Recently, I have seen some good questions regarding Rhinoplasty procedure  and post-operation procedure.

Well, it gave us the idea to ask Dr. Tavoussi these questions to get the best answers for those who are still doubtful whether or not  rhinoplasty (nose job) is the right decision for them?

What is Rhinoplasty briefly?
Rhinoplasty is cosmetic or reconstructive surgery of the nose. It is often called a nose job. A rhinoplasty can actually correct many problems of the nose from genetics, trauma, or disease and can also fix many aesthetic problems too. A hump a patient may have could be removed to give a more pleasant look. The cartilages of the nose can be molded or remodeled and trimmed to create a more pleasing shape. Rhinoplasty can bring balance and harmony to the face.
At what age can rhinoplasty surgery be performed?
Generally speaking, rhinoplasty is avoided before the face and its components have completed their growth if it is for pure cosmetic purposes only. Rhinoplasties performed on teenagers, and young adults often helps with their social development and self-confidence. In some older people, the aging process shows itself in many ways in the nose thus correction of flaws can refresh the appearance and their face.

What does a typical rhinoplasty consultation mean for patients?
A plastic surgery consultation will give you the chance to meet the right surgeon and discuss him/her what you really want out of your rhinoplasty surgery and how much of this idea you have in mind is accessible through your surgery. Your doctor will discuss your goals with you and will explain what can be achieved in reality.

He will take into account your entire face and bone structure to see what type of nose would suit you best. He will give you some computerized picture of your face of how it would look after the surgery.  The rhinoplasty procedure highly depends on the individual and result varies person to person!

What sort of surgeon is preferable?

It’s believed that ideally you want an ear, nose and throat surgeon with training in facial plastic surgery. Someone who only has experience in plastic surgery can make your nose look more beautiful but they may not have any idea of the internal function of the nose. There is no point in having a good-looking nose if you can’t breathe through it.

Surgeons with Double-Board or those who are Board-Certified for cosmetic and facial surgeries would be your best choice since their board acceptance shows they have passed all related test and are aware of all aspect of rhinoplasty procedure.

What about computer imagery?
This is essential to temper inappropriate expectations. We show people what we can do for them rather than what they want to see. With a lot of the revisions we perform, we try to do our best to show the patient their face on screen or explained to them exactly what is going to happen. Digital imaging is excellent for that. It’s very realistic and you can be gratifyingly accurate.
What if you suspect the surgeon is offering you an unrealistic prognosis?
Probably the most common erroneous claim a surgeon makes is telling a patient who has a big tip to the nose that they can make it into a neat little tip. Cosmetic surgery patients may have huge expectations and we have to make them realistic. If you have a 1/10 nose, you’re never going to have a 10/10 nose. It is realistic to hope for a 5/10.Treating tips of noses can take a very long time.
Do you feel comfortable with your surgeon?
If you don’t, then simply  walk away. If you’re not comfortable, you won’t communicate and you won’t get the results you are really looking for.
Which approach is preferred? Internal or external?
Rhinoplasty (nose job) procedure depends on what each surgeon prefers. External approaches are for difficult noses or revision noses where you need to see everything that is going on so you can fix it up – so if you think that is your problem, you might want to ensure you will receive external surgery.
Is my surgeon being totally honest with me?
Crooked noses are the most difficult to treat successfully because cartilage tends to have a memory and wants to go back the way it was. So you might have a beautiful nose after the operation but down the track it might start to bend a little bit. Also, the best bone and cartilage you get is that provided by Mother Nature. It is perfectly smooth. After surgery, you might get some bumps. And patients should also be warned that immediately after surgery, they might find their breathing pattern is affected.
How is a rhinoplasty performed?
Your Rhinoplasty could be performed under either local anesthesia or a general one. It usually lasts about one and a half to two hours (depending on the complexity of the nose and bone structure). The surgeon may use surgical tools to shave down a hum, remove or rearrange cartilage, or break and rearrange bone to reshape the nose.

After he or she is done, the incisions are closed. Your nose may be packed with gauze or other material and a splint or cast may be applied. You will be awakened after the procedure, and after two hours of recovery, you can go home. You must have someone to drive you home since you will not be able, to drive yourself. The packing usually comes out in a day or two and the splint or cast, if you have one, comes off in about 7 days.

Speaking with Surgeon's Patients?
It is not improper at all, and we would more than happy if you asked so. Usually your surgeon has a referral list of previous patients who could share their stories with you.

Talking to prior patients is another good way of ensuring that you are in a good hand before you really go under the knife! It usually gives you the idea whom you are going to deal with as your facial surgeon and a well-rounded opinion.

What should I expect after the surgery?
For the first one or two days after your rhinoplasty you will not feel well. Your surgeon has placed a dressing over your nose, and a gauze underneath your nose to catch the blood. You will also be told when to remove the dressing but you will feel sore and headache for a few days.

Because the back of your nose connects to your throat and stomach, you may have swallowed some blood during the surgery. This can cause nausea, and  you may vomit a black-looking mixture within a few hours of surgery. Usually, nausea subsides after you throw up. If you continue to vomit and/or run a high fever, contact your doctor immediately.

The cast on your nose may give you some discomfort feeling and removing the cast could be somehow painful for you. You will need to sleep with your head elevated for several days to a week after your surgery. Bruising and swelling will be present for several days after surgery and your nose will be sensitive for about a month and a half during your rhinoplasty recovery.

When will the cast be taken off and is this going to be painful?
The cast is usually removed about 7 or 8 days after the procedure, and this is not painful. You may feel a little bit stiffness since the swelling is moving downward.

You should be really careful not to bump your nose for several weeks after the cast has been removed since your nose is not as strong as it used to be until almost 2 or 3 months after the surgery.

When will I be able to see the results?
Some temporary swelling, black-and-blue discoloration of your eyelids and numbness can occur for two to three weeks after nasal surgery. Rarely, this may last up to six months, and subtle swelling may take a year to resolve entirely.

Ice packs or cold compresses can help reduce swelling and discoloration around your eyes. Some people with sedentary jobs go back to work after 3-5 days. If your job, however, requires strenuous activity then it may take as long as 3 weeks to return to work. Most people return to work in about 1 week.

What are the risks of rhinoplasty?
Rhinoplasty is considered as one of the safest surgeries but like any other surgical procedures things can go wrong.

Risk of infection, adverse reaction to anesthesia and bleeding. Even when a skilled surgeon performs your surgery, sometimes your body may not heal correctly or have adverse reactions causing undesired results. It is possible that you will need additional surgery (Secondary Rhinoplasty).

You may lose your sense of smell for a period of time. Visible scarring is usually minimal if the incisions are made inside of the nose, but if an open technique is used, scars may be visible for some time. You may also simply be unhappy with the results. Rhinoplasty has the highest rate of revision of cosmetic surgery.

How much does a rhinoplasty cost?
The cost depends on where you live and how much work you need done on your nose. Prices can vary even over the course of the year and with the popularity of your surgeon. On Average,  it ranges from $4500 to $7500.

If you need to stay overnight in a hospital or in a recovery center, it will cost you extra. You can discuss the fee for your procedure with your surgeon since they usually have plans for you to pay the fees. Here may be extra fees for the use of the surgical center or for the anesthesia. Find out what extra fees there will be in advance.

Some portions of some rhinoplasties will be covered by your health insurance if you have documented “breathing difficulties”. You need to contact your health insurer to find out what could be covered. Your surgeon’s office can contact your health insurer, but make sure that you get things in writing from the insurer.

Any advice for African-American persons on picking a plastic surgeon?
Many African-Americans look for a better looking nose but are afraid to have rhinoplasty because they are afraid of loosing some of their ethnic features. This could happen if they pick a surgeon who is unfamiliar with these types of experiences.

However, there are plastic surgeons who understand African-American rhinoplasty, and how to give you the nose you want without making you lose your heritage in the process. This is true for Asian-American rhinoplasty,  as well. The key point to rhinoplasty especially in African-American noses or Asian-American noses is experience dealing with these noses.

Don’t assume that the surgeon must be African-American to have the sensitivity and skill you need. That may be true, and it might not be. You are looking for a surgeon with skill, artistic sensibility,  to your needs, and those qualities are not tied to any one skin color. You could see Before/After photos of previous patients to make sure that your choice of plastic surgeon is the right decision.

Thanks for your time and kind attention to these questions Dr Tavoussi.
You are welcome, I hope these Questions and Answers have been useful to those who keep thinking about rhinoplasty as their next surgical procedure.
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