Rhinoplasty Information

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Rhinoplasty is changing the shape of the nose. The incisions are typically hidden inside the nostrils, and sometimes in between the skin of the nostrils, called the columella. At times, incisions around the sides of the nostrils are needed, such as in alar base reduction. In most rhinoplasty, grafting is required. Grafting material is usually obtained from the septum. However, in cases where this is insufficient, cartilage and or skin might be needed from the ear. Rarely, in primary rhinoplasty is rib cartilage needed from a tissue bank. Sometimes soft tissue grafts like a dermal substitute are needed, also from a tissue bank. Temporalis fascia grafting ( taken from within the hairline) may also be needed.

After the rhinoplasty is complete, a cast will be placed on the top of the nose for 5-7 days. Bruising around the eyes typically peaks on day 2-3, and comes down after that. By 7 days, most bruising is gone. Your first regularly scheduled visit is typically around 7 days. The nose is very stuffy initially and will clear up over a few weeks. Most patients feel as though they have a cold. They are tired, stuffy and perhaps a small dull headache. Significant pain is not typical. A small amount of bloody discharge from the nostrils might occur for the first 2 weeks. Bruising around the eyes fades between 7-10 days. There will be swelling of the nose. 50% will come down by 6 – 8 weeks. As the swelling comes down over the first 6-8 weeks, it does so irregularly. There may be days where you look great, and other days when things look off. Don’t worry, this is very normal. By 3 months, 60% of the swelling as come down; by 6 months 80%; by a year, 90% has come down. These are rough averages, and every patient is slightly different. Healing and swelling recovery always starts off fast but ends slowly. Sometimes, 2-3 years is required for the final few percentages of swelling to come down. I have also had patients whose swelling has lasted longer, although that is not typical. Noses with thicker skin can take longer to heal. Daily variations in swelling can happen, resulting in temporary crooked appearances. The nose feels hard and numb, and sometimes itches. Small contour irregularities may come and go as the nose heals. This is all normal and may take time to fully disappear. At regular intervals, we will evaluate your nose for possible treatment of these contour irregularities. Most often, we use steroid injections to speed up the recovery process for these stubborn contour irregularities.

For most patients, we make regularly schedule post op visits every 3 months for a year following the immediate recovery weeks after surgery. If there are issues we are working on, we may follow patients for longer. We always let patients know they should alert us to concerns that they have at any point in the process. But it is a process, and most issues simply require time to improve.

Athletic activity should be very light for the first few weeks. For 3 weeks, no blowing the nose and no lifting significant weights. For 4 weeks, not running and other impact exercise. Glasses and sunglasses are also to be avoided in the first 4 weeks. If you wear glasses regularly, let us know. Sometimes, we have patients get a special protective covering for the nose so that they can wear glasses without many people knowing they are wearing the protection. Smoking will adversely affect healing and potentially your final outcome.

While complications and poor outcomes can occur following rhinoplasty, they are rare. The national average for a revision following primary rhinoplasty is between 10-18 percent. Our rate is far lower, and the vast majority of our patients are very happy after surgery. However, despite meticulous surgery and proper technique, the healing process cannot be controlled, and therefore the results of surgery cannot be guaranteed. It is important for you to understand this. Swelling is the most common issue following rhinoplasty and is time dependent.

Below is a list of complications that have been reported in the literature.

• Bleeding

• Infection

• Septal hematoma

• Bruising

• Swelling

• Breathing difficulties

• Poor scar formation

• Graft displacement or extrusion

• Need for debridement

• Poor cosmetic outcome

• Need for revision surgery

• Distortion of the surrounding structures

• Skin discoloration

• Reactions to materials used in surgery

• Graft infection

Costs of Surgery

The cost of surgery involves several potential charges, including hospital facility fees if applicable, anesthesia fees if applicable, and surgery fees. If this procedure is being billed through insurance, then patients are responsible for only fees not covered by your insurance plan, such as co-payments, deductibles, and other charges not covered (cosmetic). Purely cosmetic surgery is rarely reimbursed by insurance. If this is not covered by insurance, then all fees are the responsibility of the patient. Hospital and anesthesia fees, if applicable, will be estimated for you prior to surgery because they are time-based. We will provide you with a breakdown of all estimated fees for your surgery. Surgical fees are collected at least one week prior to the procedure. The fees charged for this procedure do not include any potential future costs for additional procedures that you elect to have or require in order to revise, optimize, or complete your outcome. There are no refunds. Additional costs may occur should complications develop from the surgery. Secondary surgery or hospital day-surgery charges involved with revision surgery will also be your responsibility.

Any revision can be performed up to 15 months without surgeons’ cosmetic fees. However facility fees, materials and anesthesia fees are the patients’ responsibility. After 15 months, all fees are the patients responsibility.