turning a patient away if I can’t deliver the results they are looking for.  What I have found is that these patient’s have expectations that no one will actually ever be able to fulfill.

 

Well, I hope you’ve enjoyed my thoughts on the questions to ask a rhinoplasty specialist at the time of your consultation.  If you have any questions, you can always contact me at (303) 708-8234 or drop me an email at info@drmanishshah.com.

Thanks,

Dr. Shah

Surgical vs. Non-surgical Rhinoplasty – Your options in Denver, Colorado

Your nose is often the first thing people notice upon meeting you. If you are self-conscious about the appearance of your nose ­– whether you have an unsightly bump or the size of your nose simply does not fit the rest of your face — you could be a candidate for Rhinoplasty.

Rhinoplasty (nose job or nose reshaping) is a procedure to reshape the nose and improve its appearance. Rhinoplasty is also performed to correct breathing problems. Generally, this is a surgical procedure that involves making incisions inside, and sometimes outside, of the nose to fix various problems.

However, with the increase in popularity of FDA approved injectable tissue fillers to temporarily correct facial wrinkles, plastic surgeons in Denver, Colorado have started injecting these same fillers in the nose to alter the shape. This is referred to as “Non-Surgical Rhinoplasty”. Hyaluronic acid fillers such as Restylane®, Juvederm®, and Perlane® can be used to camouflage aspects of the nose. The longer acting filler Radiesse® is also a popular filler for this purpose. Some people even elect to take excess fat from their bodies and inject it into the nose to correct certain defects.

So, which is better—Surgical or Non-Surgical Rhinoplasty?

The answer depends on what type of results you hope to achieve.

An advantage to Non-Surgical Rhinoplasty is that it can be performed in the office, with minimal recovery time. Injecting filler helps hide a small bump on the bridge of the nose or improve the definition of the tip. The results of Non-Surgical Rhinoplasty are not permanent and will require touch up in 6-12 months. This is typically the time it takes most hyaluronic acid fillers to dissolve. Radiesse may last several months longer and may leave behind some persistent volume. Non-Surgical Rhinoplasty is ideal for candidates who want an instant result from a minimally invasive procedure.This could also be a smart option for those who are afraid to make a permanent change to their nose.

Some other patients who are good candidates for non-surgical rhinoplasty are those who have already had a rhinoplasty and need a small tweak or revision such as adding height to the bridge, defining the tip a little more, or filling in a soft tissue depression that came about after surgery.

Non-Surgical Rhinoplasty cannot alter the length or width of your nose, so if this is your main concern, or you are looking for a permanent result, the surgical option may be right for you. Another disadvantage to Non-Surgical Rhinoplasty is that choosing this option can make a later surgical rhinoplasty more difficult because of scar tissue development as a reaction to the injectable filler.

Surgical Rhinoplasty candidates are those who want significant changes to the appearance of the nose, as surgery can change the entire shape of your nose and correct nasal asymmetry. Also, any breathing problems would need to be corrected using the surgical option. Surgical Rhinoplasty is permanent and, like any surgery, carries with it greater risks, but it is still a very safe surgery in the hands of an experienced surgical team in Denver, Colorado.

Check out this video about Non-surgical Rhinoplasty…

Dr. Manish Shah, a Denver, Colorado board-certified plastic surgeon is well-versed in both types of Rhinoplasty. Dr. Shah pays careful attention to individual facial features and does not use a “one size fits all approach”. During your consultation, he will help you determine which Rhinoplasty option is best for you. Call TODAY at (303) 708-8234 and schedule your free consultation with Dr. Shah, and you’ll be on your way to a beautiful and shapely new nose. Or, visit us on the web at https://drmanishshah.com.