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If you are considering rhinoplasty in Southern California including Beverly Hills, Santa Monica and Long Beach from a Board Certified Female Plastic Surgeon continue reading ...


What is rhinoplasty? This is a surgical procedure which is done to improve the appearance of the nose and/or the ability to breathe through the nose. The operation, therefore, may be considered cosmetic, functional or, for some patients, both. Nasal deformities may be present at birth or develop with aging and growth. Traumatic injuries (broken nose) or changes from previous surgeries may result in significant deformity. (Chin augmentation with a small synthetic implant may help create better facial harmony and an improved profile and may also be recommended simultaneously.)

What features can be altered? Most often, patients request removal of a "hump" on the nose, refinement of a round nasal tip, or elevation of a drooping tip. Noses which are crooked, too wide, long pointy or flat may be improved. Realistically, there are limitations in achieving the final goal and the ultimate outcome will vary from patient to patient.

How are the breathing problems corrected? Frequently, the nasal septum (the cartilage separating the right and left nasal passages) is deviated and needs to be corrected. A crooked nose may worsen this disorder and therefore require correction at the same time. This operation is called a septorhinoplasty. Turbinates are parts of the nose which help to add moisture and filter inspired air. These structures can be enlarged for many reasons and contribute to airway blockage. When this occurs, the doctor will recommend their removal as part of the nasal surgery. Other problems such as narrowed passages and airway "collapse" may require placement of cartilage grafts for structural support. On rare occasions, scar tissue within the nose, from previous injury or surgery, may block air flow and require correction.

What type of anesthetic is used? Cosmetic rhinoplasties are frequently done with general anesthesia. Functional surgeries with septal turbinate, scar correction, or the need for grafts also require general anesthesia. These operations most often are outpatient procedures but on occasion an overnight hospital stay may be required for unusually long or difficult cases.

Where are the incisions? Most cosmetic rhinoplasties have incisions hidden within the nostrils inside the nose. A small "nick" in the skin is sometimes placed at the upper nose near the corner of the eye. More complex nasal operations often require a small incision in the skin at the base of the nose (columella). This tiny scar is barely visible yet it allows the surgeon to "lift" the nasal skin and directly vien all of the cartilage and bone requiring correction. This is termed an "open rhinoplasty". To narrow the base of the nose small incisions (Weir incisions) are placed in the groove where the nostril meets the cheek.

Where are grafts taken from? Cartilage and bone grafts are often taken from within the nose (septum). Ear cartilage, rib, hip, or outer portion of the skull are other possible grafts. Synthetic nasal implants which are made of silicone or Medpore , may also be used to build-up portions of the nose.

Will insurance pay for the surgery? Changes necessary to correct functional breathing problems or deformity from an injury should be covered by insurance. The insurance carrier will not cover charges that they determine are cosmetic in nature. Often this will not be determined until the insurance company reads the operative report and compares pre-operative and post-operative photos.

What is the recovery period like? Generally, there is a small plastic splint covering the nose which will be moved 5-10 days after surgery. Bruising around the eyes may last for 10-14 days. With functional surgery, plastic splints and/or packing may be used inside the nose. Much of the swelling is reduced within weeks of surgery with continued improvement over months. Areas of sensitivity or numbness will slowly resolve; the tip of the nose will feel stiff or "woody" and this will improve over the first several months. Other temporary conditions may include some airway or sinus blockage, nasal drainage, lumps and irregularities.

Are there alternatives? Cosmetic, functional , or a combination of these operations can be performed. The various use of incisions and implants are described above. Consent form - Rhinoplasty/Nasal surgery.

What are the risks of surgery?


1. GENERAL RISKS of surgery include infection, pain, delayed wound healing, hematoma (a collection of blood at the surgical site), bleeding, reactions to anesthetic. Smoking greatly increases many of these risks; therefore, you must stop smoking four weeks prior and four weeks after surgery.

2. BLEEDING: After surgery a "pad" may be placed under the nose to collect blood which is expected with early healing. These should be changed as they become saturated on rare occasions, persistent bleeding will require special packs or other treatment to correct the problem. This risk is increased in people who take aspirin or who bruise easily. Let your doctor know if this is the case. Do not aspirin or aspirin- containing products for two weeks before and two weeks after surgery. (See list of medications which may increase bleeding.

3. DISCOLORATION AND SWELLING are expected after surgery and resolve as previously mentioned. Occasionally "spider" angiomas (prominent veins) or persistent color changes of the skin will be noted.

4. SHIFTING OF BONES AND CARTILAGE can occur with healing resulting in a crooked or widened appearance. Septal deviation may recur or persist. These changes that occur from shifting may not be visible for many months.

5. IRREGULARITIES in bone and cartilage may be seen or felt. These frequently improve over months with healing. Sometimes these become more visible after weeks or months as swelling subsides. Some (not all) irregularities may be improved with minor "touch up" surgery . (See paragraph 13 on need for additional surgery)

6. INFECTIONS are unusual. These can be superficial and treated with oral antibiotics or rarely, if more severe, may require hospitalization. Synthetic implants may require removal if the infection does not subside. Even more rarely, grafts or implants can extrude or become exposed through the skin or nasal lining requiring removal.

7. SEPTAL PERFORATION: Infrequently, nasal trauma or septal surgery can result in a perforation, or hole, in the septum. This may require repair if symptomatic.

8. BREATHING OBSTRUCTION: Occasionally cosmetic changes in the shape of the nose can result in more breathing difficulty. Functional surgery may not completely improve breathing, on occasion relapse of obstruction can occur.

9. PAIN, NUMBNESS, SENSITIVITY: Pain lasting more that a week is unusual. There is usually more discomfort from the congestion and stuffiness. Numbness and decreased sensitivity may be replaced after several months, with increased sensitivity which can also last several months.

10. LOSS OF SMELL, TEAR DUCT DAMAGE: When changes in the sense of smell occur, this is usually temporary. The lacrimal drainage (tear duct) system lies within the nasal bones and only rarely is affected by nasal surgery.

11. PHOTOGRAPHY: Photographing , filming or videotaping of the treatment or procedure for educational or diagnostic use is a standard and required part of our patient care.

12. NO GUARANTEE: The practice of medicine and surgery is not an exact science. Although good results are expected, there cannot be any guarantee, nor warranty, expressed or implied, by anyone as to the results that may be obtained.

13. COMPLICATIONS AND ADDITIONAL SURGERY: Any of these problems or disorders noted above may require additional surgery, hospitalization, and time away from work. If this occurs, there will be additional costs for surgical fees, supplies, anesthesia, etc., depending upon the required operation. Complications of cosmetic surgery generally will not be covered by medical insurance.

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Dr Mary Powers
2888 Long Beach Blvd
Long Beach, CA 90806