Nasal Surgery
What Is Rhinoplasty?
Simply put, a rhinoplasty is shaping or reshaping the nose. Most patients present with a myriad of problems. Some initially come in with difficulty breathing. Some note that they are always short of breath. Some have complete obstruction or sleep apnea, where they wake gasping at night. Some other patients simply have had the misfortune of having their noses broken. In all these patients the complex anatomy of the nose is unfavorable. Because of this, the patient is not able to breathe properly and comes in to ask for help. A rhinoplasty then involves first defining the problem of the patient and what exactly is giving them their difficulty. The next step is to correct this problem. Along the way, as we correct the functional problem, the effort will also be to give the patient the best cosmetic looking nose possible. Rhinoplasty is one of the more complicated procedures possible. The nose is broken down into many segments: the tip, the lateral segments, the dorsum or the bridge and then internal structures like the septum and its cartilage. Each and every one of these needs to be considered in assessing the problem of the patient and each and every one needs to be tailored to the reparative operation. Only in this way will the patient be given the best result.
Is This Surgery Covered by Insurance?
Yes and no. Because a rhinoplasty has so many components, it is very possible that certain parts of the procedure are covered by insurance. If the patient initially presented with a functional problem such as obstruction, many insurances consider that as a medical necessity and will effectively pay for some of the charges. However, there are many parts of the procedure that the insurance company may consider to be cosmetic and not functionally important. Those will not be covered.
What Are the Possible Complications of a Rhinoplasty?
Like any surgery, there are risks and complications. With a rhinoplasty, the complications can be bleeding, infection, numbness, asymmetry, necrosis of the tissues, dehiscence or breakdown, septal perforation and breathing abnormalities. Of these the most often we see bleeding. Because the nose and the bones supporting it are highly vascular, any procedure affecting the contour and shape of the nose is inherently bloody. We do our best to inject medications during surgery to control this bleeding. Also following surgery, patients noses are packed allowing for us to control the bleeding. More importantly, however, bleeding can best be prevented by the patient. Patients need to be off of any type of blood thinners such as coumadin, aspirin, Plavix, and must also be off of vitamins and additives for at least three weeks. It may sound strange but many of the bleeding complications seen are due to the use of vitamins. Another complication that is seen is a septal perforation.
This is usually seen during surgery as the dissection is carried throughout the nose. When the different tissue layers of the nose are freed, in some cases small tears are seen. When a tear is appreciated and repaired, it usually heals. In some cases, the tissue is so fragile that following surgery, a small tear can occur around the septum and is not appreciated until much later. This causes the patient to have a dry nose. Most often this problem corrects itself over time. Last but not least patients sometimes end up with some obstructive symptoms after surgery with the swelling. This usually resolves. It is actually very understandable. When the patient has so much swelling due to surgery and in the post-operative period, it is common for them to feel obstructed and complain of breathing problems. Many of these problems again resolve with time as the swelling improves.
How Painful Is the Procedure?
Like any surgical procedure, there is pain involved. Most patients comment that they have a mild to moderate amount of pain. Most of the pain seen with rhinoplasty is related to swelling. Most patients complain that they have a tremendous amount of swelling and therefore their faces feel full. This is the cause for most of the angst and not the actual pain level. Most patients do not really complain of pain. Actually, most speak about the fact that they are just soaring.
To treat the pain, we routinely keep patients on post-operative oral pain medicines. We have many to choose from. Again, like the level of pain that can be related to one’s tolerance, the treatment for the pain can be individualized to give the patient the most amount of relief.
Also, most of the facial fullness of which the patients complain is relieved by the end of week one when most of the packing, internal and external splints are removed.
How Long Do I Have to Take Off From Work?
Great question. Most often I suggest to patients that they consider taking about 1 to 2 weeks from work. Let me elaborate. Once the operation is completed, the area involved becomes swollen and in many cases becomes extremely bruised. Most patients also have peri-orbital swelling, swelling around the eyes. This area then slowly goes through healing. I ask most of my patients to start walking by day#2. I ask them to stay away from exercise at the gym for about 4 weeks. I believe this prevents the development of excessive swelling. As for work though, most patients are fairly comfortable in returning by week 3. However, this does depend on what type of work the patient does.
Can I Combine This Procedure With Any Other Procedure?
Yes. Like any surgical procedure, there are limits to what can be done and what is safe. As for the yes, it can be combined with some other procedures. Multiple other procedures like a facial peel or laser therapy and ablative facial neck procedures are routinely performed. Any procedure that may be too long or too arduous and place the patient at risk for significant bleeding or significant anesthetic exposure would have to be deferred and done in two stages. Please understand I say this without knowing exactly what you, the patient, may have in mind. I can only speak from my experience.
Am I a Good Candidate?
Plastic surgery is not for everyone. It involves certain risks like any operative procedure. As long as you are aware of this fact, you can be considered for the procedure. However, in every case, the patient is best served by a thorough evaluation of their history, their body, and their overall expectations. You as the patient have to be realistic and cognizant of what is possible and what is reasonable. Trust me, I am from Beverly Hills and I have had the privilege of working with many of the famous groups of plastic surgeons in LA. I can simply tell you there is no magic. We offer an opportunity to help you with surgical procedures in correcting what you may think is abnormal about your body. Also please understand that for many patients no surgery is needed; just a friendly word of encouragement and confidence from the local plastic surgeon.