.--Rhinoplasty

Consultation  Pre-Operative Visit  Day Of Surgery  Recovery Process  Risks


Background On Rhinoplasty
Rhinoplasty, or surgery to change the shape of the nose, can alter the nose in a number of ways to achieve a patient's aesthetic and functional goals. The changes that can be made to the nose depend on what characteristics you are born with, and so it is important that you have a thorough, realistic and informed consultation with Dr. Capella.


Rhinoplasty Consultation
Dr. Capella will take a medical history and perform a directed physical examination of your nose and other facial features during your visit. This will involve identifying functional issues as well as cosmetic issues of concern to you. It is important for you to provide us with any history of trauma or surgery that you may have had to your nose. You should inform the doctor of any seasonal allergy problems that you have.
After examining your nose, inside and outside, Dr. Capella will generally want to discuss surgical options with you.

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Rhinoplasty Pre-Operative Visit
It is imperative that patients refrain from ingesting any medications or other substances which could potentially be the cause of surgical complications. A list of medications should be reviewed and discontinued at least two weeks prior to operation. Patients are seen just prior to their surgery date for a general physical examination to ensure that no underlying medical problems exist, which may interfere with the safety of their surgery. Prophylactic antibiotics are prescribed for a few days after surgery to reduce the risk of surgical wound infection. A prescription for pain medication is also written, so that you have pain pills when you return home from the operation.

Pre-operative photographs are taken so that you can see the improvement from your surgery afterwards. We generally take post-operative photographs at 3-6 months after your procedure. You will be asked to sign a surgical consent, which enumerates the risks of the procedure in detail. These risks will be explained at the consultation.
You will need to arrange for an escort to drive you to and from the operating suite located in our office. Patients cannot operate motor vehicles after surgery and we will not place recently sedated patients into taxis for transport home. We can arrange for medical transport in the event you cannot find an escort. It is mandatory to have someone stay with you for at least 24 hours after surgery for your comfort and safety.

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Day Of Rhinoplasty Surgery
Dr. Capella performs rhinoplasty surgery with either general or local anesthesia with intravenous sedation. The procedure usually takes one to two hours, but on rare occasions longer. After lifting the skin off of the skeletal framework of the nose, sculpting of that framework is carried out. The exact nature of that sculpting depends on your particular problem and will need to be discussed at the consultation. If the nose is being reduced in size, the nasal bones are carefully fractured toward the conclusion of the procedure. A splint is applied and the nose is packed lightly with medicated gauze. Often, the nasal packing is removed prior to you leaving the recovery room. Sometimes, only tapes support the nose while it is healing. The stitches are self-absorbing and do not require removal.

Following a brief monitoring period in our recovery room, you will be discharged into the company of an adult escort.

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Rhinoplasty Recovery Process
You should anticipate that you will feel and look puffy and swollen during the first 2-3 days after your procedure. Though there is some pain in the first 24 hours, after this there is usually just a feeling of pressure and stuffiness. It is advisable to keep your head elevated above the level of your heart for the first few days to reduce swelling. Bruising around your eyes is to be expected, and usually peaks at 72 hours, quickly subsiding in 7-10 days. Ice compresses over your eyes will help to reduce this, but in all likelihood, you will look worse than you feel. You may have some oozing of blood from your nostrils, which is collected in a gauze bandage you will be asked to change every several hours during the first several days.

At 3-5 days, the splint is taken off of your nose. If you have had an open rhinoplasty, several non-absorbable stitches will be removed at this time as well. You will still need to be careful to not blow your nose for about two weeks, and to avoid any compression on your nose or blunt trauma for about six weeks.

Eyeglasses should be taped to the forehead off of the bridge of the nose for the first two weeks while the tissues heal.

Though you should be able to return to most sedentary work in a couple of days, you will still not feel normal for several weeks to months after surgery. The nose might feel numb for months, especially if a lot of work is done on the tip. It is advisable to avoid strenuous activity such as exercise for about four weeks, as this will delay your healing and could lead to bleeding.

It is quite common to feel dissatisfied with the appearance of the nose in the immediate post-operative period, as the tissues are still quite swollen and much of the detail still has yet to be seen and appreciated. It is not unusual for friends or family to offer unsolicited and often negative critique during this period, when you are particularly sensitive and vulnerable. It is wise to take a wait and see approach, as the appearance of the nose will change significantly during the first three months, and even up to the first year or two. It is important to be patient during this period of time.

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Risks of Rhinoplasty
Complications of nasal surgery are infrequent and usually minor. Nevertheless, there is always a possibility of complications, including infection, bleeding, or a reaction to the anesthetic or sedative medications. After surgery, small blood vessels may appear beneath the skin, which may require treatment. The surgery is performed either using incisions on the inside of the nose, so no visible scars are present, or under certain circumstances, at the base of the nose, the "open approach." The "open approach" allows better visualization of certain internal structures of the nose. For additional reading on the risks of rhinoplasty, click here.

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