Rhinoplasty San Diego

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San Diego Rhinoplasty

As with other parts of the country, Rhinoplasty is a very popular plastic surgery procedure in San Diego. San Diego rhinoplasty is a fairly common procedure, surgically reshaping the nose for either aesthetic, reconstructive, or functional purposes, or all three. Good candidates for rhinoplasty, or nose surgery, are those who are unhappy with the appearance, proportion, or certain features of their nose in relation to the face. Common qualities of an “unattractive” nose include a large “hump” or a bulbous tip. Rhinoplasty can remove a hump and narrow and reform the tip and overall shape of the nose. Even the slightest changes to the nose can drastically affect the appearance of the face. It can help alleviate breathing problems also.

Dr Sherman details whats involved in a Rhinoplasty Procedure

FAQ's

Rhinoplasty is surgery to alter the shape or function of the nose. Rhinoplasty techniques can be performed to achieve a cosmetic result, a reconstructive/functional result, or a combination of both.

What are the advantages of having a Rhinoplasty or Nose Surgery?

Some of the cosmetic benefits of a Rhinoplasty or Nose Surgery is to remove the "hump" on the nose, narrow the tip, or shorten the nose. It can help with breathing problems also.

Who is a good candidate for a Rhinoplasty or Nose Surgery?

     - If you have a nose that is cosmetically unattractive or does not "fit" with other facial features.

     - If you want a more attractive nasal shape.

     - If you want your nose to be in better proportion to other facial features.

     - If you have an abnormal appearance of the nose as a result of birth defects, injury, or disease.

What does a Rhinoplasty or Nose Surgery procedure involve?

     - Most incisions can be made inside the nose, where they are invisible. The skin is lifted from it's underlying bone and cartilage support system. Bones, cartilage, and soft tissues are then reshaped.

     - Open Rhinoplasty: Frequently used for difficult or larger noses. Involves one external incision across the columella (strut between the nostrils). Bones, cartilage, and soft tissues are reshaped under direct vision.

     - Open Tip-plasty: If only the nasal tip is abnormal, it may be corrected with either a standard or external open approach.

     - Large nostrils may be reduced through tiny incisions at the outer base of the nostrils with either type of Rhinoplasty.

How long does a Rhinoplasty or Nose Surgery take?

It can take anywhere from 2-4 hours depending upon the extent of your surgery.

How long does it take to recover from a Rhinoplasty or Nose Surgery?

You will go home with an external cast or splint in place. The nose may be packed for 24-48 hours. The cast or splint is usually removed in one week. Majority of swelling and bruising subsides progressively over 2-4 weeks. External sutures (if any) are removed in 4-6 days. Internal sutures dissolve.

When can I expect to see results from my Rhinoplasty or Nose Surgery?

Semifinal results are evident in 3 months. Final results are evident in 12-14 months which is the time necessary for complete tissue softening.

When can I go back to work/resume my normal activities after having a Rhinoplasty or Nose Surgery?

Most people are walking in two days, and back to work or school in a week. No strenuous activities are allowed for two to three weeks.

How long will the results of a Rhinoplasty or Nose Surgery last?

The results are permanent unless you injure your nose.

What are my alternatives to having a Rhinoplasty or Nose Surgery?

There are no alternatives however, additional procedures that may enhance the result are a Chin Implant.

What are the risks involved with having a Rhinoplasty or Nose Surgery?

The specific risks and the suitability of this procedure for a given individual can be determined only at the time of consultation. All surgical procedures have some degree of risk. Minor complications that do not affect the outcome occur occasionally. Major complications are rare.

 Another video in our series on Rhinoplasty with. Maurice P. Sherman, M.D

Rhinoplasty Revision

When a nose reshaping procedure yields an unsatisfactory result, revision rhinoplasty surgery is usually the only way to salvage the situation. Patients in the San Diego area who find themselves in this predicament frequently turn to Maurice P. Sherman, M.D. for help. In private practice since 1981, and a highly experienced rhinoplasty expert, Dr. Sherman has refined his ability to repair the result and achieve a final product more aesthetically pleasing and closer to the nose the patient had originally envisioned.

It takes years of experience and a special set of skills to deal with irregularities of the nose after a substandard nasal procedure. Lack of details from the original surgery and the resulting formation of scar tissue are just two of the issues that makes revision rhinoplasty a much more demanding and challenging procedure. Other potential problems that may present in revisionary nasal surgery include: a drooping or twisted tip, asymmetric nostrils, and a deviation or unnatural fullness of the bridge (parrot beak deformity). Additionally, structural problems such as a tweaked septum or the collapse or narrowing of the internal nasal wall may have left the patient with a breathing obstruction and a compromised airway. After careful examination, Dr. Sherman will devise an individualized treatment plan and decide how to best address the patient’s specific problem(s).

The technique most often employed in a secondary nasal procedure is the “open” surgery method, providing the surgeon better visibility as he repairs any abnormalities and creates a functional and aesthetically improved nose. The open approach involves a small incision made on the columella (strut between the nostrils), as opposed to incisions made on the inside of the nose with the “closed” method. Resultant scarring from either technique is minimal and almost invisible. A revisionary rhinoplasty procedure is typically completed in two and a half to three hours depending on the type and difficulty of correctional work needed.

Post-surgical patients may return to light desk work at home after 24 hours but may wish to wait seven to 10 days before returning to fulltime sedentary work. The nasal structure will be taped and protected by a small cast for the 10 days following surgery. When the cast is removed on the tenth day almost all residual swelling and bruising will have subsided, and the patient should feel socially comfortable. Patients should refrain from strenuous activities for a minimum of three weeks, and those who wear eyeglasses should wait a full four weeks for their new nose to up to the task. Although an improvement is immediately visible, the nose will continue to refine over the next few months, and it may be as long as a year to appreciate the final result.

If you have had a rhinoplasty with a less than optimum outcome, you have a choice. You don’t have to live with it. Now is the time to carefully research and investigate your options. Schedule an evaluation with an experienced and qualified revision rhinoplasty surgeon, and put your best face forward.

Dr. Maurice Sherman is board certified by the American Board of Otolaryngology (ABOto), the American Board of Cosmetic Surgery (ABCS), and the American Board of Facial Plastic and Reconstructive Surgery (ABFPRS). Located in San Diego, and conveniently servicing the surrounding areas of La Jolla and Del Mar, Dr. Sherman excels in excellent and natural-looking rhinoplasty results.

Post Operative Care & Instructions

A personalized booklet of post operative care and recovery expectations is produced in our office for each patient.  Our nurses will go over these directions in detail; however these instructions should be carefully read and followed.  The most commonly asked question will be answered and our office staff is always available for additional assistance.

Recovery period high points:

1. The head should be elevated for ten days following surgery to minimize swelling.
2. Recuperation time is between four to seven days during which you should increase your rest time and diminish daily activities. 
3. Sometime after four to seven days, most patients can return to sedate desk work. 
4. A nasal splint to hold tissues in place and permit early removal of packing is left in place for five to seven days.
5. Discomfort is minimal and easily controlled with mild pain medications. 
6. Activity:

1. Week one
   1. Limit your activity.  You are encouraged to walk about that house or take casual strolls outside, but avoid bending down or picking up heavy objects.  Bleeding may result if you over exert yourself.
   2. When sleeping or resting, keep your head elevated on three or four pillows and avoid lying on your side. 
   3. Keep calm and quiet and try to avoid stress.  You will be given mild tranquilizers (xanax) to take as needed.
   4. Keep your diet light and soft for four to five days and avoid hard to chew foods such as steak. 
   5. On returning home, drink non-dairy fluids such as Gatorade and bland solid foods such as jello.  You may advance to more regular foods on day two. 
   6. Clean your nostrils with a q-tip and hydrogen peroxide four times a day.  Immediately afterward, place antibiotic ointment around the inside of your nostrils to avoid crusting.  A humidifier as well as saline nasal sprays may also be useful.
   7. Avoid blowing or sniffing excessively, if you must sneeze, keep your mouth open.  Expect some blood tinged discharged for several days and a congested feeling for several weeks. 
   8. Avoid picking up babies, small children or pets, in order to avoid being accidentally struck on your nose.  This will hurt but will not cause problems unless the force is excessive. 
   9. You can bath or shower, but try to keep your cast dry. If it does become wet,  dry it with a hair dryer.  IF the cast starts to come off, try to keep it on with some tape or notify our office as soon as possible.
   10. Avoid cigarette smoking and cigarette smoke from others, as this may inflame tissues and cause healing problems. 
   11. Avoid alcoholic beverages which can dehydrate your body and cause thickening of your secretions. Alcohol does not mix well with most medications.
2. Week two to six
1. It takes six weeks for your nasal bones to heal, slowly increase your activity, but let your body tell you how much to do.
2. Strenuous activity can be resumed in six weeks, but semi contact sports should be avoided for another month.  Swimming is allowed after six weeks.  Avoid sun burn which may cause redness and swelling.  Use sunscreen of at least spf 30 on your nose. 
3. Avoid letting glasses of any kind rest on your nasal bridge since this can cause indentations.  A small amount of tape suspending you glasses to your forehead can keep your glasses just a fraction off of your nose.
4. Your cast will be removed on the tenth day.  At that time, eighty five percent of any minor bruising or swelling will have resolved. Most patients feel comfortable being out in public that same day. 
5. If you notice some degree of tip elevation, be assured that this is expected, the nose will gradually settle to the level created during surgery over several weeks.  Occasionally an injection may be needed to reduce swelling in one area.  Any touch up surgery is not even considered for at least six months.

What to expect following nasal surgery?

Pain, swelling, bruising or bleeding: The first day or two, you will have some bleeding that is handled with a “mustache” dressing of gauze under your nose, which can be changed as needed.  When cleaning your nose, it is also normal to have pinkish-reddish discharge for four to five more days.  Most patients feel a discomfort described as soreness or tenderness with congestion, and not true pain.  While pain medications are available, try to use extra strength Tylenol first, especially after the slight amount of nasal packing is removed the next day.  Swelling and bruising around the eyes and cheeks is variable, but often very mild.  The worst is over after forty-eight hours and can be helped using ice packs to the eyes.  Usually eighty-five percent of swelling and bruising will be resolved when your cast is removed in ten days.   

Medications:  Avoid aspirin, vitamin E or Ibuprofen for two to three weeks.  Pain medications, a steroid dose pack to reduce swelling and antibiotics will be prescribed.  A trans-derm skin patch placed behind your ear can help prevent or minimize nausea.  Follow instructions and avoid driving while taking pain medications.

Infections: While very unusual, infections occasionally develop.  Fever over a hundred degrees, sweats and chills, excessive pain or swelling with redness may signify a developing infection.  Please call our office and appropriate antibiotics will be called in. 

Post operative visits: Mild nasal packs will be removed the next morning after surgery.  On day five to seven, nasal splints and any sutures will be removed.  Finally, on day ten the cast is discarded.  A visit in six weeks will be scheduled to assess healing and pictures may be taken in two to three months.  If desired a complimentary photo album of before and after pictures will be available.  Dr Sherman also urges his patients to have a final visit around the year anniversary of your surgery to discuss any concerns.

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