NOSE JOB/RHINOPLASTY/SEPTOPLASTY/INFERIOR TURBINATE REDUCTION SURGERY
This information provides you with general information which may or may not pertain to your case. Each patient is unique and you are encouraged to seek advice from Dr. Chow about any concerns. Every aspect of the surgery cannot be covered and you are encouraged to ask questions during your consultation.
Septorhinoplasty
Surgery to reshape the nose (septorhinoplasty) is a common plastic surgery procedure and is performed to improve the external appearance and/or internal breathing, which may have been a result of birth deformity, trauma, genetic influences, infection, aging, tumours or other diseases. Nothing has a greater impact on how a person looks than the size and shape of the nose. Because the nose is the most defining characteristic of the face, a slight alteration can greatly improve one’s appearance. It is arguably the most underrated operations in terms of difficulty by many surgeons from different disciplines, however, in the correct hands it is also one of the most satisfying. If you are considering having a rhinoplasty, it is of the utmost importance that you see a fully trained and accredited facial plastic surgeon.
Changing the size or shape of your nose includes:
• Removing an unwanted hump
• Altering the shape of the tip or bridge of your nose
• Narrowing or expanding the width of your nostrils
• Improving symmetry, correction crooked nose
• Changing the angle between your nose and upper lip
• Improving breathing
• Improve snoring and obstructive sleep apnoea
• Improving the profile or augmentation of the dorsum of the nose – augmentation rhinoplasty /nasal implant /nasal augmentation
Results following rhinoplasty vary depending on each person’s facial shape, facial asymmetry, ethnicity, gender, skin, age and shape/structure of the nose (bone/cartilage). It may take years for the final appearance to be appreciated so please be patient and accept it will be a long journey. Asymmetries in the final appearance of the nose may occur as it is difficult to predict how your body will heal after surgery. Therefore, it is important to be realistic about what can be achieved with surgery and the complications and limitations of surgery before proceeding. Open communication about what results you want with your surgeon prior to the surgery is important and generating mutually agreeable/reasonable goals is the first step in obtaining a satisfying result. You must feel comfortable and trust your surgeon. A second opinion is advised if you have doubts.
Rhinoplasty is very complex and one of the most technically difficult operations. The aim is to improve the nose cosmetically as well as functionally. There is no point making the nose look ‘beautiful’ without being able to breathe well afterwards. It is important to remember there is no such thing as a ‘perfect nose’ and the aim of rhinoplasty is to make the nose blend into your face. Dr. Chow’s philosophy in approaching rhinoplasty surgery is to create a natural and balanced appearance – subtle changes can achieve dramatic results.
Cosmetic surgery is not a guarantee of happiness, success in life or relationships, and you need realistic expectations before embarking on surgery. Please think carefully about the reason why you are considering surgery and why at this point in your life. Suitable patients for cosmetic surgery are currently happy in their life and not obsessed about their appearance. These patients are seeking to enhance their appearance with subtle changes and realise the final result will not be perfect. If you are constantly thinking about the appearance of your nose negatively and how others may perceive it, experiencing life problems and other stressors, you may require psychological help rather than cosmetic surgery.
Techniques
Rhinoplasty takes between 2-4 hours depending on the complexity of surgery. There are two basic techniques for surgery – closed or open. The only difference is the extra external incision at the skin of columella between the nostrils for added exposure. The remainder of the incisions are made on the inside of the nose. The majority of my rhinoplasties are open as this allows direct visualisation of the cartilage and bone. The columellar incision heals well with a small scar that is difficult to detect months after surgery.
Rhinoplasty can improve the airway, nasal tip, nasal hump and width of the nose. Sometimes, chisels are required to make a cut into the nasal bone. Certain amounts of underlying bone and cartilage are removed, added to, or rearranged to provide a newly shaped structure. For example, when the tip of the nose is too large, the surgeon can sculpt the cartilage in this area to reduce it in size. Sometimes, rhinoplasty is performed for functional reasons to achieve the best possible airway and reduce collapse of the sidewalls of the nose. Surgery for improving breathing and airway are not always adequately
addressed with straightening the septum and removing inferior turbinates alone. The tissues are then redraped over the new frame and the incisions are closed.
Dr. Chow may take grafts from ear cartilage, rib cartilage and/or temporalis fascia (under the scalp above the ear) to shape and strengthen the nose. There is no change to the form or function of the ear. The incisions heal up very well.
Nasal operations are performed under general anaesthesia. A pack may be placed inside the nose and removed 1 day after, or plastic splints are left for a week. A small plastic cast will be applied to the external nose for the first week and most of the swelling will be gone by the time the cast is removed. 80% of the swelling should be improved at 6 weeks, 90% at 3months and 95% at 6 months. The final cosmetic result is not achieved until 12 months to two years after the operation when the skin has reformed to its new framework.
Rhinoplasty in Teenagers: Skin type, ethnic background, and age are important factors to be considered in discussions prior to surgery. Before your nose is altered, you must have reached full growth, which is usually 16 years for females and 17 years for males. Exceptions are made in cases where breathing is severely impaired.
Nasal Augmentation / Augmentation Rhinoplasty /Nasal Implant
In certain ethnic background (such as East Asian) or due to genetic, developmental or acquired conditions the nasal dorsum or profile is under developed or low. This may be associated with a small round nasal tip and wide nasal base or ala. The nose can be augmented or enhanced to improve the nose aesthetically, by harmonising it with other facial features. This is performed by using
1. Autologous material (from your own body) – cartilage (septal or nasal, conchal or ear, costal or rib), bone (rib, calvarial) or fascia (temporalis), or combination
2. Alloplastic or synthetic material– Gortex, Silicone, Silastic or Medpor
Each material has its advantages and disadvantages. Dr. Chow usually prefers to use autologous material first and synthetic material as an addition if required. Patients from East Asian background commonly request nasal augmentation with double eyelid surgery blepharoplasty together.
Additional Surgery
Before deciding on rhinoplasty, Dr. Chow may advise if any additional surgery is recommended to enhance the appearance of your face or improve chronic sinusitis. Patients may have Chin Surgery – Chin implant, Genioplasty/ Mentoplasty in conjunction with rhinoplasty to create better balanced features. Rhinoplasty can be combined with other types of rejuvenation surgery such as blepharoplasty, brow lift / forehead lift or facelift / mini face lift .
Patients may have endoscopic sinus surgery at the same time as rhinoplasty.
Initial Consultation
Some of the questions you may wish to ask are :
• Am I a good candidate for this procedure?
• What is a realistic outcome for me after surgery?
• How long will the operation take?
• What is the recovery time?
• What are the risks involved?
• Is post-operative medication necessary?
• What is the charge for the procedure?
It is a good idea to write down the answers Dr. Chow provides so that you can review these carefully later. The consultation also provides you with an opportunity to meet Dr. Chow to determine whether your personality and hers are compatible and that you feel comfortable with her as your surgeon.
Two consultations are usually required prior to rhinoplasty surgery to ensure preoperative counselling, photography and consent are performed thoroughly.
Medical History
It is important that you are candid with Dr. Chow and her staff regarding your medical history so that she can plan the best possible treatment. This information is strictly confidential. Please inform her of any:
• Previous facial and/or cosmetic surgery (nose, eyelids, breast etc.)
• Past and current medical conditions such as heart, lung and kidney disease, prolonged bleeding or excessive bruising, blood clots in the legs or lungs, or gastric reflux
• Current medications especially Aspirin, Anti-inflammatories, Warfarin, Plavix / Iscover, Xarelto or Rivaroxaban, blood thinners, Insulin and oral contraceptive pills. Over the counter products such as vitamins and herbal medications may also influence wound healing
• Allergies or adverse reactions to antibiotics, anaesthetic drugs or other medications
• Psychological and psychiatric illnesses
• Past keloid scarring or poor healing
• Connective tissue disorders such rheumatoid arthritis, lupus erythematosis, scleroderma or similar
• Previous radiotherapy to the head, neck or chest areas
Follow-up care is vital for this procedure so that healing can be monitored. Obviously, anything unusual should be reported immediately. It is essential that you keep your follow-up appointments. Follow up appointments are required up to 1 year after the operation.
Possible Complications
Modern surgery is safe but does have risks. Complications can occur despite the highest standards and world’s best practice principles used by Dr. Chow. It is not possible to list all the risks but you should be informed of the common side effects and benefits so that you can make an informed consent. Dr. Chow will discuss these in greater detail at consultation. You should write down any particular questions or specific concerns.
The potential risks are
General risk of surgery
• Wound infection – may require antibiotics
• Bleeding, blood clots or seroma
• Chest infection
• Sore throat from the breathing tube
• Scars that become raised (hypertrophic or keloid)
Specific Risks
• Bruising and bleeding for first 7-10 days
• Return to hospital or operating theatre to control post operative bleeding (less than 1%)
• Donor graft (ear or rib) harvest site complications if applicable. Pneumothorax (punctured lung) is a rare complication of rib (costal) cartilage harvest.
• Swelling and numbness for up to twelve months
• Asymmetry or crooked nose
• Painful or unattractive scarring
• Subjective dissatisfaction with the final outcome
• Numbness of the tip for 3-6 months
• Nerve damage – Numbness in the tip of the nose, upper front teeth, or roof of the mouth following surgery is to be expected because the intranasal surgery has caused a temporary disruption of some of the nerves in this area
• Recurrence of the original problem
• Worsening of the deformity or nasal obstruction
• Persistent deformity or nasal obstruction
• Septal perforation, whistling, crusting and ongoing bleeding
• Revision surgery 5-10%
• Saddle deformity – flattening of nose
MAKING A DECISION TO PROCEED WITH SURGERY
Whether your surgery is desired for functional or cosmetic reasons, your choice of a qualified facial plastic surgeon is of paramount importance. As a Facial Plastic and Reconstructive Surgeon, Dr. Chow is trained in both Otolaryngology Head & Neck Surgery and Facial Plastic surgery, which provides you, the patient, with the highest level of training and expertise. You should be informed as much as possible before making a decision to proceed with plastic surgery.
Cosmetic rhinoplasty is an elective procedure, which means it is a personal choice and not necessary for maintenance of good health. You can expect a thorough explanation from Dr.Chow regarding the various types of surgical procedures. Dr. Chow will inform you of the best methods of anaesthesia, the surgical facility where your procedure will take place and the benefits and risks involved in surgery. Following a joint decision by you and Dr. Chow to go ahead with a procedure, photographs of you will be taken and Dr. Chow will further discuss the options available.
A good rapport between you and Dr. Chow, and realistic expectations are prerequisites for successful outcome. You are most likely to be pleased with the results if you have a realistic idea of what surgery can and cannot do. The goal is for a natural, aesthetically pleasing and balanced look.
Whilst every effort is made to produce a satisfactory improvement in appearance and optimal result, postoperative irregularities and asymmetry do sometime arise. Whilst such things can often be corrected, no guarantees are made in regards to eventual final results.
Please do not hesitate to seek another doctor’s opinion if you are uncertain about Dr. Chow’s advice. If you have any concerns please contact Dr. Chow’s office. Remember, we are all here to give you the best possible care.