Patient Education

RHINOPLASTY, or nose shaping surgery, is a common plastic surgery procedure in Miami and Ft. Lauderdale. Rhinoplasty can not only reduce the size of your nose but it can also give it more definition.  It can be made narrower, shortened, and uplifted.. It may also correct a birth defect or injury, or help relieve some breathing problems.

If you are considering rhinoplasty, this information will give you a basic understanding of the procedure.  A more specific discussion about your individual nose can be done during your consultation.  There are no two noses that are alike and often even on the same person there is significant asymmetry from one side to the other.

THE BEST CANDIDATES FOR RHINOPLASTY

Rhinoplasty can enhance your appearance and your self-confidence.  When properly done it should give your face a softer look.  It should not be a focal point of your face.  Instead it should complement all of the other features.

The best candidates for rhinoplasty are people who are looking for improvement, not perfection, in the way they look. If you are physically healthy, psychologically stable, and realistic in your expectations, you would be a good candidate.

Age may also be a consideration. Dr. Hochstein prefers not to operate on teenagers until after they've completed their growth spurt-around 14 or 15 for girls, a bit later for boys.

ALL SURGERY CARRIES SOME UNCERTAINTY AND RISK

When rhinoplasty is performed by a qualified plastic surgeon the results are consistent and predictable. Complications are infrequent and usually minor but they can occur.  We strive to reduce these risks by using a team approach in surgery.  The nurses and anesthesiologist at our center have an extensive experience with rhinoplasty surgery and are well tuned to any complication that might occur.

Dr. Hochstein has a very low revision rate in rhinoplasty in the range of 5%.  This is extraordinarily low when 15% is accepted in the most experienced of surgeons.  A second minor procedure may be required to correct such issues as a residual bump on the bridge or excessive scar tissue.

PLANNING YOUR SURGERY

Good communication between you and your physician is essential. In your initial consultation, Dr. Hochstein will ask what you would like your nose to look like, evaluate the structure of your nose and face, and discuss the possibilities with you. He 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.

Be sure to tell Dr. Hochstein 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 any questions you may have, especially those regarding your expectations and concerns about the results.  Sometimes it is useful to bring in pictures of noses that you like or dislike.  It is impossible to re-create another person's nose but the surgery can be influenced by your critique of the noses of others.  This is not a cookie cutter operation.  It can and should be influenced by your input.

PREPARING FOR YOUR SURGERY

We will give you specific instructions on how to prepare for 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 are 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 is performed in our state of the art AAAA certified surgery center. It is done on an outpatient basis.  We find that this is the most convenient and comfortable method for our patients.

TYPES OF ANESTHESIA

Rhinoplasty can be performed under local or general anesthesia, depending on the extent of the procedure and on what you prefer.

Our board certified anesthesiologist, Dr. Livschutz, will discuss all of the options with you including the benefits and drawbacks of each method.

THE SURGERY

Rhinoplasty usually takes slightly over an hour, though complicated procedures may take longer. During surgery the skin of the nose is separated from its supporting framework of bone and cartilage, which is then sculpted to the desired shape. The sculpting is performed by removing or adding bone and cartilage to create the desired appearance.  Finally, the skin is redraped over the new framework and a in-fracturing or breaking of the bones is performed.

CLOSED RHINOPLASTY

There are two techniques of performing a rhinoplasty which is termed either open or closed.  The open technique uses internal incisions as well as an external incision while the closed technique relies on solely internal incisions.

Dr. Hochstein uses the closed technique.  He feels that the incision in the middle of the nose is difficult to impossible to hide and can even create problems with healing such as depressions and potential disruption of the blood supply which can lead to catastrophic complications such as loss of skin and necrosis.  The postoperative swelling is also reduced with the closed technique.

AFTER YOUR SURGERY

After 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. 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 surgery, and you may continue to feel some stuffiness for several weeks. You should refrain form blowing your nose for 6 weeks.

The nasal packing is typically removed within 24 hours.  If there are external sutures such as when the nostrils are reduced, they are removed within 5 days and the splint is removed after 7 days.

Most patients are surprised t find that this is not at all a painful surgery and many do not require narcotic pain medication although it is provided.

GETTING BACK TO NORMAL

Most rhinoplasty patients quickly return to their regular routine.  Return to work can happen with 3-4 days although many patients wait until the splint is removed.

Return to the gym will generally take 10 days to 2 weeks.  Sun exposure should be avoided for at least two weeks and protection should be applied.

You can wear contact lenses as soon as you feel like it, but glasses are another story. Once the splint is off, they'll have to be taped to your forehead or propped on your cheeks for another six to seven weeks, until your nose is completely healed.

YOUR NEW LOOK

In the days following surgery, when your face is bruised and swollen, it's easy to forget that you will be looking better. In fact, many patients feel depressed for a while after plastic surgery-it's quite normal and understandable.

Rest assured that this stage will pass. Day by day, your nose will begin to look better and your spirits will improve. Within a week or two, you'll no longer look as if you've just had surgery.

Still, healing is a slow and gradual process. Some subtle swelling may be present for months, especially in the tip. The final results of rhinoplasty may not be apparent for a year or more.

Pain Level: Moderate-severe discomfort. 2-10 days of pain medication
Swelling and Bruising: 1-6 weeks for closed, 1-6 months for open
Numbness: lasts several weeks (tip of nose)
Bandages: Changed in 5-10 days
Work: Return after 1-3 weeks
Exercise (including swimming): Wait 6 weeks
Sun Block: very important for first few months
Final Result: Seen 3 months-2 years

During recovery your nose may be:

• asymmetrical
• crooked
• swollen
• bruised
• numb
• painful

For faster recovery:

• Apply cold, dry compresses often (follow your doctor's protocol, some recommend warm compresses after 24 hours)
• Avoid nasal medications for 3 months
• Use humidifier and saline spray for 2 weeks
• Keep head elevated to reduce swelling

Avoid blowing or picking your nose for the first 4 weeks to reduce bleeding and abnormal healing. Immediately after surgery a splint is usually applied to the nose to maintain the shape. Nasal packs or soft plastic splints also may be placed in the nostrils to stabilize the septum. If it is necessary to pack the nose, it is usually taken out within the first few days (Dr. Hochstein likes to take it out the next day if possible). Most doctors recommend ice packs over your eyes for the first 2 days to minimize swelling. Pain medication and sleeping pills can help with pain management. The splint will be removed by your surgeon at your first post operative visit (usually a week after the surgery).

After surgery, your nose and eyes will be swollen and bruised, they may ache, and your face will feel puffy. The extent of this will depend on the extent of the operation and if the nasal bones were broken. The swelling and discoloration increase in the first few days and then will subside after the first week or so. Your upper lip and tip of your nose may feel numb for a few months. You'll also feel like you have a cold for the first few weeks because of the congestion of the nasal passageways. A little bleeding is common during the first few days following surgery. Any sudden increase in bleeding or pain should be reported to your physician.

If you swallowed a lot of blood during the procedure, you may be more likely to feel nauseated and possibly vomit post-operatively. Your stool may also be darker due to blood content.

Take the time to ensure that your nose properly heals. The nose is delicate and you'll greatly reduce your chance of complications and secondary surgery by following your doctor's advice carefully.

A good diet helps the healing process. Start your recovery with a mild liquid diet (water, juice, soup or broth). It's important that your stomach is settled before you resume normal eating and drinking. Vomiting can interfere with your recovery and healing time. Avoid taking medications on a empty stomach as well, this could cause nausea and vomiting.

Keep your head elevated while you sleep. You should also keep your head up during the day and avoid bending over. This will minimize swelling. You may have a slightly longer recovery period, if your surgery required breaking the nasal bones. You are usually able to return back to work in 7-10 days - 3 weeks with make-up. Bruising may occur for 10-14 days.

Although you will see results in about two weeks, small changes may continue to occur over the next 6-12 months. The final outcome depends upon your age, skin type, and healing ability.

Activity:

The best rule is to avoid any activity which causes you discomfort. Any strenuous activity or exercise that has the possibility of resulting in a nose injury should be avoided for at least 6 weeks. You'll also want to avoid bending over. Check with your doctor regarding bathing and showering; generally it is allowed as long as the nose splint remains dry.

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