General Information
Nasal surgery has undergone considerable innovation in the last few years.
Customization
Nasal surgery is tailored now to the patient’s anatomy and desires. The “cookie cutter” formula for nasal surgery is now considered unacceptable. All nasal surgeries are performed differently and tailored to the patient.
Breathing
We now pay far more attention to breathing by recognizing the anatomy of the nasal valves.
Open Rhinoplasty
For different tip problems, it is often possible to achieve beautiful, inconspicuous results with this newer technique, allowing precise sculpting of the delicate tip cartilages.
The Bones
Often manipulation of the bones can be avoided with new septal graft techniques. This greatly reduces healing time and bruising. Nasal surgery is usually performed to alter the size and/or shape (Rhinoplasty) and the function of the nose.
The exact appearance of the nose cannot be determined before surgery is carried out. A patient cannot expect to be able to select a particular nose since changes are limited by such factors as skin and bone thickness, nostril size and general facial configuration. In general, the doctor’s surgical and aesthetic judgment must be trusted.
Pre-operative photographs are very important to the plastic surgeon and are taken on all of our patients. The photos are reviewed by the doctor before and during surgery and are used for comparison with the post-operative results. The pictures are taken during the first visit to the office and become a part of the confidential medical record.
The operation can be performed in either our office surgery center or the hospital. If the office surgery center is selected you will return home 2 to 3 hours after surgery. If the hospital is selected, you may go home the same day or you may stay overnight and go home the next morning.
Recuperative period of two weeks away from your customary work or school activities should be planned.
The Anesthesia
Most nasal surgery is performed under a “light” general anesthetic (patient is asleep). This technique provides excellent operating conditions while affording maximal patient comfort and safety. Occasionally, in nasal procedures requiring less extensive reconstruction (e.g., tip of the nose), a local anesthetic with intravenous sedation can be comfortably performed. This technique involves the combined administration of intravenous sedative drugs and the injection of local anesthetic into the tissues of the nose while the patient is asleep. Local anesthetic injection is administered by the surgeon; the general anesthetic or intravenous sedation is administered by a licensed, professional anesthesia provider who remains in attendance throughout the operation. All of the required monitoring, anesthetic delivery and emergency equipment are present at all times. The appropriate anesthetic will be explained and discussed fully by our anesthesiologist prior to your surgery.
Pre-Operative Preparation
You must be in good health to undergo any elective cosmetic surgery. A physical examination and routine lab work will need to be performed by your own primary physician. If you do not have a primary doctor, we can refer you to local doctors in our area. We do not provide these services. It will be required that all this pre-op paperwork is in our office 1-2 weeks prior to surgery
It is very important that our office is aware of any medical conditions and all medications you are taking.
It is imperative that you not smoke 2 weeks prior to surgery, and 2 weeks after surgery. This would impede your healing greatly. Talk to us about options.
It is a required that someone drive you home upon your discharge. Also arrange for transportation to and from our office for your post-operative appointments until your doctor gives you permission to drive.
DO NOT take aspirin or aspirin-containing products for 2 weeks prior to surgery and for 2 weeks after surgery.
An adequate diet with vitamin supplements, especially Vitamin C, is recommended. You should be in the best nutritional state possible prior to surgery.
If you will be preparing your own meals at home after surgery, have on hand easy to prepare foods.
Have on hand at home, plenty of your favorite fluids- juices, ginger ale, etc. to drink after surgery. Chapstick is useful to have on hand to apply to your lips following surgery. Mouthwash will be needed to use in place of brushing your teeth during the 1st post-operative week.
The Surgical Procedure
The length of time required to perform the operation is 1 to 3-1/2 hours. The surgical procedure of remodeling excess bone and cartilage is usually done through incisions inside the nose, so the scars are not visible. Very large and wide nostrils may be corrected by removing part of the nostril next to the lip and cheek, leaving a fine scar along the nostril base. A newer technique allows this to be performed with no visible scars in many patients. At the completion of the operation, a light plastic splint is placed inside the nose. A plastic protective is placed over the bridge of the nose in order to hold everything in the desired position.
Possible Complication
Complications of nasal surgery are rare. Bleeding from the nose may occur and a temporary packing with surgical gauze may be necessary. Excess scar tissue may form under the skin during the healing process, causing swelling to last longer than the expected time. Swelling occasionally persists to the extent that a minor revision operation may be needed to obtain the best result. Infection post-operatively is very rare.
What to Expect After Surgery
Pain:
There is usually no real pain in the post-operative period. The usual complaints are those of discomfort due to headache and a feeling of stuffiness.
Pain medication:
Pain medication is made available in order to ensure optimum comfort post-operatively.
Swelling and Bruising:
These occur usually around the eyelids since these are the softer structures. The bruising is usually gone within 7-10 days as is a major portion of the swelling. Occasionally the white part of the eyes will become bloodshot. This is harmless and painless. Expect more swelling during the 2nd 24 hours than during the 1st 24 hours. There will be an unusual firmness to the tip of the nose due to the swelling and reaction of the surgical procedure. Subtle changes may persist for as long as a full year in some instances.
Bleeding:
Expect mild oozing of the blood-tinged fluid for a few days.
The Packing:
The packing will be removed in the office 24-48 hours after surgery.
The Splint:
The splint will be removed in the office 5-7 days after surgery.
Normal nasal breathing can take as long as two to three months to return, due to the swelling inside the nose. Because of the manner in which the nose swells following surgery, it sometimes appears that the nose has been shortened too much. This appearance may be present for as long as 3 weeks, but as the swelling subsides, the nose will come down and assume a more natural appearance. It is not unusual for a patient to go through a period of the “blues” and worry about the look of the nose. It must be remembered that it is impossible to judge the final result of surgery until all of the swelling has subsided.
Post-Operative Care
Apply ice pads to your eyes continuously for the first 2 days. The more diligent you are about applying the ice pads, the less likelihood of prolonged swelling and bruising.
Our office will provide you with an ice mask. You can also use frozen peas in a ziplock bag. Use a barrier (soft cloth) do not allow plastic to touch skin.
A soft light diet should be followed after tolerating clear fluids on the first day following surgery.
A soft diet should be followed for the next four days. Excessive chewing may cause bleeding and increase the swelling.
Do not drink alcohol for 4 or 5 days.
Change the “mustache” dressing under the nostrils carefully and only as necessary. If oozing seems to become excessive, apply ice to the upper lip and stay in a semi-sitting position. If this does not stop the oozing in approximately 1/2 hour, call the doctors office and do not panic.
Do not remove the packing or tamper with the splint. Avoid bumping your nose and avoid bending over.
Brush teeth very gently for seven days after surgery. Use a warm mouthwash, with a gentle massage to the gums with the fingers. Toothpaste may be used in place of the mouthwash. Brushing your teeth with a firm toothbrush may cause bleeding.
Do not blow your nose for the first week. You may sniff in gently.
Do not smoke for the first week.
Do not sunbathe or get overheated for the first week.
Lightweight eyeglasses should not be allowed to rest on your nose for 2 weeks after surgery. If you must wear glasses, wrap one end of a piece of tape around the bridge of the glasses and affix the other end of the tape to your forehead, lifting the glasses off the nose.
Contact lenses may be inserted 1 week after surgery. Do not spend time looking in the mirror. The nose is distorted for 1-2 weeks before it looks presentable.
Resumption of Physical Activities – General Rules of Thumb: Two, Four, Six Rule
First week:
TAKE IT EASY!! PATIENTS WHO ARE TOO VIGOROUS FREQUENTLY DEVELOP COMPLICATIONS!
At two weeks:
take long walks on a flat surface. No other kind of workouts. Any activity that would raise your blood pressure would compromise the healing incisions and newly developing blood supply.
At four weeks:
light exercise such as aerobics, but no weight training. Start light. For example, if you normally do 30 minutes on a treadmill, begin with 15 minutes, then increase as your body gets used to things. Use of vitamin C and E concentrate and scar-fade gel should begin as soon as the incisions are completely healed, usually 3-4 weeks.
At six weeks:
resume all previous activities with clearance from Dr. Moelleken. Avoid sun exposure to incision site for months following surgery, as this may result in a hyperpigmented scar.
