1) Can you make my nose look like the one in this photo?
Photos help the doctor to better understand what it is you like and don’t like – both about the nose you have now and the way you would like your nose to look after rhinoplasty. For that reason, photos can be useful as a place to begin a discussion. However, a cosmetic surgeon can not put someone else’s nose on your face. Surgeons can only make certain changes to the nose you already have. A good plastic surgeon with board certification will a) consider what you are trying to accomplish, b) qualify what is possible and c) qualify what is not possible, and d) add his recommendations based on his knowledge and experience. The discussion should lead to an agreement of what you both see as a realistic expectation from surgery. At this point, if the recommendations and expectations your surgeon discusses seem reasonable to you, ask to see some Before and After Photos to evaluate his work. By all means if you feel your surgeon doesn’t understand or isn’t listening to you, this is a good time to interview another surgeon. Selecting the board certified plastic surgeon that is right for you is a process. Once again, listening is the key to a successful rhinoplasty and a satisfied patient.
2) My nose sticks out too far. Can you fix that?
What you are describing is the projection of the nose. Take a moment to look at our before and after photos that demonstrates the improvements accomplished by changing the nasal projection. Another term you will here is projection of the nasal tip. The nose tip droops as we age. Many patients who request rejuvenation procedures are surprised to learn that by rotating the nasal tip slightly upwards, the nose regains a younger appearance.
3) How do you remove the bump in my nose?
First, when patients ask about a bump or hump in their nose, they are most often referring to the nasal bridge – the part of the nose that creates the profile seen from a side view of the nose. Surgeons refer to the bridge of the nose as the dorsum and a hump is referred to as a dorsal hump. To reduce the size of this, a rasp (like a nail file or emery board) can be used to shave off and smooth down excess bone. Nasal skin is very accepting of this change and will drape or adhere well to the new shape.
4) When my nose is made smaller, what happens to the extra skin?
Nasal skin has elasticity so it adheres to the new shape of the nose.
5) My nose is too close to my face. Can you fix that?
Surgeons sometimes use a term “saddle nose” deformity – where the middle of the nose is too close to the face. A low bridge can be traumatic (from an accidental blow to the nose), the result of a disease process or congenital (from birth as seen in Asian noses).
One of the best ways to explain the process of repairing a low bridge is to begin with a look at Before and After Photos. Building up the dorsum of the nose can be accomplished in many ways. Each approach has advantages and disadvantages.
One repair option is to borrow cartilage from the patient’s nasal septum, ear or rib. One obvious advantage of cartilage is that it does not introduce something foreign into the patient’s body. A disadvantage for ear or rib cartilage is the need for a separate incision. Depending on the amount of cartilage needed, there may not be enough nasal cartilage to accomplish the task.
When trying to build up a bridge that was lowered too close to the face, there is often not enough available cartilage left in the nose from the previous surgery. Cartilage can be difficult to carve into the right size and shape and can have rough edges that can show through the skin of the nose.
There are many artificial materials that are safe to use in the nose. Gortex®, a material that has been used successfully for years in heart surgery to replace valves, is soft, pliable and smooth under the nasal skin.
Again, ask review Before and After Photos and talk to patients who have undergone surgery for this same concern. By all means voice your concerns but allow the final decision on how best to augment the nasal bridge to be up to the surgeon.
6) My nose is too long/I have a droopy nose. Can it be shorter?
The profile line from between the eyes to the tip of the nose gives us the length of the nose. In our before-and-after photographs, we demonstrate how shortening a nose that is too long brings it into proportion with the rest of the nasal features. As we age, the nasal tip loses support and drops. Using a cartilage graft to support the nasal tip, we create a more youthful appearance.
7) My nose is too wide. How do you fix that?
Many factors contribute to the width of the nose including the distance between the nasal bones, cartilage in the tip of the nose that is too wide and the thickness of the nasal skin, particularly at the tip of the nose. If the nose is too narrow or the nasal tip is turned up too much, the result doesn’t look natural. Our before and after photos demonstrate how narrowing the nose makes it naturally more elegant.
8) Why is a chin implant sometimes recommended with rhinoplasty?
It’s all about balance. Facial features in good proportion are perceived as beautiful. Chin augmentation readjusts overall facial proportions. In some cases, it is possible to reduce the appearance of the size of the nose just by adding the chin implant for balance. If neck liposuction is requested this can be performed through the same small incision used for the chin implant.
9) Will I still look like “me” after surgery?
Many of our patients report that, upon return to work and routine daily activities, friends and acquaintances make the following remarks: “Gee you look great. Did you change your hairstyle?” or “Have you been on vacation?” Retaining your uniqueness is the sign of a successful procedure. Although the change may be significant to you, it’s not uncommon that friends and family don’t really notice the specific changes. Before and After Photos
10) Yes, but I want to dramatically change the appearance of my nose. Can I do that?
This is an excellent question because it leads to evaluating realistic expectations. This question can only be answered on an individual basis. A sign of a good facial plastic surgeon is one who can tell the difference between realistic and unrealistic expectations and one who will be truthful about meeting each patient’s desires. Our biggest referral source is from satisfied patients – ones who have had realistic expectations and were satisfied with results.
11) Will I have any incisions in my skin?
Most likely. See the illustration for placement of incisions in the column that supports the tip of your nose. This is called Open Rhinoplasty. These incisions heal very well and most patients and family members will not notice them after a few weeks.
When a patient wants the base of the nose narrowed, tiny incisions called Weir incisions are made in the outer rim (ala) very close to the junction of the nose to the face. Surprisingly, these incisions heal very well and are often imperceptible to others.
12) What’s the difference between open rhinoplasty and closed rhinoplasty?
In an “open” rhinoplasty, a small V-shaped skin incision is made in the post that divides the two nostrils so the skin can be lifted up off the tip of the nose. This allows the surgeon to work on the nasal tip cartilage in their natural position and see what needs to be done. It also allows better access to evaluate and correct asymmetry, projection (how far the nose sticks out from the face), overall length, a hump and how straight the nose is.
In closed rhinoplasty there is no external skin incision. Some surgeons prefer closed rhinoplasty and can achieve excellent results. We prefer open rhinoplasty most of the time because an incision that heals extremely well is an acceptable trade off for the benefits of increased access and visualization.
In both open and closed rhinoplasty, incisions are made inside the nose to access the bone and cartilage framework. In our Before and After Photos notice the views showing the base of the nose. These show how well the external skin incision heals.
13) What if I have a history of bad scars?
If you have pierced ears, the way you healed there is a good indication of how you will heal from facial plastic surgery. Scars on the rest of the body typically are not an indication for how patients heal following facial plastic surgery. At the time of your consultation, it’s important to show your physician any previous scars that are of concern so he can give you a realistic assessment of your healing potential following facial plastic surgery.
14) Is it painful?
After any surgical procedure, some discomfort can be expected. All patients are provided with prescriptions for pain medication. Patients sometimes use the prescription medication two to three days after surgery and then switch to acetaminophen. It is uncommon for patients to report unmanageable pain after surgery. Numbness behind the two front teeth is common and temporary.
15) When can I go back to work?
Most patients take one week off work but others prefer two weeks. The cast on the nose comes off one week postoperatively. At that time, any residual bruising and swelling can be camouflaged with make-up. Patients who are more concerned with privacy prefer two weeks off work.
16) How long does the surgery take?
The length of surgery depends on several factors including the complexity of each person’s nose. Many patients who have previously had a rhinoplasty are referred to the Lindsay House for revision surgery. Revision rhinoplasty is more difficult than primary rhinoplasty and can take a little longer because of corrections that need to be made as a result of the initial surgery.
17) When can I “work out?”
Aerobic activities should be avoided for two weeks following surgery and heavy weight lifting or more strenuous workouts should be avoided for three weeks postoperatively. It’s important to avoid bending, lifting or straining during the postoperative period as these activities can increase swelling and delay healing.
18) Can I drive myself home after surgery?
NO. Because of the effects of anesthesia, patients are not able to drive themselves home after the surgery. If you are from out of town and transportation is an issue, you may want to consider the accommodations at Carriage House located next door to the Surgery Center.
19) I’m from out of town. Where can I stay overnight in Rochester?
Accommodations are comfortable and convenient for Lindsay House clients. The Strathallen, located “just down the street” provides upscale, affordable accommodations for Lindsay House visitors. For added convenience following ambulatory surgery, some patients elect to stay in our Carriage House, located adjacent to the Lindsay House. For guests without the benefit of family or friends in the Rochester area, our staff will be happy to assist you with arrangements for a smooth, restful experience following your procedures.
20) How long should I stay in Rochester following surgery?
Most patients stay in Rochester about seven to ten days following surgery. After that it’s ok to fly or travel long distances.
21) How old do I have to be to have a rhinoplasty?
Rhinoplasty should be performed only after nasal development is complete – for most patients this means after puberty. In general, surgeons do not like to perform cosmetic rhinoplasty until a patient is about 16. Along with being more physically developed, a patient under 16 may change their concept of beauty as they mature. A patient needs to be mature enough to participate fully in the decision-making process as well as comprehend fully the procedure itself.
22) I don’t like my rhinoplasty result. When can I have revision rhinoplasty?
It is vital that patients wait one full year before undergoing revision rhinoplasty. First of all, final results of rhinoplasty are not evaluated until one full year postoperatively. It takes a year for postoperative swelling to subside and healing to be complete. Changes, however subtle, continue throughout the 12-month course following rhinoplasty. As time goes by, the nose gradually looks different. Features refine as the swelling resolves. These refinements sometimes are enough for a result to be deemed acceptable.
A second consideration is scar formation. Revision rhinoplasty is challenging enough without battling through scar tissue that has not matured. Scar tissue is somewhat more compliant in the hands of the surgeon when it has been allowed to soften over time. Even after a year the presence of scar tissue makes revision surgery more complex.
Circumstances advocating revision rhinoplasty at less than one year after the primary (first) rhinoplasty are almost nonexistent. If a surgeon recommends revision rhinoplasty at less than one year, at the very least obtain a second opinion. Give your nose every possible opportunity to “settle” and refine before undergoing another surgery.
23) Why is a revision (secondary) rhinoplasty so much more difficult than a first-time (primary) rhinoplasty?
Many reasons. First, after any surgery, scar formation creates a thick, tough layer that is more difficult to work with than original tissue. Second, the original location of (anatomical) landmarks have been altered. Third, cartilage needed to reshape the nose, which was available for use during a primary rhinoplasty, is no longer available to the surgeon performing revision rhinoplasty. Cartilage grafts borrowed from the ear or other parts of the body (as previously discussed) require a second incision. If artificial material is used in revision rhinoplasty, experience selecting and working with artificial material requires advanced skill level. Fourth, the overall skill level required to perform a successful revision rhinoplasty is greater. Revision rhinoplasty has humbled even the most experienced facial plastic surgeon. Before and After Photos
24) What’s the septum?
The septum is the internal divider of the nose made up of two components: 1) septal cartilage – the mobile, lower part of nose closer to lips, and 2) bony septum – the immobile upper portion of nose closer to eyes.
25) What is a septal perforation?
The nose is divided by the septum, a wall made of cartilage and bone that separates the right side of the nose from the left. A perforation is a hole or opening. Septal perforation is a hole in the septum. Trauma (whether from an accident or repeated nose picking) and nasal surgery are the most common causes of septal perforations but other causes include cocaine drug abuse.
Location and size of a septal perforation makes a big difference. If a septal perforation is small and posterior (close to the face), oftentimes it causes no problems and a patient may even be unaware they have a septal perforation. If a septal perforation is anterior (towards the tip of the nose), air passing through the opening can make a distracting whistling sound. Because airflow is disturbed by the communication between the two sides of the nose, patients complain of nasal airway obstruction. Septal perforations can result in chronic crusting which compounds airway obstruction and creates a maintenance problem. Patients with septal perforations must keep edges of the nose lubricated so they don’t dry out and bleed.
From a cosmetic standpoint, a septal perforation can spell trouble. If a septal perforation is large enough, bridge (profile line) support is lost, creating a weakened area in the nose that can collapse. This can result in a “dent” in the profile.
Septal perforation repair is challenging – even for an experienced surgeon. If a septal perforation creates any of the problems discussed above, the perforation should assessed for repair prior to rhinoplasty.
26) What is possible from a revision rhinoplasty?
Nowhere in cosmetic surgery is communication more important than in revision rhinoplasty. It is essential to understand precisely what can and cannot be accomplished from revision surgery. Few plastic surgeons are expert at rhinoplasty. Only plastic surgeons with advanced rhinoplasty skill and experience are qualified for revision rhinoplasty procedures. Before and After Photos
When a surgeon evaluates a patient for revision rhinoplasty, many factors are taken into account – not the least of which: whether the result the patient seeks is possible with revision rhinoplasty. To answer that question the surgeon will take the following into consideration:
Projection (how far the nose sticks out from the face)
Opportunity for correction exists if no significant alteration was made to nasal tip cartilage during primary rhinoplasty
Length (the length of the profile line from between the eyes to the tip of the nose)
Opportunity for correction exists if no significant alteration was made to nasal tip cartilage during primary rhinoplasty
Persistent dorsal hump
Evaluate opportunity to shave down dorsal hump
Bridge too low to face (over-correction of dorsal hump)
Evaluate opportunity for correction with cartilage or artificial graft
Nose too wide
Evaluate opportunity for correction by narrowing nasal bones, narrowing nasal tip
cartilage, removing excessive scar tissue and evaluate nasal tip skin thickness
Is the improvement worth the risk? For example, will a significant improvement from the primary rhinoplasty be lost in the revision? Is it worth the trade off?
For example, the primary rhinoplasty result is acceptable and the patient is following this year’s latest “fad”?
Is the patient motivated to deal with the prolonged swelling that often accompanies revision rhinoplasty?
It is critical that the surgeon present a realistic picture of the benefits and limitations of revision rhinoplasty. For patients with realistic expectations, even the most subtle improvements can make all the difference in the world.
27) Will I be awake during surgery?
Using IV sedation (medicine administered through an IV) and local anesthesia (numbing medication administered in the surgical area), patients are asleep during surgery. Patients do not hear or feel anything and are comfortable during surgery. Patients wake up very soon after the surgery is completed. Intravenous sedation is a type of anesthetic; therefore all patients must have a responsible adult to stay with them through the night following surgery.
28) Can I have a face lift or brow lift at the same time as rhinoplasty?
Rejuvenation surgery such as a browlift to address frown lines between the eyes, facelift to address a “turkey wattle” neck, blepharoplasty to remove “bags” of excess fat and skin around the eyes, and skin resurfacing such as a chemical peel to improve fine wrinkles can all be performed at the time of rhinoplasty.
29) I really want to do this but I’m nervous. What if I get stressed?
It’s ok to be nervous. (Frankly, we would be nervous if you were taking this step lightly!) One of the best ways to deal with nervousness is to see what other patients have gone through. Before and After Photos present results and experiences of patients who have been in the same position you are right now. Your Consultation gives you an idea of questions that other patients have asked as part of their decision-making process.