Nose Correction (Rhinoplasty)
Rhinoplasty, or surgery to reshape the nose, is one of the most common of all plastic surgery procedures. Rhinoplasty can reduce or increase the size of your nose, change the shape of the tip or the bridge, narrow the span of the nostrils, or change the angle between your nose and your upper lip. It may also correct a birth defect or injury, or help relieve some breathing problems.
If you’re considering rhinoplasty, this information will give you a basic understanding of the procedure- when it can help, how it is performed, and what results you can expect. It can’t answer all of your questions, since a lot depends on the individual patient and the surgeon. Please ask your surgeon about anything you don’t understand.
The Best Candidates
Rhinoplasty can enhance your appearance and your self-confidence, but it won’t necessarily change your looks to match your ideal, or cause other people to treat you differently. Before you decide to undergo a surgery, think carefully about your expectations and discuss them with your surgeon.
The best candidates for rhinoplasty are people who are looking for improvement, not perfection, in the way they look. If you’re physically healthy, psychologically stable, and realistic in your expectations, you may be a good candidate. Rhinoplasty can be performed to meet aesthetic goals or for reconstructive purposes such as to correct birth defects or breathing problems.
Age may also be a consideration. Many surgeons prefer not to operate on teenagers until after they’ve completed their growth spurt – around 14 or 15 for girls and a bit later for boys. It’s important to consider teenagers’ social and emotional adjustment too, and to make sure it’s what they, and not their parents, really want.
All Surgeries Carry Some Uncertainty and Risk
When rhinoplasty is performed by a qualified plastic surgeon, complications are infrequent and usually minor. Nevertheless, there is always a possibility of complications, including infection, nosebleed, or a reaction to the anaesthesia. You can reduce your risks by closely following your surgeon’s instructions both before and after surgery.
After surgery, a small burst of blood vessels may appear as tiny red spots on the skin’s surface; these are usually minor but may be permanent. As for scarring, when rhinoplasty is performed from inside of the nose, there is no visible scarring at all. When an “open” technique is used or when the procedure calls for the narrowing of flared nostrils, the small scars on the base of the nose are usually not visible.
Planning Your Surgery
Good communication between you and your physician is essential. In your initial consultation, the surgeon will ask what you’d like your nose to look like, evaluate the structure of your nose and face, and discuss the possibilities with you. They will also explain the factors that can influence the procedure and the results. These factors include the structure of your nasal bones and cartilage, the shape of your face, the thickness of your skin, your age, and your expectations.
Your surgeon will also explain the techniques and anaesthesia they will use, the type of facility where the surgery will be performed, the risks and costs involved, and any options you may have. Most insurance policies don’t cover purely cosmetic surgery; however, if the procedure is performed for reconstructive purposes, to correct a breathing problem or a marked deformity, the procedure may be covered. Check with your insurer and obtain pre-authorization for your surgery.
Be sure to tell your surgeon if you’ve had any previous nose surgery or an injury to your nose, even if it was many years ago. You should also inform your surgeon if you have any allergies or breathing difficulties; if you’re taking any medications, vitamins, or recreational drugs; and if you smoke.
Don’t hesitate to ask your doctor any questions you may have, especially those regarding your expectations and concerns about the results.
Preparing for Your Surgery
Your surgeon will give you specific instructions on how to prepare for the surgery, including guidelines on eating and drinking, smoking, taking or avoiding certain vitamins and medications, and washing your face. Carefully following these instructions will help your surgery go more smoothly.
While you’re making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days if needed.
Where Your Surgery Will Be Performed
Rhinoplasty may be performed in a surgeon’s office-based facility, an outpatient surgery center, or a hospital. It’s usually done on an outpatient basis, for cost containment and convenience. Complex procedures may require a short inpatient stay.
Types of Anaesthesia
Rhinoplasty can be performed under local or general anaesthesia, depending on the extent of the procedure and on what you and your surgeon prefer.
With local anaesthesia, you’ll usually be lightly sedated and your nose and the surrounding area will be numbed. You’ll be awake during the surgery, but relaxed and insensitive to pain. With general anaesthesia, you’ll sleep through the operation.
Rhinoplasty usually takes an hour or two, though complicated procedures may take longer. During the surgery, the skin of the nose is separated from its supporting framework of bones and cartilage, which is then sculpted to the desired shape. The nature of the sculpting will depend on your problem and your surgeon’s preferred technique. Finally, the skin is re-draped over the new framework.
Many plastic surgeons perform rhinoplasty from within the nose, making their incision inside the nostrils. Others prefer an “open” procedure, especially in more complicated cases. They make a small incision across the columella, the vertical strip of tissue separating the nostrils.
When the surgery is complete, a splint will be applied to help your nose maintain its new shape. Nasal packs or soft plastic splints also may be placed in your nostrils to stabilize the septum, the dividing wall between the air passages.
After Your Surgery
After the surgery, particularly during the first twenty-four hours, your face will feel puffy, your nose may ache, and you may have a dull headache. You can control any discomfort with the pain medication prescribed by your surgeon. You may have to plan on staying in bed with your head elevated (except for going to the bathroom) for the first day.
You’ll notice that the swelling and bruising around your eyes will increase at first, reaching a peak after two or three days. Applying cold compresses will reduce this swelling and make you feel a bit better. In any case, you’ll feel a lot better than you look. Most of the swelling and bruising should disappear within two weeks or so. (Some subtle swelling, unnoticeable to anyone but you and your surgeon-will remain for several months.)
A little bleeding is common during the first few days following the surgery, and you may continue to feel some stuffiness for several weeks. Your surgeon will probably ask you not to blow your nose for a week or so, while the tissues heal.
If you have nasal packing, it will be removed after a few days and you’ll feel much more comfortable. By the end of one or, occasionally, two weeks, all dressings, splints, and stitches should be removed.
Plastic surgeons use facial implants to improve and enhance facial contours. Frequently, these implants will help provide a more harmonious balance to your face and features so that you feel better about the way you look.
There are many implants available, manufactured from a variety of materials. They may help strengthen a jawline or bring the chin or cheekbones into balance with the rest of the face.
If you feel that one or more of the procedures described here may be of benefit, be sure to ask your plastic surgeon for more information.
What to expect from a facial implant?
Facial implants can enhance your appearance and bolster your self-esteem. If you are looking for improvement, not perfection, in your appearance and are realistic in your expectations, you may find that a facial implant is the right choice for you.
Plastic surgeons frequently use such implants to bring better balance to the features of a younger patient. For instance, a teenage girl may want her nose reshaped or her chin brought forward so that these traits are better proportioned. The more mature patient may choose to have an implant placed in conjunction with another cosmetic procedure. For example, during a facelift, a patient may wish to have implants placed over the cheekbones to help restore a more youthful appearance. Implants may also be selected to fill out a face that appears “sunken” or tired.
All Surgeries Carry Some Uncertainty and Risk
Facial implants can produce some remarkable changes. Problems rarely occur, but you need to be informed about such possibilities. We will touch upon a few, but is not intended to provide a detailed or complete inventory of potential risks.
A facial implant can shift slightly out of alignment and a second operation might be necessary to place it in its proper position. Infection can occur with any operation. If infection were to occur around a facial implant and did not clear up after treatment with antibiotics, the implant might have to be temporarily removed and replaced at a later time. Other, less-frequent risks may be associated with certain implants. Be sure to ask your plastic surgeon for a description of the risks associated with the procedure in which you are interested.
Some of the implant materials are made of a solid silicone. Currently, there is no scientific evidence that this is a harmful substance. Your plastic surgeon will be happy to discuss any current scientific findings concerning the type of implant you’re considering.
Planning Your Surgery
When you discuss your surgery with your plastic surgeon, be certain that you clearly express your expectations. Your plastic surgeon will help you determine what it is possible to achieve. It may be helpful to provide your surgeon with photos of people who have facial features similar to those you would like to have. Be sure you understand the details of the proposed surgery, including the cost and what to expect during your recovery.
If the surgery will entail an incision inside your mouth, it is important that you inform your physician if you smoke or if you have any dental or gum problems. Your plastic surgeon will advise you on these matters.
While preparing for your surgery, be sure to find out if you’ll be able to drive home afterward or will require transportation. You should also ask if you’ll need to refrain from eating or drinking the night before your surgery, and if you should stop taking any medications, including aspirin and similar drugs. You may be instructed to take oral antibiotics both before and after the procedure to help guard against infection.
Your plastic surgeon will provide information about these important matters during your pre-operative consultation.
Where Will Your Surgery be Performed?
Your operation may take place in an office-based facility, a freestanding surgical center or a hospital outpatient facility. Sometimes, your plastic surgeon may require that you stay overnight. Your doctor will make such a recommendation based on your overall medical condition and whether another cosmetic procedure was performed simultaneously with the facial implant surgery.
Types of Anaesthesia
In some cases, facial implant surgery may require only local anaesthesia combined with a sedative. However, more frequently, a general anaesthesia may be recommended.
Insertion of a chin implant may take anywhere from 30 minutes to an hour. During the procedure, the surgeon selects the proper size and shape implant to enhance your appearance and inserts it into a pocket over the front of the jawbone. The small incision to create the pocket and insert the implant is placed inside the mouth (along the lower lip) or in the skin just under the chin area.
Usually, the chin is taped after surgery to minimize swelling and discomfort. Sutures in the skin will be removed in five to seven days. If an intra-oral incision is used, the sutures will dissolve.
Recovering from Chin Surgery
You will experience some discomfort and swelling in the affected area for several days. It’s normal to experience some temporary difficulty with smiling and talking. Black and blue marks may be visible around the chin and neck. Your plastic surgeon will instruct you about dental hygiene, eating and any restrictions to your activities after surgery.
Cheek implant surgery usually takes about 30 to 45 minutes. When cheek implants are being placed in conjunction with another cosmetic procedure, such as a facelift, forehead lift or eyelid surgery, the implants may be inserted through the incisions made for those procedures. Otherwise, an incision will be made either inside your upper lip or your lower eyelid. A pocket is then formed and an implant is inserted.
After surgery, a dressing will be applied to minimize discomfort and swelling. The severity and duration of such side effects may vary, especially if another cosmetic procedure was performed at the same time.
Recovering From Cheek Surgery
Your plastic surgeon will provide you with instructions about post-operative care. There will be dietary restrictions as well as limitations to your activities. Again, these instructions will vary, especially if another procedure was performed along with your implant surgery. However, you should be aware that your ability to move your mouth and lips may be diminished temporarily. Stitches used to close the incisions inside your mouth usually dissolve within about 10 days.
Insertion of a jaw implant usually takes about one to two hours. Internal incisions are made on either side of the lower lip to provide access for creating a pocket into which the lower-jaw implant can be inserted. Dissolving sutures are used to close the incisions.
Recovering from Jaw Surgery
Swelling is sometimes significant immediately following surgery, usually peaking 24 to 48 hours afterward. Although most of the significant swelling will subside over a period of several days, prolonged mild swelling may prevent your final facial contour from becoming apparent for several months.
During the healing phase, your activities and diet will be restricted. Your ability to smile, talk or move your mouth in any way may be limited for several days to weeks following surgery. Your plastic surgeon will instruct you about dental and oral hygiene during your recovery.
Getting back to normal
Remember, with any facial surgery, you may feel and look better in a short period of time. However, it may not be advisable to participate in certain activities — especially activity that may result in the face being jarred or bumped — for several weeks. It’s best to check with your plastic surgeon about such matters.
Your New Look
You may not be able to accurately evaluate your appearance for weeks, or perhaps even months. Give yourself plenty of time to get used to your new look. You may be surprised to find that most people won’t recognize that you’ve had facial implant surgery — only that you look better.
Eyelid Correction or Blepharoplasty
Every year thousands of people opt for eyelid correction. Top and bottom eyelids that have begun to droop have an aging effect on the face. Not only does it make you look older and tired but quite often people interpret this as a sign of an exuberant lifestyle. An eyelid improvement offers the solution.
Below you will find a list of frequent questions about eyelid surgery (Blepharoplasty). If you cannot find the answer you are looking for, please write to us. Be sure to include the procedure name and your question!
- How is this procedure done?
- How do I prepare for my eyelid lift?
- How long does the procedure take?
- What form of anesthesia is used?
- Can I return home the same day?
- How long before I can return to normal activity?
Q. How is this procedure carried out?
Eyelid lift is performed by making an elliptical incision in the upper lid first. Excess skin, muscle and fat bags will be removed and the skin will be stitched (sutured). If necessary, an incision that extends slightly beyond the outside corner of the eye will be made in the lower lid, beneath the eyelashes. Excessive skin and fat will be removed, sagging muscles will be tightened and the incision stitched (sutured). Often the lower lid bags can be removed without any visible incision or scar.
Some women have hereditary or acquired darkening of the lower eyelid skin in addition to bags and wrinkles. The eyelid lift may not improve this darkening, but most people can be helped by a chemical peel of the lower lids some weeks after the procedure. A peel is rarely done at the same time as an eyelid lift. Consult with your surgeon to determine if additional procedures will enhance your eyes.
Q. How do I prepare for my eyelid lift?
During your initial preoperative visit with your surgeon, be prepared to give a complete medical history including all your medications, allergies and previous surgeries. You will undergo a thorough physical examination and blood tests. If you are at or over age 40, an electrocardiogram will be required. Photographs are important aids in planning and performing your eyelid lift. They become a permanent part of your patient record and are taken before and several months after your procedure.
During your consultation, you will be given specific directions to help you prepare for your procedure. Instructions generally include cautions about taking certain medication and drinking alcohol, the shaving process and use of antibacterial soap. You must stop smoking, taking aspirin or taking diet pills at least two weeks prior to the procedure.
You must not eat or drink anything eight hours before your procedure. If you take daily medication, ask your surgeon if it is safe to take before your procedure. If you have any sores on your body, if you have a cold, sore throat or allergic condition, inform your surgeon so you may be examined prior to your procedure.
Q. How long does the procedure take?
If both upper and lower eyelids are done together an eyelid lift takes approximately one hour. Less time is required if the procedure is performed only on the lower or only on the upper eyelids.
Q. What form of anaesthesia is used?
General anaesthesia is used for all surgical procedures and is performed by a professional M.D. (Anaesthesiologist).
Q. Can I return home the same day?
Yes. An eyelid lift is done on an outpatient basis. Be sure to arrange for someone to drop you off, pick you up, take you home and stay with you for at least 24 hours. You will not be able to drive yourself.
All Patients must schedule check-up appointments for the following times:
Q. How long before I can return to normal activity?
Most people return to work and regular functions in less than a week.
Eyelid lift rarely produces a serious complication. Any form of surgery will leave scars. With an eyelid lift, the scars are placed within natural eyelid folds and facial lines so that they are inconspicuous and rarely detectable. Nevertheless, you should be aware that scars are permanent, and their width, height, and colour are not totally predictable.
Patients occasionally ask if blindness can result from this procedure. While this complication has been reported, it is exceedingly rare. Lesser complications include improper closure of the eyes during sleep (lagophthalmus), dryness of the eyes, light sensitivity and sagging (ptosis) of the upper eyelids.
It is important to enter into your procedure aware not only of the benefits, but also of the possible complications. Talk to your surgeon about every question and concern you may have.