Rhinoplasty, or nasal sculpting, is the art of making a prominent, misshapen, or unattractive nose look more normal. A prominent bump, a drooping or ball-shaped tip, or crookedness can attract attention to the nose and away from your better features. Correcting these issues allows the eyes and smile to take center stage.
Cosmetic rhinoplasty is performed in our AAAHC-accredited surgical suite. Dr. Nayak uses advanced suturing techniques which prevent the need for packing, so recovery is comfortable. The splint taped to the outside of the nose is removed at 1 week, and most patients return to work or school at that point.
Rhinoplasty is often combined with straightening a deviated nasal septum to allow improved breathing after the procedure.
During your consultation for rhinoplasty surgery, Dr. Nayak will ask you what about your nose bothers you, and may also ask you to talk about other, related areas of your face, such as your chin, jawline, or neck. Dr. Nayak will likely ask you to point out, very specifically, what you’d like to see changed. Identifying exactly what needs to be addressed is the cornerstone of good results!
Dr. Nayak will then review your medical history form, and may ask for some additional information from you. Special attention will be paid to previous nose, septum, or sinus procedures, and to your ability to breathe. Current and past smoking habits, or the use of nicotine gum or patch products, are especially important to mention to Dr. Nayak during this part of the consultation as nicotine dramatically reduces the chances of proper healing. Dr. Nayak will also pay special attention to parts of your medical history that need to be considered carefully when undertaking rhinoplasty surgery, such as uncontrolled high blood pressure, or any medications or supplements you may take that thin the blood. In general, all over-the-counter pain/fever reducers (except Tylenol) are off-limits for 2 weeks before and 3 weeks after rhinoplasty surgery, as are ginkgo biloba, St. John’s Wort, or high doses of fish oil, flax seed oil, or vitamin E.
The Physical Examination
Dr. Nayak will then examine the inside and outside of your nose, along with your face as a whole, to determine exactly what must be corrected to achieve optimum results.
In addition, should you desire improvements of the chin, eyelids, brows, nose, jawline, or neck areas to achieve balanced results. Dr. Nayak will take a few moments to discuss these options with you to make sure they meet your personal esthetic goals.
The Preoperative Visit
Once you have decided to undergo rhinoplasty surgery, Dr. Nayak’s staff will help you schedule your surgical date, and, about 2 weeks preceding that, a preoperative visit. Expect to spend about 90 minutes in the office on the day of your preoperative visit. During this visit, you will be educated on before instructions, after instructions, and prescriptions. Written copies of all of these will be given to you at this visit, as well, and you will be able to fill your prescriptions ahead of time. You will also be reminded at this time to avoid for 2 weeks before and and 3 weeks after surgery any medications and supplements that thin the blood.
Also at the preoperative visit, your private preoperative photographs will be taken, the surgical consent form will be read to you, and you will have an opportunity to discuss with Dr. Nayak any questions you still have remaining. Finally, at the conclusion of this visit, the balance of your surgical, facility, and anesthesia fees will be due.
The Surgical Visit
In general, you will be asked to arrive at 7:15 AM the morning of your planned surgery. You should have nothing to eat or drink (not even water, candy, or gum) after midnight the night before your procedure. If Dr. Nayak prescribed antibiotics, or if you take blood pressure medication in the mornings, you may take these with a small sip of clear water.
You will need an adult driver on the day of your surgery to bring you and to take you home. Your companion may wait in our comfortable reception area, watching TV, reading, and enjoying coffee, soda, and snacks. Alternatively, if your companion wishes to leave a cellular telephone number, we can call him or her with updates and also at the conclusion of the procedure.
Upon your arrival, Dr. Nayak’s staff will greet you and review your medical history, looking for any new changes since your initial consultation. Dr. Nayak and his staff will also confirm that they and you are in agreement about which procedures are to be performed, and those areas will be marked with you sitting upright in a chair. If you are a woman under 50 and have not been surgically sterilized, a urine pregnancy test may be performed. In any case, you will have one last opportunity to have last-minute questions answered and use the restroom, and will be escorted to our AAAHC-accredited surgical suite.
Once there, you will be positioned comfortably on your back, with pillows behind your knees and under your neck. Painless blood pressure and oxygen monitors will be placed on your arm and finger, and massaging air-filled stockings will be placed on your legs and thighs to encourage excellent circulation while you are lying down. Most patients truly enjoy these stockings and find them very soothing.
Dr. Nayak and his staff will then perform one final “time-out” aloud to ensure they are about to embark on the appropriate procedure on the appropriate patient. As the sedation takes effect, you will drift off to sleep and your nose will be slowly, gently numbed with local anesthesia, and sterile towels will be placed around your face and neck.
Dr. Nayak will begin the procedure only after you are fully asleep, and will be completely finished before you wake up. When you awaken, you will have no packing in your nose.
Your Recovery – Day 1
At the conclusion of your procedure, Dr. Nayak will tell your companion how everything went, and he or she will have the opportunity to see you. You will be moderately bruised and swollen at this point. You will have paper tape and a metal splint on the bridge of your nose, and three tiny sutures underneath your nose, between your nostrils. There will be no packing.
You will be asked to spend 1-2 hours with us prior to being discharged. Dr. Nayak will call you the evening of the procedure to check on your progress, and you will also be given Dr. Nayak’s personal cellular phone number in case questions should arise after hours or on the weekends.
Your Recovery – Week 1
Most patients feel no pain whatsoever immediately after surgery. Many patients find they nap intermittently the first afternoon. Later in the evening, most rhinoplasty patients feel that their nose is stuffy and only mildly, if at all, sore.
Most patients take their prescribed pain medication for 24-36 hours after the procedure, and then switch to Tylenol – all other over-the-counter pain preparations are off-limits. Many patients take Tylenol alone right from the start.
If rhinoplasty surgery has been performed by itself, there is no need for a checkup the day after surgery. If other procedures, such as a facelift, were performed, you will be asked to come to the office for a dressing removal and checkup visit.
You will be able to shower the first day after surgery, provided you keep your nose dry. You will be asked to use intermittent cold compresses and sleep with your head elevated for the first few days.
On the 6th or 7th day after surgery, you will return to the office for a checkup and dressing removal. You should get your nose splint very wet in the shower that morning to help it come off more easily. If you have significant bruising remaining at this point, it may be treated with a laser to hasten its disappearance.
By the 7th day, women may wear makeup, men may shave, and almost everyone is “presentable” to run errands or go back to work. Especially easy bruisers, or patients over 65, may require another 2-3 days for most of the bruising to resolve. By 2-3 weeks, most people are “undetectable”. If you are not self conscious about being seen with bruising or the splint in place, or work from home, expect to be back to work within 3-4 days!
Your Recovery – Long Term
Over the ensuing weeks and months, you will find your nose looks better and better. The profile often looks good early, with the front view seeming “fat” for a few weeks longer. While most patients are happy with their breathing and appearance within a few weeks, full resolution of internal and external swelling takes 12 months.