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Rhinoplasty (Nose Job)

INTRODUCTION

“I do not want a Michael Jackson nose.” We hear that frequently from our rhinoplasty patients. Our goal has always been to keep the nose looking natural and keep the patient’s character, while making it look better. There are few perfect noses in this world. Since the “hey day” of the Greeks, many criteria have been proposed to guide us towards the ideal dimensions of the aesthetically-pleasing nose, given that it is the centerpiece of the face. As our society becomes more ethnically diverse, so do the noses that a plastic surgeon has to address.

You may seek a rhinoplasty for a variety of reasons. Sometimes the reason is self-consciousness about the appearance of your nose, and the belief that it makes you less attractive. Other times, it is for functional reasons – for example, difficulties breathing due to a deviated septum – but perhaps you will opt for “a little touch-up of the tip” while you are under anesthesia. Whatever your reasons may be, a rhinoplasty on a patient who is realistic about his or her reasons and expectations will yield tremendous satisfaction, as long as they remember that a rhinoplasty offers improvement, not perfection.

PREPARING FOR SURGERY

An initial consultation is set-up where we discuss the rhinoplasty procedure and whether you are a good candidate for the surgery. A thorough discussion about why you want a rhinoplasty, and what you hope to accomplish, is very important. You will be asked what bothers you about your nose, dividing it into top, middle, and lower thirds. It is important to provide as much information as possible about what you would like your nose to ideally look like. We will address, together, what bothers you about the bridge, the tip, the nostrils, and the width of your nose, as well as if you have breathing problems, and their causes. We will devise a plan together and make sure that your concerns will be addressed. Unfortunately, a perfect result can never be promised, or guaranteed, in plastic surgery.

Your medical history is reviewed, and you will be asked to see your medical doctor for a physical check-up and a few labs, to make sure you can undergo the surgery safely. You are asked to stop medications that cause bleeding, such as aspirin, or aspirin-like products (Motrin or Ibuprofen), a week before this procedure. You are asked to stop smoking two weeks before and two weeks after surgery, for the surgery to be performed safely, and for you to have optimal results. You are given the opportunity to talk to patients who have had the same surgery that you are considering. We will see you shortly after the surgery (in a day or two usually). You are seen regularly after your surgery. You are always welcome to come back for follow-up, even years after your surgery, free of charge.

PROCEDURE DESCRIPTION

We perform both open and closed rhinoplasties. A closed rhinoplasty is performed where the incisions are hidden inside the nose. An open procedure is performed where an incision is made across the columella, the narrow area of skin that separates the nostrils.

With closed rhinoplasties, there is the avoidance of the scar at the base of the nose (columella), and perhaps quicker healing. In our opinion, this technique has limitations, such as good exposure, creating excellent symmetry with both nostrils, and the ability to shape the nose according to a patient’s desires.

The open rhinoplasty approach offers great exposure and ease of visualization of the entire nose, when the skin is lifted up. Since every nose is different, so is every procedure. However, there are common problems that are fixed in a nasal surgery:

• The bridge of the nose can be either augmented or shaved.
• The width of the nose can be narrowed.
• The nasal tip can be altered in shape and size.
• The angle between the upper lip and the tip of the nose can be increased or decreased.
• The nostrils can be reduced.
• The septum can be straightened.
• Breathing can be improved by doing several maneuvers.

REVISION SURGERY OF THE NOSE (SECONDARY RHINOPLASTY)

A rhinoplasty is a difficult operation, and sometimes patients are not happy with the result. Either, they are not satisfied with the aesthetic outcome, or they may have difficulty breathing. It is important for a patient to understand that the final result, both functionally and aesthetically, in a rhinoplasty, may take one to two years to be achieved. If a patient has waited until the final result of a rhinoplasty has occurred and is still not happy, then a revision rhinoplasty (or a secondary rhinoplasty) may be appropriate.

Before we agree to offer a patient a secondary rhinoplasty, it is very important to understand why a patient is unhappy with the first rhinoplasty, and whether a secondary one will make them happy. We go into detail with the patient about the plan of the secondary rhinoplasty and make sure that they understand that the risks of complications increase significantly anytime a second operation is done on the nose because of the scar tissue from the previous operation and the possible compromise of the blood supply to the nose. The same principles of surgery apply to a secondary rhinoplasty and will typically make an otherwise unsatisfied patient very happy.

HOW WE MINIMIZE COMPLICATIONS OF NOSE SURGERY

At the Bitar Cosmetic Surgery Institute, we take pride in making sure we provide for our patients the best surgical experience possible, anticipating problems or set-backs, and addressing them before they happen. This is a process that includes the pre-operative preparation, the actual surgery, and the after care.

General Complications
General complications can occur with any surgery. Cosmetic surgery is usually a safe surgery performed on healthy patients and, as all surgeries go, is with low risk. What we do to even lower the risk of complications is to operate at a first class surgery center with board certified anesthesiologists and nurses. To avoid post-operative complications, we advocate early mobilization –patients seen in our office one or two days after surgery- and active participation in their own post-operative care. When we create a partnership, the results invariably improve.

Bleeding
Bleeding after a rhinoplasty is rare. Before surgery, our patients are tested to make sure they don’t have any common bleeding disorders by their own physicians, and by lab tests. Before the surgery commences, the nose is injected epinephrine to decrease the bleeding during and after surgery. Among our practice, the rate of significant bleeding has been less than 1%. The treatment of continued bleeding from the nose is to apply pressure and usually the bleeding will stop.

Infection
The most important step in avoiding infections, in our opinion, is to perform the surgery at a first-rate surgical facility with board certified anesthesiologists and nurses. Patients are given the appropriate intravenous antibiotics coverage throughout the surgery. During the surgery, the skin surface of the patient is cleaned properly. After the procedure, our patients are prescribed antibiotics to minimize infection. As a result of these extra precautions, and the fact that the face has great blood supply, we have not seen any significant number of infections in our rhinoplasty patients.

Open Wounds
In an open rhinoplasty, the skin is elevated from the underlying cartilages and bones of the nose. The skin may be thin, especially if the operation on the nose is a revision or secondary rhinoplasty. Also, a splint is placed on the nose. Patients are cautioned not to sleep on the pillow face-down, or engage in any activities in which the nose can get hit, because that may cause a wound of the fragile skin covering the nose. In the rare occurrence that a wound may occur on the nose, usually it heals very nicely on its own. Very rarely, we have to do a scar revision to improve the appearance of that scar.

Nerve Injury
By having a rhinoplasty, some of the nerves that provide sensation to the nose may be cut and so the sensation of the nose, in particularly the tip, may be altered for several months. This is very common, and usually not a source of patient complaints because it does not interfere with the function of the nose.

Smoking
Smoking is an absolute contraindication in rhinoplasty. The carbon monoxide and nicotine in cigarette smoke causes severe reduction in blood supply to the skin during healing. This results in delayed wound healing, wound separation, death of the skin, and a higher risk of infection. Cotinine testing is performed in patients with a smoking history to ensure that they are safe when having this procedure.

RECOVERY

Our office will provide a comprehensive post-operative plan to ensure the best possible outcome. The plan will include what to expect postoperatively, such as estimated recovery time, pain management, garments or dressings, and anticipated activity level. For your safety, we require that an adult stay with you at least the first 24 hours after surgery and drives you to your next day follow-up visit. With most facial procedures, you will be instructed to limit activity for the first week or two, which could include restrictions on driving, prolonged travel and flying. In addition, we ask you refrain from exercise until cleared by the physician, usually around four weeks post-op. You are asked to refrain from smoking for a minimum of two weeks. To optimize healing, we recommend that you eat a high protein diet. You should anticipate a variable degree of bruising and swelling, as with any surgical procedure; light make-up may be used to cover bruises starting a week after surgery. We also offer scar creams at an additional cost to optimize results.

To promote healing and minimize complications, you will be seen in a series of post-op appointments, including the day after surgery. These appointments will continue throughout the first year after the procedure to make sure you are healing as planned. For your added convenience, you also have direct access to Dr. Bitar’s cell phone number if you need to reach him after hours. The final post-op visit, one year after surgery, is one of our favorites since the results are fully apparent and we love seeing our patients happy. You are always welcome to come back and see us, even years after your surgery.

MAXIMIZING POSITIVE OUTCOMES

At the Bitar Cosmetic Surgery Institute, we take pride in providing our patients with the best surgical experience possible, emphasizing patient safety while trying to optimize surgical results. This is a process that includes comprehensive pre-operative preparation and patient education, the development of a personalized operative plan, and a thoughtful post operative care regimen emphasizing patient comfort and promoting recovery.

There are a number of strategies which the Institute has adapted to further ensure patient safety. We are selective and only offer surgery to patients whose general health and lifestyle choices permit healing and facilitate recovery. To minimize risk, we require a preoperative assessment that includes a thoughtful history and physical exam, as well as targeted laboratory tests.

We operate at accredited hospitals and surgicenters that have demonstrated a commitment to the highest standards of care, employing board certified anesthesiologists and nurses. We adhere to well established surgical principles designed to ensure patient safety and have developed policies and protocols to minimize the risk of infection. Dr. Bitar is committed to continuing education, honing their skills and introducing new techniques always with the aim of improving safety and surgical results.

We emphasize patient safety in our peri-operative care plan, advocating early mobilization, optimizing nutrition, and providing detailed care instructions. After surgery, patients are seen in our office frequently and early, starting the day after their procedure, and a staff member is available around the clock for any questions or concerns. Our entire team is committed to our patients’ well being and every measure is designed to minimize potential complications, promote comfortable and rapid recovery, and optimize surgical results.

WHY CHOOSE BITAR COSMETIC SURGERY INSTITUTE?

Our commitment to excellence and exceptional patient care is in every step of your doctor-patient experience. Dr. George Bitar is a distinguished board certified plastic surgeon who stays on the cutting edge of advancements in cosmetic surgery and technology to offer the best possible results. With a blend of artistry and meticulous surgical technique, he is able to achieve beautiful and natural results for our patients. We provide a high level of patient safety and our experienced and caring staff will be with you every step of the way. Our institute offers a wide variety of surgical and non-surgical options, from skin care, injectables and lasers to in-office or hospital options, to provide a versatile approach to fit individual patient needs. Your aesthetic goals are our priority and each procedure is customized to ensure you receive the best possible outcome.

For more information, call our office at 703-206-0506.

Content on this website is for information only and should not be used to diagnose or treat your plastic surgery or cosmetic surgery problems. Please contact your plastic surgeon with all questions and concerns.