Rhinoplasty is widely considered the most difficult operations in cosmetic surgery. There are few surgeons who have “mastered” this operation, and many surgeons who have been humbled by it.
Who is a good candidate?
Individuals who have completed growth of the face (Dr. Prischmann prefers to wait until 18 years old for consideration of rhinoplasty)
Good cartilaginous support of the nose and have not had previous nasal operations
Looking for improvement and not perfection. Someone who is seeking a better version of his/her current nose, versus a completely different (or someone else’s) nose.
The best candidates are healthy, do not use nicotine products, and do not have excessively thin or thick skin of the nose.
Dr. Prischmann only offers the surgical rhinoplasty procedure. She does not perform the so-called “liquid rhinoplasty,” which involves dermal filler injections to modify the shape and appearance of the nose, due to a high rate of complications that have been associated with that treatment.
How is the surgery performed?
Rhinoplasty is performed by our facial plastic surgeon, Dr. Jess Prischmann, in a fully accredited outpatient surgery center under general anesthesia. On average, total time in the operating room is four hours. Rhinoplasty can be performed with incisions completely inside the nose (endonasal), or with a small incision on the outside of the nose (external). Dr. Prischmann prefers the external approach and finds that the small external scar is very well concealed within weeks after surgery.
What is the recovery?
Rhinoplasty is considered “outpatient” surgery, which means that patients rest at home the night of surgery. Patients are seen in the office the day after surgery to learn how to clean the surgical area. Patients wear an external splint (white cast) for one week. External stitches are removed on Day 4. The splint is removed on day 7. Ten to 14 days after surgery, our advanced practice esthetician cleans the skin of the nose, performs lymphatic massage for swelling, and conceals any remaining bruising. This is typically the first day our patients feel like being seen in public.
Swelling and stuffiness are common for the first few weeks. Downtime from work or school can range from 10 to 21 days, depending on the extent of the procedure. In general, pressure cannot be placed on the bridge of the nose for 6 weeks (until the bones heal). The swelling on the bridge of the nose typically settles down faster than the swelling on the tip of the nose. For the first few months after surgery, patients often report that, on some days, their nose appears bigger (more swelling), and on some days it appears smaller (less swelling). Often, this can be attributed to diet and lifestyle factors (sodium and stress, for example).
With regards to pain after surgery, many of Dr. Prischmann’s patients say that there is NOT significant pain after the procedure (they often say it feels “sore, but not painful”). One of the reasons why the recovery is less painful is because Dr. Prischmann does not pack the nose after surgery.
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Rhinoplasty Frequently Asked Questions (FAQ)
If you are interested in rhinoplasty and are looking for more information, Dr. Prischmann has provided the following answers to some common questions regarding the procedure. If you would like to learn more about nose surgery, please contact our office today.
What’s the difference between “open” and “closed” rhinoplasty? How do i know which method will best suit me?
“Open” and “closed” rhinoplasty are terms that can be confusing to patients. They simply describe two different surgical techniques to address external and internal changes to the nose.
In an open approach, a small incision—called an “inverted V”—is made in the columella. All other incisions are made inside the nose.
In a closed approach, all incisions are made inside the nose.
Dr. Prischmann believes that it is not the approach that matters, it is the surgeon who is performing the approach that is really important. She personally prefers an open approach, but she also knows many great rhinoplasty surgeons who primarily utilize a closed technique.
What is “tip” rhinoplasty? How is it different from other rhinoplasties?
A tip rhinoplasty is characterized by cosmetic changes made to the tip of the nose only. No changes are made to other parts of the nose. In other words, patients seek out a tip rhinoplasty if they only desire improvement for a boxy, bulbous, asymmetric, or trapezoidal tip, but do not have a significant dorsal hump.
Sometimes, patients can be really focused on the nasal tip, but may not see other areas of the nose that could be improved. A good consultation with photo imaging can help visualize some of these areas.
How can patients minimize bruising from a rhinoplasty procedure?
You can minimize your risk of bruising and hematomas by doing several things before and after your rhinoplasty surgery, including:
Before surgery:
- Avoid naproxen, ibuprofen, or aspirin two weeks before surgery
- Avoid fish oil two weeks prior to your procedure
- Avoid supplements that include Vitamin E, garlic, ginko, and ginseng
- Monitor your blood pressure three times daily for one week (at different times of the day). High blood pressure generally has no symptoms. Please tell Dr. Prischmann if you experience high blood pressure, and we will decide how to move forward.
Consider taking Arnica Montana one week before your surgery. Some studies suggest your risk of bleeding after surgery could decrease after taking this supplement.
After surgery:
- Control nausea and pain. Any sharp increases in nausea or pain can raise your blood pressure and increase your risk of bleeding.
- Continue Arnica Montana supplements. Dr. Prischmann can suggest a protocol for taking this.
- Avoid strenuous activities for two weeks after treatment.
PLEASE NOTE: IT IS IMPORTANT TO TALK TO YOUR PERSONAL PHYSICIAN BEFORE STARTING OR STOPPING ANY MEDICATIONS OR SUPPLEMENTS.
Rhinoplasty is recognized as one of the most complex of cosmetic procedures. What should a patient look for when selecting a rhinoplasty surgeon?
When selecting your surgeon, trust your instincts. Nothing is more powerful than intuition. Make sure that you feel that all of your questions are answered and your surgeon will take care of you. Then, if you are still unsure, ask to speak to someone who has had the specific surgery you are desiring from that particular surgeon.
For more information on rhinoplasty, please contact our facial plastic surgeon today. Dr. Prischmann can meet with you for a confidential consultation to answer any questions you may have.