| Rhinoplasty | Revision rhinoplasty |
| Non-caucasian rhinoplasty | Facts about rhinoplasty |

Figure 6-a (click image to enlarge)

Figure 6-b (click image to enlarge)

Figure 6-c (click image to enlarge)

Figure 6-d (click image to enlarge)

Figure 6-e (click image to enlarge)

Figure 6-f (click image to enlarge)

A large nasal alteration requires marked tissue redraping. The
surgeon has to use careful judgment with regard to the amount of
the reduction in the framework to avoid an unnatural and poorly
defined nasal contour. Please note the perfect balance and definition
of the nasal features in this patient after surgery.

• When the nasal cast is first removed there will be a great deal of swelling noticeable around the eyes, cheeks and nose. The nose may appear turned up, stiff and there will be a fair degree of numbness. A patient who expects to see a perfectly shaped nose as soon as the cast is removed, will suffer keen disappointment. A great deal of swelling disappears within four or five days after the removal of the cast. Do not use ice compresses post operatively. They are only effective during the first few hours after surgery. Using them may cause pressure on the cast and displace the nasal tissues. It usually takes up to one year for the last one or two percent of the swelling to disappear. There are minute changes that will be occurring while normal healing is in progress and while the nasal appearance continues to improve. The average acquaintance on the street would probably not notice any signs of nasal surgery after two or three weeks.
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• There is a fair amount of swelling of the tissues inside the nasal cavity after surgery and therefore the nasal airways can be expected to be partially blocked for up to two weeks. A small amount of bloodstained discharge from the nostrils can be expected. If bleeding becomes profuse and does not stop after applying gentle but firm pressure with the index finger and thumb, squeezing the nostrils for five to seven minutes, you should proceed to the nearest emergency department immediately. Such complications are very rare.
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• Use an antibiotic ointment, applied with a cotton tipped applicator, around the margins of the nostrils twice daily for the first seven days. This will decrease unpleasant crusting.
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• The thicker the nasal skin, the longer it takes for the nose to attain its improved shape. Thick and oily skin limit the amount of surgical correction that can be obtained. The condition of the skin becomes aggravated by the surgery and may require special attention with cleansing and moisturizing preparations during the first six to ten months after the operation.
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• Your hair can be washed on the third day after surgery, you will need help to keep the nasal cast dry. Do not use excessively warm water and use a moderate heat setting with the blow dryer.
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• There are no scars on the outside of the nose, as the work is done inside. There are exceptions and in some instances the incision may have to be made on the skin under the nasal tip (fig 9a), or where the side of the nostril adjoins the upper lip. These scars become practically invisible within a few weeks. In most patients, all the sutures dissolve and fall out by themselves. Sometimes minute sutures may have to be removed on the fifth or seventh day after surgery.
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• If a premaxillary (below the nostril base) augmentation has been carried out (fig 6c,d), the upper lip movements may appear different, especially during the initial four to six months. This may cause a small change in the look of your smile. At times, small areas of numbness around the nasal tip may occur. These usually subside after several months.
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• In most instances the operation is carried out with the patient being put to sleep. In some cases the patient is not totally anaesthetized and local freezing is applied while the patient sleeps naturally throughout the procedure under sedation. Please discuss during the pre-operative visit the kind of anaesthesia you will receive. The post-operative course is painless in most cases. Only occasionally may a pain killing drug be required.
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• Patients should remember that there is a limit to the corrective procedures possible or recommended. The surgical goal is improvement, not to match the ideal which might be present in one's mind. Some of the influencing factors in rhinoplasty are the contour and shape of the face, the texture and thickness of the skin, the inclination of the chin, lip and forehead, the depth of the angle between the forehead and the nose, the height of the individual, and the healing powers of his/her tissues.
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• Finally, noses that have been severely injured (as from boxing, football playing or an accident for example) or those which are markedly crooked are technically difficult to correct. I try to make the correction in one operation and succeed in the vast majority of cases but sometimes a short additional procedure is required six to twelve months later.
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What are the risks?

1. Post-operative nasal bleeding is rare and generally not difficult to stop. It can be precipitated by trauma, alcohol, smoking or prolonged hot baths or showers. Allergy to some drugs or antibiotics used may occur. I try to avoid this happening by taking a careful history of the patient.
2. People who normally have dark circles under the eyes may experience worsening of this condition, but it returns to its original state within six to ten months.
3. In as much as there are over one hundred and forty steps in the average septorhinoplasty, it is not surprising that there may be slight contour irregularities apparent only to the patient and the surgeon but not noticed by others; these frequently disappear gradually; if not, a determination is made if further improvement can be obtained. The greatest risk, however, is that the operative result, though surgically acceptable, may not live up to the patient's expectations, that is, accomplished what he or she really hoped it would. In this connection patients should clearly understand that this operation will do one thing and only one thing: It will change the contour of the nose, it will not solve any other appearance, personal or social problems.
4. In addition to the above, there are numerous or remote risks as in any surgery, car driving or commercial flying. I will be glad to answer any questions you may have about these.