Rhinoplasty or Nose Job

Dr.Ali Karbalaeikhani
Plastic Surgeon In Iran Tehran

What is rhinoplasty?

Rhinoplasty enhances facial harmony and the proportions of your nose. It can also correct impaired breathing caused by structural defects in the nose.

Rhinoplasty surgery can change:

·         Nose size in relation to facial balance

·         Nose width at the bridge or in the size and position of the nostrils

·         Nose profile with visible humps or depressions on the bridge

·         Nasal tip that is enlarged or bulbous, drooping, upturned or hooked

·         Nostrils that are large, wide, or upturned

·         Nasal asymmetry

If you desire a more symmetrical nose, keep in mind that everyone’s face is asymmetric to some degree. Results may not be completely symmetric, although the goal is to create facial balance and correct proportion.

Rhinoplasty to correct a deviated septum

Nose surgery that’s done to improve an obstructed airway requires careful evaluation of the nasal structure as it relates to airflow and breathing.

Correction of a deviated septum, one of the most common causes of breathing impairment, is achieved by adjusting the nasal structure to produce better alignment.

Rhinoplasty cost

The average cost of rhinoplasty is range from 5,000,000 Toman t0 10,000,000 Toman.

Rhinoplasty surgery costs can vary widely about what we must do for our patient.

Rhinoplasty and health insurance coverage

When rhinoplasty is performed to improve breathing function, the cause is most commonly an obstructed airway.

This procedure, whether performed alone or in conjunction with cosmetic rhinoplasty, is considered reconstructive and may be covered by insurance.

This requires a detailed examination to verify the cause of your breathing impairment and prior authorization from your insurer.

Who is the Ideal Candidate for Rhinoplasty?

The best candidates for nose reshaping have realistic expectations about what surgery can accomplish. Dr. Karbalaeikhani carefully screens each patient to ensure that they are physically, emotionally, and financially prepared to undergo this major cosmetic procedure. During an in-person consultation, each patient will be thoroughly examined to determine if the patient is a good candidate for nasal surgery and to create an individualized surgical plan to achieve the desired goals. Dr. Karbalaeikhani Center offers you 2D and 3D imaging to simulate the proposed before-and-after results of rhinoplasty surgery.

If you are considering rhinoplasty but live outside the Tehran, our Rhinoplasty Center offers you Email consultation please send your opinions to our Email at alikhanikhani@gmail.com

Rhinoplasty recovery

During your rhinoplasty recovery, a splint and/or packing will likely be placed inside your nose and a splint or bandages placed on the outside to support and protect the new structures during initial healing.

While initial swelling subsides within a few weeks, it may take up to a year for your new nasal contour to fully refine. During this time you may notice gradual changes in the appearance of your nose as it refines to a more permanent outcome. 

Swelling may come and go and worsen in the morning during the first year following your rhinoplasty surgery.

You will be given specific instructions that may include:

·         How to care for the surgical site

·         Medications to apply or take orally to aid healing and reduce the potential for infection

·         Specific concerns to look for at the surgical site or in your general health

·         When to follow up with your plastic surgeon.

Be sure to ask your surgeon specific questions about what you can expect during your individual recovery period:

·         Where will I be taken after my surgery is complete?

·         What medication will I be given or prescribed after surgery?

·         Will I have dressings/bandages after surgery?

·         When will they be removed?

·         Are stitches removed? When?

·         When can I resume normal activity and exercise?

·         When do I return for follow-up care?

Rhinoplasty before and after results

The results of rhinoplasty surgery will be long-lasting.

You can view before and after photos in our gallery.

While initial swelling subsides within a few weeks, it may take up to a year for your new nasal contour to fully refine. During this time you may notice gradual changes in the appearance of your nose as it refines to a more permanent outcome.

As your body ages, it is natural to have some gradual changes to your face including your nose. But most of your improvement should be relatively permanent.

A healthy lifestyle and life-long sun protection will help extend the results of your new appearance

 

 

Rhinoplasty surgery steps

Rhinoplasty surgery includes the following steps:

Step One: Anesthesia

Medications are administered for your comfort during the surgical procedure. The choices include intravenous sedation or general anesthesia. Your doctor will recommend the best choice for you.

Step Two: The incision

Rhinoplasty is performed either using a closed procedure, where incisions are hidden inside the nose, or an open procedure, where an incision is made across the columella, the narrow strip of tissue that separates the nostrils.

Through these incisions, the skin that covers the nasal bones and cartilages is gently raised, allowing access to reshape the structure of the nose.

An overly large nose may be reduced by removing bone or cartilage. Sometimes surgery of the nose may require the addition of cartilage grafs.

Most commonly, cartilage from the septum, the partition in the middle of the nose, is used for this purpose. Occasionally cartilage from the ear or rarely a section of rib cartilage can be used.

Step Four: Correcting a deviated septum

If the septum is deviated, it can be straightened and the projections inside the nose reduced to improve breathing.

Step Five: Closing the incision

Once the underlying structure of the nose is sculpted to the desired shape, nasal skin and tissue is redraped and incisions are closed.

Additional incisions may be placed in the natural creases of the nostrils to alter their size.

Step Six: See the results

For a few days splints and gauze packing will likely support the nose as it begins to heal. Get more information 

Rhinoplasty risks and safety information

The decision to have plastic surgery is extremely personal. You will have to decide if the benefits will achieve your goals and if the risks and potential complications of rhinoplasty are acceptable.

Your plastic surgeon and/or staff will explain in detail the risks associated with surgery. You will be asked to sign consent forms to ensure that you fully understand the procedure and any risks or potential complications.

Rhinoplasty surgery risks include:

·         Anesthesia risks

·         Bleeding (hematoma)

·         Infection

·         Poor wound healing or scarring

·         Change in skin sensation (numbness or pain)

·         Nasal septal perforation (a hole in the nasal septum) is rare. Additional surgical treatment may be necessary to repair the septum but it may be impossible to correct this complication

·         Difficulty breathing

·         Unsatisfactory nasal appearance

·         Skin discoloration and swelling

·         Possibility of revisional surgery

These risks and others will be fully discussed prior to your consent. It is important that you address all your questions directly with your plastic surgeon.

Your rhinoplasty consultation

During your rhinoplasty consultation is prepared to discuss:

·         Your surgical goals, with regard to both appearance and breathing

·         Medical conditions, drug allergies, and previous medical treatments

·         Current medications, vitamins, herbal supplements, alcohol, tobacco, and drug use

·         Previous surgeries

Your rhinoplasty surgeon may also:

·         Evaluate your general health status and any pre-existing health conditions or risk factors

·         The options available to you for nose reshaping

·         Examine and measure your face

·         Take photographs

·         Discuss your nose surgery options

·         Recommend a course of treatment

·         Discuss likely outcomes of a nose surgery and any risks or potential complications

It’s very important to understand all aspects of your rhinoplasty procedure. It’s natural to feel some anxiety, whether it’s excitement for your anticipated new look or a bit of preoperative stress. Don’t be shy about discussing these feelings with your plastic surgeon.

 

Preparing for rhinoplasty

In preparing for rhinoplasty surgery, you may be asked to:

·         Get a lab test

·         Take certain medications or adjust your current medications

·         Stop smoking

·         Avoid taking aspirin, anti-inflammatory drugs, and herbal supplements as they can increase bleeding

Dr. Karbalaeikhani will also discuss where your procedure will be performed.

Rhinoplasty may be performed in an accredited office-based surgical facility, a licensed ambulatory surgical center or a hospital. Be sure to arrange for someone to drive you to and from surgery and to stay with you for at least the first night following surgery.

Post-operative Care Instructions:

Sleeping position:

 

·         During the first 7 days the head should be positioned higher than normal. Using two pillows will be helpful.

·          It is best to sleep on the back, and avoid sleeping on the stomach. It is also possible to sleep on the sides; however, the nose should not be in contact with anything and should not be under pressure. The side of the face which you sleep on might become more swollen.

Nutrition:

 

·         It is essential to stay fasting 2-3 hours after the surgery.

·         After that, if not nauseous, you can drink water, light tea and juice using a spoon.

·          In the first 24 hours only liquids and very soft food can be consumed. From the second day till two weeks a normal diet including soft foods should be adopted. During this time, avoid foods which are hard and require a lot of chewing such as apples and carrots.

·         If there are sutures in your mouth or under the upper lip, it is important to consume soft foods for two weeks and wash your mouth every time after eating.

·         For 2-3 days after the surgery due to nasal congestion and stress you can lose your appetite, however it is important to eat so you can avoid feeling weak or having blackouts.

·         Natural fruit juice helps the recovery of inflammation. Concentrated juices do not help a much. Pineapple is as useful as other fruits thus any available fruit can be substituted.

·        Medications:

 

·          Take all your medications as prescribed, do not refill or use other OTC’s without consulting your surgeon. If you have allergies to medications or in case of any side effect inform your surgeon as soon as possible.

·          If you have pain, only take the painkillers that are prescribed for you.

·          Do not use nasal drops or nasal spray (e.g. phenylephrine), without consulting your surgeon. Generally, they are not necessary but they are rarely used when the nose is blocked and breathing is impossible or before taking flights. If they are prescribed it will be in small dose.

·          After being discharged from hospital in case of nausea, vomiting, breathing problems, diarrhea, hives, fever (above 38 °C measured from under the tongue) and any redness or pain in the area of surgery contact your surgeon as soon as possible.

 

Bruises and inflammation:

 

·        From 24-72 hours after surgery the bruises may get worse. Bruised and swollen eyelids and cheeks, blood spots in the eyes and watery eyes are normal for a few days after the surgery.

·          For the first 24 hours after surgery use ice packs (if the surgeon approves) around the nose to reduce swelling and bruises (use crushed ice wrapped in a cloth or ice packs). Do not place the ice directly on the skin. Also, do not put pressure on the splint and make sure the splint does not get wet or damp.

·          There are a few factors that can increase bruising such as:

·         constant movement of the head, straining,

·         low positioning of head

·          using blood Anti-clotting medications before the surgery,

·          gagging and vomiting after surgery,

·         blood clotting diseases, which are not noticed in investigations prior to the surgery,

·          And menstrual cycle at the time of the surgery.

·          Crying after surgery increases the amount of swelling.

·          Majority of the swelling will decrease during a few weeks after surgery, however complete recovery (specially the swelling on the tip of the nose) and establishment of final appearance of the nose will take at least a year. In fleshy noses this time may increase to 3 years after the surgery.

Nasal Packs, stitches, splint and plaster:

„h The gauze in front of the nostrils might need to be changed due to bleeding. The nurse can change it while you are hospitalized. After discharge, when the gauze needs to be changed, carefully take it off, gently clean the blood around the nose and lips with a damp cotton and replace it with another gauze. Do not be scared of cleaning the blood around the nose and lips.

„h Depending on your surgeon¡¦s decision, the nasal pack will be removed 1-3 days after the surgery. The surgeon or trained medical staff will remove the nasal pack in the hospital or doctor¡¦s clinic. Do not attempt to remove your nasal pack or let anyone else to remove it , since it may cause severe bleeding.

„h Removing the nasal pack would be easy and not painful, so there should be no worries.

„h After removing the nasal pack, a small gauze will be placed in front of your nose to absorb the discharged blood; it might need to be replaced. After the bleeding stops( usually one day after the nasal pack is removed) the gauze can be taken off.

„h The patient with severe nasal septum deviation may need nasal pipes instead of the nasal pack; these nasal pipes allow breathing through the nose. The nasal pipes are removed after 1-3 weeks by the surgeon. The pipes are fixed in position, so it should not be manipulated under any circumstances. In case of blockage of the pipes due to blood clotting or secretions, wash your nose with sodium chloride solution until normal breathing is reached.

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„h Do not remove, replace or touch the tape and splint without consulting the surgeon as this can affect the shape of the nose. If for any reason the tape and splint get wet or they come off,contact your surgeon immediately and do not take any actions by yourself.

„h The splint will be removed 10-12 days after the surgery. The nose will be taped afterwards and after 5 days you can remove the tapes yourself.

„h After removing the splint the tape is required for 5 days or up to 7-14 days. It is rare that the surgeon recommends taping for a longer period (which is definitely no more than a month). Taping for a longer period of time will not affect the shape of your nose; do not insist to have it for longer.

„h If the tape causes allergy inform the surgeon so that he can replace it with a tape for sensitive skin.

„h The itchiness and discomfort under the tape or splint is because of spots, sweating and allergies. Normally, it will disappear after 24 hours and does not need any more attention. Rarely, a long treatment might be needed due to a severe allergy reaction.

„h The stitches are dissolvable and normally will come off after one months. The solid pieces which are felt in the nostrils belong to the stitches, they are disposed with time.

„h If there are external stitches the surgeon will remove those 7 days after the surgery.

„h For travelers, the splint will be replaced 5 days after surgery and 7 days later, the splint should be removed by the patient by soaking it first.

Washing inside the nose:

„h Starting a day after removing the nasal pack, the patient should start washing inside the nose with sodium chloride saolution. This helps to prevent any blockage and keep the air stream open through the nose.

„h Sterile sodium chloride 9% solution and a 10 ml syringe should be purchased from the pharmacy which are OTC and do not require prescription.

„h Fill the syringe with sodium chloride solution. Standing against the mirror, tilt your head down, hold the syringe in front of the nostrils and flush the solution into the nostrils so that the excess liquid is poured into the sink. Blow your nose carefully but do not squeeze the nose.

„h Repeat the rinsing process as above for a few times for both nostrils.

„h Be careful that while washing your nose the split and tapes do not get wet or damp.

„h The above process is recommended twice a day (especially before sleep). Continue to rinse your nose for 2-3 years after the surgery.

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Work out and strenuous activities:

„h Stay in bed 8 hours after the surgery and try to remain in bed. If it is necessary to get up ask for assistance and be very cautious. There is a high possibility that you might feel dizzy and fall.

„h For the first 3 weeks do not do any heavy sports which can increase your heartbeat. Do not bend over or lift anything more than 5kg. At the end of 3 weeks you can slowly return to normal activities.

„h From week 4 to 6 you can start mild work out that do not require physical contact (e.g. running, aerobics, mild mountain climbing, ping pong etc.). Strenuous activities which involve physical contact (e.g. football, volleyball, basketball etc.) are only allowed at least 6 months after the surgery.

Washing and showering:

„h Carefully and gently clean the face with a moist cloth. You can also clean the upper lip and below the nostrils. Do not rinse the face with water under any circumstances.

„h For 2-3 days after the surgery washing the body below the neck is allowed.

„h To wash your hair, sit on a chair, tilt your head backwards and by the assistance from someone wash and rinse your hair away from your body so that the split and tapes do not come in contact with water.

„h To avoid dampening the splint, keep the humidity in the bathroom very low.

„h You should not wash your face whilst having the tape and the splint.

„h When you are advised to remove the tapes yourself. Take a shower and wash your body and hair as usual and at the end gently remove the tapes which have been completely soaked with water. Wash the skin of the nose with soap and water in an upwards direction to remove any dirt or remainder of the tape.

„h After removing the splint slowly clean the nostrils with damp q-tips (ear swabs) and apply some antibiotics ointment (such as sterile eye Gentamicin or Erythromycin ointments). Do not insert ear swabs more than the cotton ends.

„h After removing the splint and tapes you can cleanse the nose skin with water and soap. In case of dry skin you can apply moisturizing lotions. Also, there is no problem in using make up on the nose.

Brushing the teeth and mouth wash:

„h You can start brushing your teeth a day after the surgery; it should be done slowly to avoid the movement of the upper lip.

„h You can also wash your mouth with mouth wash.

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Swimming and sauna:

„h Swimming is forbidden up to two months after the surgery especially in chlorine water pools, since the chlorine may damage the nose tissues.

„h Due to the numbness of the nose,using wet and dry sauna is not recommended up to two months after the surgery.

Bleeding nose:

„h In case of severe or fresh bleeding (in which you will need to replace the gauze in front of the nostrils more than every half an hour) follow the instructions below:

Stay calm and sit down, squeeze the nose with two fingers and tilt your head backwards and wait for 15 minutes. Following these steps the bleeding will be under control and there is no reason to panic. After the bleeding stops, do not insist on cleaning the inside of the nose and removing the clots immediately as this can again initiate another bleeding. Do not touch the nose for a few hours to avoid bleeding. In case the bleeding did not stop or it started again contact the surgeon immediately.

Post-operative surgery, dental visit and pregnancy:

„h It is advised that any non-emergency surgery which is not associated with the nose and the surrounding area should be delayed a month after Rhinoplasty.

„h Any dental and orthodontic treatments are preferably delayed at least 6 months (in case of emergency 3 months) after Rhinoplasty.

„h Lasik eye surgery can be conducted a month after Rhinoplasty.

„h Skin laser and hair removal (without direct contact with the nose) can be done a month after the surgery.

„h Women should delay pregnancy up to 6 months after the surgery.

Traveling:

„h It is advised to avoid traveling for up to 3 days after Rhinoplasty.

„h In case of traveling with an airplane and still having the splint you may need to have a permission medical form for boarding which has been filled out and stamped by your surgeon.

Driving:

„h It is advised to avoid driving for up to 3 days after Rhinoplasty.

„h If there is no urgency start driving after removing the splint, and in case of necessity you can drive after 3 days. Until your general condition is not back to normal driving is not recommended.

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Do not worry in the following cases:

„h Early after surgery and until removing the nasal pack, the nose is blocked and there is no choice but to breathe through the mouth. This will cause your mouth to be dry; you do not need to worry about this.

„h After removing the nasal pack breathing through the nose will temporarily get better, however difficult breathing through the nose and congestion may continue for 2-3 weeks due to internal inflammation, this problem will gradually be eradicated.

„h Sore throat after the surgery (which will take up to 48 hours) is due to the anesthesia and it is not a sign of flu or cold. Warm liquids can help cure sore throat faster.

„h For 3-4 days after Rhinoplasty, blood discharges from the nose and the throat are normal. You may need to change the gauze in front of the nostrils. After the blood discharges stop you can remove the gauze.

„h Congested nose and experiencing difficulty breathing is normal and will disappear gradually. Nasal drops and sprays are not helpful and necessary. If the nose is severely congested that breathing is impossible, inform your surgeon as soon as possible.

„h Nostrils will not be as symmetric as prior to the surgery for the first 3 months this is normal and therefore you should not worry.

„h Due to the change of the nose size and the activity of oil glands on the skin, the nose skin will appear oily. In addition to swelling, these two factors cause a shiny appearance of the nose. However it will improve gradually.

„h Nasal tip, nose skin, upper lip, and rarely the front upper teeth may feel numb which will disappear in a few months.

„h After the surgery whilst smiling and talking the nose might feel stiff, hard and not as flexible as prior to the surgery. This does not draw anyone¡¦s attention and will improve progressively.

„h After removing the splint the nose might start swelling and will look different from the past it will recover gradually and return to its original form.

„h Spots on the nose can be due to antibiotics, allergies to the tape, stress and lack of skin hygiene while the splint was on. If the reaction is mild it will heal itself otherwise, a dermatologist consult may be necessary.

Important hints:

„h It is important not to rub or massage the nose.

„h Do not chew gum for 3 years and do not be exposed to allergy causing materials.

„h The head position during daily activities does not affect the shape of the nose. Unlike the common belief, there is no harm in bending your head while it is above your heart level.

„h To prevent bleeding, do not blow your nose or sneeze for two weeks. Open your mouth during sneezing.

„h During the first 4 weeks avoid any impact and strike to the nose.

„h In case of any impact during the first 6 months especially in the first month contact your surgeon.

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„h Do not wear glasses and sunglasses for 6 weeks after the surgery. In case of necessity, the glasses should be tightened on the head with a string so it does not touch the nose. Contact lenses are the best options during this period of time.

„h The skin nose is very sensitive after surgery so avoid direct sun for at least 6 months. When it is necessary to go out in the sun wear UV-A, UV-B proof creams with SPF-30 and up.

„h Do not smoke and take aspirin or aspirin containing medicine for 2 weeks after the surgery.

„h To speed up the healing process and decrease the side effects, reduce talking to the minimum and avoid severe laughing or crying for the first 10 days after the surgery.

„h A beautiful nose is not necessarily smooth once touched and also not necessarily symmetric and perfect. The most important factor is that the nose seems good upon looking, and any irregularities that are only noticed by touching are not important.

„h You need to be tolerant during recovery after Rhinoplasty. The final results reveals after a few months or even after 1 year (in fleshy noses sometimes up to 3 years). Do not judge the final shape of the nose quickly. The nose is swollen and looks bigger during the first month. The nasal tip looks upper and bigger than usual. These issues will improve gradually and should not make you worried. Do not pay attention to other people¡¦s opinions and comments. Ask your questions only from your surgeon. It is wrong to compare the shape of your nose with others; it will only lead to psychological damage.