What do you don’t like about your nose?
This is a very specific question that helps me identify the problem that is bothering you and I can compare your concern with actual physical finding on your nose. If it matches I am confident to give a good result. If I feel it does not match than there may be some element of body dysmorphism that is not a good indication for rhinoplasty. I suggest before coming for a consultation just stand in front of mirror and identify your concerns. Alternatively take a portrait size photo in different angles such as frontal, 3 quarter view, profile view, and basal view.
What are your expectations?
It is very important to understand patient’s expectations. Some people prefer minimal changes that will not be obvious, others prefer radical changes. Some patients ask for natural results, which I am happy and skilled to provide. I am not comfortable with unnatural looks and visible scars that can give away (tell tale) signs of surgery.
I will also ask details of airway problems, sinus infections etc to evaluate your functional status of the nose.
I will than grade you according to ASA (American Society of Anesthesiologists) physical status classification system. This will help me assess your fitness for surgery.
The levels are as follows; ASA type
- Healthy person.
- Mild systemic disease.
- Severe systemic disease.
- Severe systemic disease that is a constant threat to life.
- A moribund person who is not expected to survive without the operation.
What you like or don’t like about the shape of the Nose that you desire?
I do not like to do Morphing in computer except for small changes such as hump removal, nasal tip width reduction, augmentation and tip elevation. These changes I can do in the computer and gives me an idea of what patients are thinking. Extensive Computer morphing can be unrealistic and cause
misunderstanding between patient and doctor.
I will then examine you in details and make a plan
I will examine your nose thoroughly in different angles. I will evaluate following-
- Facial proportion
- Bony structure of your nose
- Cartilage framework
- Tip structures
- All aesthetic lines and angles
- Balance of the nose
- Intranasal examinations for septum, turbinates and airway sphincters
What Rhinoplasty procedure is suitable for you?
Based on our discussion and finding of the problems, you may need-
- Endonasal or closed rhinoplasty
- Open tip rhinoplasty
The bone if required is shaped to suit your profile either by rasping or using an electric saw. The tip is than adjusted to balance the dorsum. This is done by various ways including removal of fatty layer called “SMAS”, trimming of cartilage, restructuring of cartilage, enhancing of tip using grafts etc. The septum and turbinates are addressed if necessary.
In Augmentation rhinoplasty there are few choices of grafts-
- Silicone Implant: Silicone (dimethylsiloxane) implants are very commonly used in facial cosmetic surgery since a very long time (1950′s). Silicone nasal implants are solid in nature unlike breast implant. In selected individuals silicone implant can be used to enhance the dorsum
of the nose and elevate the tip. It has some risks of infection, mobility and limited augmentation.
- Porex Implant: This is my personal preference. MEDPOR® Implants are biocompatible, porous polyethylene implants used for augmentation. It has specialized porous structure that allows for fibrovascular in-growth and integration of the patient’s tissue. It is more stable in long run. But also has some risks including infection, visible sharp edges in thin skin people and difficulty to remove if required in future.
- Cartilage Grafts: These are more natural autogenous material harvested from your own body. They are taken from septum of the nose, ears or chest ribs. Since there is a limited supply of cartilage except for costal cartilage they may not be enough in many situations.
- Bone Grafts: these are limited to reconstructive use only and not suitable for cosmetic surgery as it involves extensive surgery with
additional scars and pain.
What anaesthesia is used for Nose surgery?
It can be performed in Local anaesthesia and IV sedation (twilight anaesthesia) in many situations. But a complete septorhinoplasty requires general anaesthesia.
What are the risks of the surgery?
Rhinoplasty surgery does carry some risks, although in expert hands it is minimal. The risks include bleeding, infection, scars, deformities, need for a corrective surgery, altered smell sensation, implant displacements etc. The risks can be minimized if a proper protocol is followed and all the instructions are carried out by the patient.
What is the recovery process?
After the surgery a nasal splint is applied on the nose, sometimes there may be a pack inside the nose. There may or may not be a need for hospitalization depending upon the extent of the surgery. The nasal pack is removed in 24- 48 hours, sutures of open tip approach are removed on the 5th day and the splint is removed after 6-7 days.
There may be some bruising and swelling that may be visible for 5-10 days. Many patients are able to return to work in 1 week to 10 days time by using makeup to cover the bruise. Patients are able to socialize in 7-10 days time, but the patient will experience swelling, hardness, numbness and discomfort for few weeks. The nose can take about 4-6 months to completely heal from inside.
How to ensure natural looking nose?
The key to have a natural rhinoplasty is to understand the proportion of the nose, correct the deformity that is causing problem and keep the scars within the nose and nostrils. The commonest issues causing unnatural appearances are overdone nose, excessive thinning of the nose, scar in the alar groove area and breathing problems due to damage to sphincters.
How do I proceed from here?
Before you leave my office you will get a handbook that explains the details of before and after care, medications to avoid, risks and complications, financial agreement, consent and permission forms, medical history form etc. Please spend some time reading the booklet completely. My patient coordinator will get back to you with details of cost and booking protocol.
Then a preoperative appointment will be arranged where we will do complete medical checkup, measurements, Sizing, surgical planning, photographic documentation and other necessary documentations.