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1. What is Rhinoplasty?
2. When can rhinoplasty be performed?
3. What does a typical
Rhinoplasty consultation entail?
4. How is Rhinoplasty performed?
5. What should I expect post-operatively?
6. When will the cast be taken off and does this hurt?
7. When will I be able to see the results?
8. What are the risks of Rhinoplasty?
9. What are Arnica montana and Bromelain homeopathics, I have heard that it reduces swelling and
bruising? Which is the best kind to take?
10. Are
there any new techniques to repair a deviated septum. Is cauterization
used? Does the nose always have to be packed after surgery?
11. I
am 16 and have been thinking of rhinoplasty for a long time. At what age
is it safe to have a rhinoplasty?
12. I'm
getting a deviated septum and a hump fixed all in one and I wanted to know
what kind of scarring I should expect. Also, how long is it after the
operation that I'll see good results?
13. How
much would a rhinoplasty, without insurance ect...be? Is the average price
range like $5000 to $6000?
14. It's
been five months since my surgery and now since I started to get back in
shape and returned to my gym. I have notice that when I run and workout my
nose drips. It is very runny, here I am walking away and every few min. I
have to use a tissue. Is this just part of the healing stage or need I
bring this up to my doctor? Its really annoying! Has anyone experienced
this at all?
15. My
PS mentioned a shot of cortisone to help some of the scar tissue. Why is
this and what will this do?
16.
I'm going to get my nose done soon and my doctor also recommended me
getting a chin implant because he says my nose will still appear 'big'
since my chin goes a little further in then it should...Do people get both
these procedures at the same time? And do you recommend I should do this?
17. I have to get my cast off soon and wanted to know if it
is going to hurt? Is there anything I can do beforehand?
18. I have thick nasal skin and a surgeon I spoke with said
that I may not be able to see much detail with my rhinoplasty? Is this
true? Should I see another surgeon?
19. Is
it improper to ask to speak with previous patients who have had revision
rhinoplasty done by the surgeon I am considering for the same procedure?
20. What is a "hanging columella"?
21.
Is it possible for someone to be allergic to dissolvable stitches?
And if so, what would the reaction be?
22. I
had a rhinoplasty done around 13 years ago and since then I have
experienced impaired breathing. When I sleep on one side, the upper
nostril seems to collapse a bit and obstruct my breathing. Can this be
corrected? and How?
23.
Do you have advice for African American persons on picking a PS?
24. Can Pollybeak deformity be corrected? How is this done?
25. I used
to be addicted to cocaine. As a result, my past (I'm recovered) addiction left a
hole inside my nose, between my nostrils. Can I have the hole filled?
26. I recently had a rhinoplasty & septoplasty, its almost 6
months & on one of my nostrils I still can hardly breath. Is this normal?
27. How much does rhinoplasty cost?
Return to the Rhinoplasty Section
Rhinoplasty is cosmetic surgery
of the nose. It is also known as nasal refinement and the layman's term
nose job. With rhinoplasty, 'defects' from either birth or trauma
can be corrected by infracturing or breaking the bones of the nose
and re-setting them in the desired shape, often narrow and straight.
A hump may be removed
to give a more pleasing, symmetrical look. The cartilages of the nose can be
molded and trimmed to create a more compact or pleasing shape. Rhinoplasty can
soften an otherwise beautiful face by refining one's features.
Extensive nasal surgery is
generally avoided in children. There are major growth centers in the nose that
affect the growth of the face. In cases of severe disfigurement due to
accidents, surgery is performed in an attempt to restore the alignment of those
centers. For lesser deformities surgery is deferred until after the child stops
growing. Rhinoplasties performed on teenagers and young adults, it seems, are
often beneficial to the social development and self confidence of the
individual. The aging process is reflected in many ways in the nose and its
correction can add youthfulness and freshness to the appearance.
First, your doctor will discuss
your goals with you and he will explain what can be achieved realistically.
A
good doctor will not just slim your nose or shorten it, rather he will take into
account what your facial features and bone structure would benefit from.
Be it a slimmer more defined or perhaps more turned up. Perhaps it
is only a hump that is desired to be removed, making it unnecessary
to even have a Full Rhinoplasty. There is no "one size fits all" when
it comes to this procedure. It is all individual. Just like you!
Usually, Light Sleep Anesthesia
is utilized. A Rhinoplasty can also be performed under General Anesthesia.
The
patient usually arrives early and medications are administered and supplemented
with intravenous medication. After you are asleep and your vital
signs are determined as safe and stable, local anesthesia is then applied to the
nose. Surgery generally lasts about one and a half hours. The patient
experiences no pain during the surgery.
A splint or cast is applied and
will be worn for approximately 7 days. Many patients remember very little about
the surgery. After the procedure is completed, the patient then recovers in a
relaxed environment and monitored for a couple of hours before being driven home
by a companion. You absolutely can not drive yourself home after a ANY
procedure.
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After your surgery your surgeon
will have placed a pressure dressing over your eyes and a gauze pad
underneath your nose to catch blood and mucous. You will remove the pressure
dressing after a few hours or as specified by your surgeon. You may become sick
from ingested blood during the procedure and vomit, expelling a black mixture of
stomach acid and blood. This will pass as soon as the blood is expelled.
It really isn't that much so you shouldn't be sick for long unless you were
under general anesthesia -- you may become sick from this alone. Your
doctor can give you special medications to remedy or prevent this. If you
continue to vomit and/or run a high fever, contact your doctor immediately.
You nose will be sensitive for
approximately a month and a half although patients report no serious pain
or discomfort. However, patients do report the discomfort of breathing with the
packing and cast on the nose. Some patients feel claustrophobic feeling as if
they cannot breathe. This feeling widely resembles a head cold or sinus
infection. Only when the cast is removed do you feel slight discomfort, unless
you bump it accidentally.
The cast is removed approximately
7 days post-operatively. You may feel a slight stiffness in the upper lift as
the swelling moves downward. This will subside in a matter of
hours. you must be very careful not to bump it as it is vulnerable to breakage.
It isn't a bone china figurine but it isn't as strong as your nose was before
the rhinoplasty either. Don't worry, the bones will completely mend within 2
months.
If you had a rhinoplasty where
the nostrils were narrowed (in the case of flared nostrils) you will have your
sutures removed. This may sting a bit, especially since it is in a sensitive
area. Although most patients still feel numb in the tip area and report only
minor discomfort.
The nose will be very sensitive
for approximately a month and a half. The patient will start to see a difference
immediately but it will still be swollen. The swelling starts to generally
disappear about a week after the cast is removed. Approximately 80% of the
swelling and 100% of the discoloration are usually gone by 2 weeks after
surgery. 90% of the swelling is gone by two months after surgery and the rest
slowly disappears over the next year. Although the nose is still swollen after
the first month, most people would not recognize this fact. The patient will not
notice this swelling. Instead the patient will notice that the nose becomes more
refined with better definition over the first year. The inside of the nose may
be swollen for approximately three weeks after the surgery. Nasal breathing may
be difficult during this time. If surgery is performed to straighten the nasal
septum, an improvement in breathing will be appreciated at about 3 weeks.
It is possible to develop tiny
red marks and spots, this can be the result of blood vessels that
may have burst under the skin's surface during the surgery. Although this is
extremely infrequent it can happen and the spots may not ever go
away. Scarring is minimal if the incisions are made inside of the nose, however
when an "open" technique is used, or if narrowing of the nostrils is
desired the scars made on the outside of the nose may be visible for am
undetermined amount of time (usually until maturation). Even when a highly
skilled surgeon performs your surgery, sometimes your body may not heal correctly or have adverse reactions causing undesired results.
If so
it is quite possible that additional surgeries may be needed. Some patients will
lose their sense of smell, temporarily. Your nose may be slightly swollen and
for over a year. Scar tissue may heal in a way that may cause a whistling sound to be heard when you breathe in and out.
This surgery has the highest rate
of revisions. It seems that some people, especially mature people, may not
readily accept the new look. Being accustomed to their old nose, they just can't seem to comfortably make the transition.
Although there are a few rhinoplasties that just don't heal correctly, due to
something as serious as human error (the surgeon's) or as simple as not having
your head elevated enough or sleeping on one side a lot without a proper cast.
The nose can pull to one side if the cast does not support it
properly in the first week. Or quite simply, your body may just heal that way.
also known as: Mountain
Tobacco, Leopard's Bane.
parts used: Roots, flowers.
description: Arnica montana or Leopard's Bane is a perennial herb,
growing close to the ground. The leaves form a flat rosette, from the center of
which rises a flower stalk, 1 to 2 feet high, bearing orange-yellow flowers. The
rhizome is dark brown, cylindrical, usually curved, and bears brittle wiry
rootlets on the under surface.
habitat: Indigenous to Central Europe, in woods and mountain pastures,
although it has been found in England and Southern Scotland.
Arnica Montana is
an herb which grows wild in the Swiss Alps and has been used as a part of
European herbal medicine for over a thousand years for the reduction of bruising
and swelling and to shorten the recovery period after physical trauma.
Bromelain
from the plant of the: Pineapple
also known as: Ananas, Nanas, Pina
plant family: Bromeliaceae
type: herbaceous
perennial
parts used: mostly in the stems of pineapples, but some fruit is used as
well.
description: 2 1/2 to 5 ft. high with a spread of 3 to 4 ft. The plant is
like a thick stem with a rosette of wide, waxy leaves. These pointed
green, red, and white/off white striped leaves are approximately 18 - 70 inches
long and graced with a spiny needle-like tip. The
plant produces a sweet to tangy and sometimes sour fruit that is yellow to white
in color. The unpeeled fruit is brownish with a hard, spiky covering and a large
green sprout from it crown. The fruit is shaped like a coffee can with rounded
ends and is about 10-12 inches long usually when considered prime and may even
weigh up to 10 lbs.
habitat: Indigenous
to southern Brazil and Paraguay, The fruit is now
grown all over in green houses and in the fields of Spain, Guatemala, Hawaii and
more. The pineapple is a tropical plant and thrives in hot, humid places.
Although it can survive cold snaps, it is not recommended for the more northern
areas if intended to be grown outdoors.
Bromelain is an anti-inflammatory formula
containing the proteolytic enzyme from the stems of pineapples.
Proteolytic enzymes are capable of dissolving proteins. It is most often used
after sports injuries, to relive edema and after surgical procedures to help
with swelling.
ALWAYS ASK YOUR SURGEON FIRST
BEFORE TAKING ANY MEDICATION.
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10.
Are there any new techniques to repair a deviated septum. Is cauterization used?
Does the nose always have to be packed after surgery?
There are many ways to fix a septum.
Generally cautery is used only on the turbinates or the initial incision on the
columella in open techniques. The septum is like a wall frame in a house.
The skin (mucosa) over it is like wall paper, and the cartilage on the inside is
like drywall. You place an incision in the front part of the nose where it
is hidden and raise the wallpaper off the wall. Then you can perform the
necessary correction to the drywall (cartilage) and when you put the
"wall paper" (mucosa/skin) back it looks like nothing was done.
Usually packing will be required
however, some patients are eligible for tubes or straws placed in the
center of the packing on each side so that direct airflow through the nose is
possible. Most patients find this a psychological discomfort rather than a
physical.
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11.
I am 16 and have been thinking of rhinoplasty for a long time. At what age is it
safe to have a rhinoplasty?
Usually rhinoplasty
is performed at the earliest, 13 or 14 years of age in girls and 15 to 16 years
of age in boys. Reason being, and it is a known fact, girls physically mature
faster than boys and the collective goal is to perform surgery when at least 90%
of the growth is complete. There are major growth centers in the nose that
affect the growth of the face.
In cases of severe
disfigurement due to accidents, surgery is performed in an attempt to restore
the alignment of those centers. For lesser deformities surgery is deferred until
after the teen stops growing. Rhinoplasties performed on teenagers and young
adults, it seems, are often beneficial to the social development and self
confidence of the individual.
In other words, this
depends upon the stage of growth in the face as well as the gender of the
patient. A qualified surgeon can better help you upon personal
examination.
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12.
I'm getting a deviated septum and a hump fixed all in
one and I wanted to know what kind of scarring I should expect. Also, how long
is it after the operation that I'll see good results?
Usually, there is no
visible scarring unless it is an open rhinoplasty. Some surgeons
perform all of their rhinoplasties, open -- some, all closed. It
solely depends upon the surgeon. You will find that most surgeons tend to
disagree when it comes to technique. They either prefer open or they prefer
closed, OR if they are highly skilled, know that it is case-dependent and
different patients have different needs. If it is an open rhinoplasty the scar
would be on the columella (the skin that separates the nostrils) sometimes
resembling a straight line or a flattened z.
You can expect
swelling, especially in the tip if you are having tip work
performed. The swelling usually begins to subside within the first month but the
end result may not be seen until at least 9 months [post-operatively. Although
this time period tends to lean towards a year and over.
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13.
How much would a rhinoplasty, without insurance ect...be?
Is the average price range like $5000 to $6000?
It really depends
upon your region and the amount of work performed. If you just need a Tiplasty,
with no bone work then it can average about $3,800.US. and up. The averages are
as follows:
The average prices
for rhinoplasty and it's related surgeries: Primary open rhinoplasty $3,152. -
$6,500.; Primary closed rhinoplasty $2,879. - $5,800.; Primary
Septoplasty/Turbinectomy $3,500. - $6,500.; Secondary open rhinoplasty $7,000.
- $9,000.; Secondary closed rhinoplasty $2,643. - $10,000.; with implant:
$2,500. - $10,200. Although, fees vary from state to state, region to region.
Some more - some less.
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14.
It's been five months since my surgery and now since I
started to get back in shape and returned to my gym. I have notice that when I
run and workout my nose drips. It is very runny, here I am walking away and
every few min. I have to use a tissue. Is this just part of the healing stage or
need I bring this up to my doctor? Its really annoying! Has anyone experienced
this at all?
Many patients
complain of runny noses after rhinoplasty/septoplasty surgery. Some
over 2 years. Most of the excess mucous production ceases at 9 months but can
continue well after that. For now I can only advise to carry more Kleenex
around as it may persist for several more months.
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15.
My PS mentioned a shot of cortisone to help some of the scar tissue. Why is this
and what will this do?
A
Injections of Cortisone or Kenalog can help break up excess tissue. It is a
common remedy to inject steroids such as these and also is used primarily to
reduce swelling and inflamed tissue. Although care must be taken regarding
excess use of these injections as it can break down the tissue too much.
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16.
I'm going to get my nose done soon and my doctor also recommended me getting a
chin implant because he says my nose will still appear 'big' since my chin goes
a little further in then it should...Do people get both these procedures at the
same time? And do you recommend I should do this?
This is very common. A weak chin can
and does make even an ideal sized nose look larger than it actually
is. The chin augmentation is a relatively minor procedure when implants are used
although it entails some risks all on its own. Such as lower lip numbness which
can be remedied (usually) by removing the implant and trimming the implant so
that it is not pressing up against the nerve as much.
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17.
I have to get my cast off soon and wanted to know if it is going to hurt? Is
there anything I can do beforehand?
Most patients report a little
tenderness when the cast is removed but if your surgeon uses a cotton swab
saturated with alcohol to help remove the adhesive from the tape and glue you
should be okay. Although it really shouldn't cause you great discomfort.
The sutures that may be removed may
hurt when someone else removes it due to them not actually being able to tell
when they are hurting you. They also may snip your flesh slightly when the
scissors are used to cut the actual suture. This isn't as rare as it as it
should be and solely depends upon the surgeon's meticulous nature.
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18.
I have thick nasal skin and a surgeon I spoke with said that
I may not be able to see much detail with my rhinoplasty? Is this true? Should I
see another surgeon?
For many patients with thick skin,
the skin is thinned out in the surgery as the tip is worked on. This
really adds a lot to help with definition . Excess skin length just shrinks away
as the swelling decreases. Also, many patients with thick skin actually do
better with rhinoplasties because the flaps that are elevated are so firm that
you can do a lot more with the cartilages and it is better hidden. Very
thin skin, shows every little imperfection.
Going on several consults and
getting a second, third and even more opinions is a good idea in any case.
Searching for surgeons is a serious matter and you should be as
comfortable as you can be with a surgeon, his skill, and his bedside manner.
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19.
Is it improper to ask to speak with previous patients who have had revision
rhinoplasty done by the surgeon I am considering for the same procedure?
Not at all! And you absolutely
should. All surgeons should have a referral list of prior patients
to discuss particulars and trade stories. I personally spoke with patients
beforehand and as a matter of fact am on my own doctor's referral list.
If you are wondering if all of the
patients are going to be happy or receive compensation... I have found in my
experience that there are about 1 to 2 patients who wish they had done more
research beforehand or had gone to another doctor entirely so be advised that
although this is unfortunate I think it is helpful to the patient considering
the procedure to gain a well-rounded opinion.
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20.
What is a "hanging columella"?
A nasal columella is the external,
and sometimes partial internal, fleshy section of the nose which
separates the nostrils. When it is referred to being a hanging
columella this section is often prominent or hangs down.
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21.
Is it possible for someone to be allergic to dissolvable stitches? And if
so, what would the reaction be?
This isn't as
uncommon as you may think. There are usually two types that promote a response
in those who are sensitive to these sutures. These two are usually Absorbable
Poly(glycolide/L-lactide) Surgical Suture material and Absorbable Gut Suture
material.
If you experience redness and
itchiness and sometimes pus formation -- you very well may be allergic to the
dissolvable type sutures. Sometimes the symptoms may not show up until about 3
to 4
weeks after surgery, if this happens, antibiotics can be given but it usually
reoccurs. The best thing to do in some cases is to remove any of the left over
material and replace it with nylon sutures. These sutures are usually removed in
10 days. Another option can be tissue glue although this isn't very
mainstream for rhinoplasty.
Also be advised that when the skin
gets red and itchy around a suture, be it absorbable or non-dissolving -- usually
it is time for them to be removed. Your body knows and will tell you when your
healing. Besides healing skin always turns itchy. Know the difference between
typical irritation and an allergic reaction.
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22.
I had a rhinoplasty done around 13 years ago and since then I have experienced
impaired breathing. When I sleep on one side, the upper nostril seems to
collapse a bit and obstruct my breathing. Can this be corrected? and How?
coming soon!
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23.
Do you have advice for African American persons on picking a PS?
coming soon!
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24.
Can Pollybeak deformity be corrected? How is this done?
coming soon!
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25.
I used to be addicted to cocaine. As a result, my past (I'm recovered) addiction
left a hole inside my nose, between my nostrils. Can I have the hole filled?
Most of the holes that come from
cocaine are large and not treatable. A silicone button can in some cases
be placed to close the hole.
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26.
I recently had a rhinoplasty & septoplasty, its almost 6 months & on one
of my nostrils I still can hardly breath. Is this normal?
Usually by the 6th month the
breathing is most definitely restored. In fact, most patients notice improved
breathing within a month to two months of surgery if they had difficulty
breathing beforehand. I would suggest that you have a follow up with your
surgeon and ask his advice or determine if the lack of airway is indeed from a
deviated septum, redundant mucosa or enlarged or redundant turbinates. I do not
know from your question if this is a constant occurrence or if this is at
certain times of the day, while the body is horizontal or after exercise. These
factors can also hinder breathing due to engorged tissue due to increased blood
flow.
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27.
How much does rhinoplasty cost?
Between $3,500 and $20,000US
depending upon the level of correction needed, whether it is a primary or revision
surgery, if there are grafts needed, be they autologous (from your own body) or
synthetic, how many surgeries are needed for complete correction, functional
needs (septoplasty, turbinectomy, sinus problems, polyp removal, etc.),
anesthesia choice, region and surgeon.
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rhinoplasty-specific website for more information...
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