I’ve heard there are two types of rhinoplasty, “open” and “closed”. What do you prefer?
“Closed” rhinoplasty refers to a form of limited surgical access in which all of the surgical incisions are hidden within the nostril. Because of the limited exposure the “actual” surgeons vision is limited. As a result, many surgeons prefer the “open” rhinoplasty approach, which connects the nostril incisions at the columella.
Although the columellar incision is initially visible, when carefully re-approximated, it seldom results in an objectionable nasal scar and it often fades completely. The choice in my opinion should really be based on patient anatomy, preference and expected outcome. If the rhinoplasty concerns mainly the tip or its a revision the going open is the more likely option. Otherwise I prefer the closed approach.
I’ve decided to undergo rhinoplasty, but I’m afraid of having anesthesia. What are my options?
In my opinion, general anesthesia is superior to intravenous sedation (IV sedation) in all respects. In most hospitals, the cost is equivalent. But unlike IV sedation where patients may endure unpleasant sights, sounds or even surgical pain, with general anesthesia there is no conscious awareness and comfort is unsurpassed.
Because all of my patients receive their general anesthetic in a fully-accredited hospital facility with a board-certified MD anesthesiologist present for the entire operation, safety is also optimized. Although both anesthetic options require drugs to induce unconsciousness, in the case of IV sedation, the anesthesiologist (or nurse anesthetist) must walk a fine line too much anesthesia and the patient may stop breathing; too little anesthesia and the patient may experience pain or become confused, uncooperative or even combative during surgery.
In contrast, with general anesthesia, a breathing tube and ventilator allows the anesthesiologist to more easily maintain a steady level of deep anesthesia in the patient, without the risks of awareness, sudden movements or an unprotected airway. In addition, non-narcotic general anesthetic protocols developed specifically for nasal surgery are seldom associated with post-operative nausea or other common anesthetic side effects.
However, perhaps the biggest advantage of general anesthesia is superior blood pressure control. By maintaining a comparatively low “resting” blood pressure throughout the entire operation, bleeding is minimized and post-operative swelling, inflammation and bruising are all significantly reduced.
Can my breathing be improved after rhinoplasty?
When I perform rhinoplasty I also deal with any breathing issues. Any standard approach involves a consultation with my ENT associate who performs endoscopy in order to visualize everything in detail. If correction of septum or the turbinate is necessary it also performed at the time of rhinoplasty. Improving both form and function is feasible and affordable.
How long do I need to be of my everyday routine?
I advise my patients that they will not be very social for the first 7-10 days. That largely depends on the extent of surgery. When there is no need for nasal bone fracture the swelling and bruising is significantly reduced so you can return to your everyday activities faster. In general you should have an easy going 15 days post surgery. Going to the gym will have to wait at least 6 weeks.
How long before I see the results?
As a world wide standard the final result after a rhinoplasty will show post surgery after 12-18 months depending on gender and skin thickness. That doesn’t mean you have to wait that long to visualize the result. Even after the first week you can start to comprehend the new shape of your nose. But still waiting is the best advise I can give. There will be times that swelling can make you wonder of the outcome, of your choice or your surgeon. Be patient.
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