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Nasal Surgery
(Rhinoplasty)

Background

Rhinoplasty, or surgery to change the shape of the nose, is a commonly performed Plastic Surgery procedure in Dr. Creasman’s practice. The nose can be altered in a number of ways to suite the patient’s aesthetic goals, but usually the importance one places on the appearance of one’s nose is out of proportion to what others see. It is important to think through the prospect of altering the appearance of your nose prior to undergoing the procedure. One should never change one’s appearance for the perceived acceptance or validation of others, but rather to improve one’s self-esteem. No nose is perfect, despite the idealized images often seen in our image-conscious culture, and it is unlikely yours will be the first; no two noses are the same, so trying to attain the nose of a particular celebrity or fashion model is usually not possible.

Everything depends on what characteristics one is born with, and so it is important that you have a thorough, realistic, and informed consultation with Dr. Creasman, so that you have an accurate concept of what can be done surgically to make you feel better about your appearance.

The Consultation

Dr. Creasman will take a medical history and do a directed physical examination of your nose and other facial features during your visit. This will involve identifying functional issues as well as cosmetic issues of concern to you. It is important for you to provide us with any history of trauma or surgery that you have had to your nose. You should inform the doctor or any seasonal allergy problems that you have.

After examining you nose, inside and outside, Dr. Creasman will generally want to discuss your surgical options with you using computer imaging, which can demonstrate for you the changes he would suggest for you nose. We will obtain digital images of you which he can then manipulate to show an educated estimate of what might be achievable with surgery. Though this is not to be implied as a warranty of the surgical result, it does provide a visual communication aid both for you to give feedback, and for him to convey to you the limitations of what can be done, as well as the possibilities of nasal surgery. Though it is important and often reassuring to view any doctor’s work with other patients, it is equally important to see how one actually looks with the nose they think they want, and it becomes an educational process to view the result as a third party, rather than just leaving it to the verbalization of the surgeon while looking in a mirror.

It is not uncommon that adjunctive procedures are performed at the same time as the nose is altered, such as liposuction of the neck or a chin augmentation. You may wish to visit those sections of the website prior to your consultation to familiarize yourself with the effects achieved with these procedures. If Dr. Creasman feels that you would benefit from another minor procedure, he will tell you during the consultation as part of a comprehensive facial esthetic evaluation.

Risks of Rhinoplasty

Complications of nasal surgery are infrequent and usually minor. Nevertheless, there is always a possibility of complications, including infection, bleeding, or a reaction to the anesthetic or sedative medications. There may or may not be a scar underneath your nose, but this is seldom prominent. There can be some numbness of the nose after surgery, on the inside or the outside of the nose. The nose may not appear perfectly straight, but most noses are a bit crooked. Some people are find rhinoplasty has an adverse effect on their breathing, but this is rare. Seasonal allergies are usually not affected by nasal surgery. After surgery, small blood vessels may appear beneath the skin, which may require treatment. When grafts of cartilage are used, or in the case of a prosthetic implant, shifts over time may lead to visibility or crookedness, which may require surgical revision. An infected implant requires removal, and may not be replaceable. Secondary nasal procedures are more complicated and have a higher complication rate.

Before Your Procedure

It is imperative that patients refrain from ingesting any medications or other substances which could potentially be the cause of surgical complications. A list of medications should be reviewed and discontinued at least two weeks prior to operation. Patients are seen two weeks prior to their surgery date for a general physical examination to ensure that no underlying medical problems exist which may interfere with the safety of their surgery. Specifically, any infections which arise prior to operation, however seemingly trivial, should be reported to our office. Even an otherwise innocent infection can result in a surgical wound infection, and must be treated prior to surgery.

Prophylactic antibiotics are administered intravenously just prior to surgery to reduce the risk of surgical wound infection. A prescription for pain medication is written for you at your preoperative visit, so that you have your pain pills when you return home from the operation. Dr. Creasman also recommends a homeopathic preparation of vitamins and herbs, available for purchase in our office, to reduce swelling and bruising.

Pre-operative photographs are taken so that you can see the improvement from your surgery afterwards. We generally take post-operative photographs at 3 - 6 months after your procedure.

You will be asked to sign a surgical consent which enumerates the risks of the procedure in detail. These risks will be explained herein and also at the consultation.

This is a preoperative checklist to follow prior to your nasal surgery procedure:

1. Please pick up liquid Ivory hand soap and cleanse the skin of your face with it for the three days prior to your operation. 
2. Stock up on Coca Cola Classic. It may help with any nausea you might feel after your anesthetic.
3. Purchase frozen peas and small ziplock bags. Prepare handfuls of peas in several bags and keep them in the freezer to rotate as light cold compresses to your eyes. This reduces swelling and bruising.
4. Please remove any artificial nail material from both of your index fingers. We monitor your oxygen levels through your nail beds, and artificial nail products interfere with this.
5. Avoid alcohol for 48 hours prior to surgery. It can lead to dehydration and can interfere with clearance of your anesthetic medications.
6. Report any signs or symptoms of infection, such as fever, inflamed body parts, burning with urination, cough, diarrhea, or flu symptoms. 
7. Wear a non-pullover shirt to your operation. We suggest a zipper front sweatshirt. Wear slip on shoes with smooth soles for ease of ambulation. Wear cotton underwear and clean white socks. Do not wear makeup.
8. Do not wear jewelry or bring other valuables to the office on the day of your surgery. Pierced body parts need to be free of jewelry for your safety.
9. Take any prescribed medications as directed.
10. DO NOT EAT OR DRINK ANYTHING FOR SIX HOURS PRIOR TO YOUR ARRIVAL.
11. Avoid smoking for six hours prior to surgery.
12. Shampoo the morning of surgery and dry your hair well. Do not apply any hair care products afterwards. Floss and brush your teeth thoroughly the morning of surgery, and rinse with Listerine Mouth Wash.

The average current fee for rhinoplasty can be obtained by calling our office (408-369-9300), and includes surgeon, operating room, and follow-up care. Charges vary according to the complexity of the operation, and an accurate fee will be quoted at your consultation.

You will need to arrange for an escort to drive you to and from our office operating suite. Patients cannot operate motor vehicles after surgery, and we will not place recently sedated patients into taxis for transport home. We can arrange for medical transport in the event you cannot find an escort. It is mandatory to have someone stay with you for at least 24 hours after surgery, for you comfort and safety.

The Operation

The overwhelming majority of Dr. Creasman’s rhinoplasty are performed under a local anesthetic, with intravenous sedation. Patients are very groggy during the procedure, and are completely unconscious during the phase when the nose is being injected with local anesthetic. The nose is made completely numb. Though patients sometimes report remembering movement, you will feel no pain. Very rarely, a general anesthetic is requested by the patient or is necessary for the nature or extent of the procedure. A general anesthetic request would involve additional charges from the standard fee.

The procedure usually takes about two hours, but on rare occasions longer. After lifting the skin off of the skeletal framework of the nose, sculpting of that framework is carried out. The exact nature of that sculpting depends on your particular problem and will need to be discussed at the consultation. If the nose is being reduced in size, the nasal bones are carefully fractured toward the conclusion of the procedure. A splint is applied and the nose is not usually packed. Sometimes, only tapes support the nose while it is healing. The stitches are self-absorbing and do not require removal. In the event that an incision is made across the columella (vertical strip of tissue separating the nostrils), skin stitches are placed which require removal in 3-5 days.

Following a brief monitoring period in our recovery room, you will be discharged into the company of an adult escort.

The Post-operative Period

You should anticipate that you will feel and look puffy and swollen during the first 2-3 days after your procedure. Though there is some pain in the first 24 hours, after this there is usually just a feeling of pressure and stuffiness. It is advisable to keep your head elevated above the level of your heart for the first few days to reduce swelling. Bruising around your eyes is to be expected, and usually peaks at 48 hours, quickly subsiding in 5-7 days. Ice compresses over your eyes will help to reduce this, but in all likelihood, you will look worse than you feel. You may have some oozing of blood from your nostrils, which is collected in a gauze bandage you will be asked to change every several hours during the first several days.

At 3-5 days the splint is taken off your nose. You will still need to be careful to not blow your nose for about two weeks, and to avoid any compression on your nose or blunt trauma for about six weeks. Eyeglasses should be taped to the forehead off of the bridge of the nose for the first 2-3 weeks, while the tissues heal. Avoid bending over for at least 3 weeks. 

Though you should be able to return to most sedentary work in a couple of days, you will still not feel normal for several weeks to months after surgery. The nose might feel numb for months, especially if a lot of work is done on the tip. It is advisable to avoid strenuous activity such as exercise for about four weeks, as this will delay your healing and could lead to bleeding or prolonged swelling.

It is not uncommon to feel dissatisfied with the appearance of the nose in the immediate post-operative period, as the tissues are still quite swollen and much of the detail still has yet to be seen and appreciated. It is not unusual for friends or family to offer unsolicited and often negative critique during this period, when you are particularly sensitive and vulnerable. It is wise to take a “wait and see” approach, as the appearance of the nose will change significantly during the first three months, and even up to the first year or two. It is important to be patient during this period of time.