Plastic Surgery Specialists - Dennis T. Monteiro, MD, FACS  
 
   
   
Nasal Reconstruction

 

Nasal Surgery (Rhinoplasty)

Because your face is one-of-a-kind, your nasal surgery needs to be customized to address your particular needs. Dr. Monteiro will beautify your nose and correct breathing difficulties.

Please ask Dr. Monteiro about anything you don't understand.

Nasal Surgery



About rhinoplasty...

In general, rhinoplasty, which is cosmetic nose surgery, is designed to reduce excess cartilage and bone in the nose, removing irregularities and bumps to give a straightened, smooth and, usually, smaller appearance. Adding tissue to enhance certain features of the nose can also occur. The overall trend in modern rhinoplasty is away from over-reduction of tissue which can reduce the ability to breath through the nose and towards individualized treatment of each segment of the nose to give a balanced and refined look without compromising function.

In some cases rhinoplasty is performed to alleviate nasal breathing difficulties.

About deviated septum...

The condition named above is usually associated with a deviated septum (or a bent internal framework of the nose.) Most of the time this results from trauma such as a broken nose but many patients with this condition cannot recall an episode where this might have occurred. The condition described in this question however, could also result from allergies or the two conditions can exist simultaneously. Careful examination is needed before surgery to separate the two conditions. While individual insurance policies can vary, in general, functional surgery to improve breathing is considered a covered benefit in many group policies. If additional correction of a cosmetic deformity of the nose is done at the same time the cost of this part of the procedure is usually not covered by insurance.

All surgery carries some uncertainty and risk.

When nasal surgery is performed by a qualified plastic surgeon, complications are infrequent and usually minor. Still, individuals vary greatly in their anatomy, their physical reactions, and their healing abilities, and the outcome is never completely predictable.

Poor healing of the skin is most likely to affect smokers. You can reduce your risks by closely following Dr. Monteiro's advice both before and after surgery.



Planning your surgery

In your initial consultation Dr. Monteiro will evaluate your nose, including the skin and underlying bone, and discuss possible breathing difficulties, and your goals for the surgery.

The doctor will check for medical conditions that could cause problems during or after surgery, such as uncontrolled high blood pressure, blood clotting problems, or the tendency to form excessive scars. Be sure to tell Dr. Monteiro if you smoke or are taking any drugs or medications - especially aspirin - or certain vitamins or other drugs that affect clotting.
Don't hesitate to ask him any questions you may have, especially those regarding your expectations and concerns about the results.

Preparing for your surgery...

Dr. Monteiro will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. Carefully following these instructions will help your surgery go more smoothly. If you smoke, it's especially important to stop at least a week or two before and after surgery; smoking inhibits blood flow to the skin, and can interfere with healing.

Whether your rhinoplasty is being done on an outpatient or inpatient basis, you must arrange for someone to drive you home after your surgery, and to care for you for a day or two if needed.


Where your surgery will be performed?

A rhinoplasty may be performed in Dr. Monteiro's office-based facility, at an outpatient surgery center, or in a hospital. It's usually done on an outpatient basis, but some patients may be hospitalized for a day when general anesthesia is used. Certain conditions such as diabetes or high blood pressure should be monitored after surgery, and may also require a short inpatient stay.





Types of Anesthesia

Most nasal surgeries are performed under local anesthesia, combined with a sedative to make you drowsy. You'll be awake but relaxed, and your nose and face will be insensitive to pain. Dr. Monteiro may choose to administer a general anesthesia, depending on the extent of the procedure. In that case, you'll sleep through the operation.




 

The Surgery

Rhinoplasty usually takes one to two hours - or somewhat longer if the procedure being done is more complex. During surgery the skin of the nose is separated from its supporting framework of bone and cartilage and is then sculpted into the desired shape. Incisions are ususally made within the nostrils. Dr. Monteiro will discuss your particular procedure with you in advance of your surgery.

1. Incisions are made inside the nostrils or at the base of the nose, providing access to the cartilage and bone, which can then be sculpted into shape.
   
 

2. Dr. Monteiro can remove a hump using surgical instruments.
   

3. Cartilage is trimmed to reshape the tip of the nose.
   
4. Trimming the septum improves the angle between the nose and upper lip.
   

5. If the nostrils are too wide, Dr. Monteiro can remove small wedges of skin from their base, bringing them closer together.
   

6. To improve the nasal airway, the shape or position of the septum may be altered. Or, the deviated protion of the septum may be partially removed.
   


7. A splint bandage made of tape and an overlay of plastic, metal, or plaster will be applied to help the bone and cartilage of the nose maintain its new shape.
   





After your surgery...

After surgery - particularly during the first twenty-four hours - your face will feel puffy, your nose may ache, and you may have a dull headache. Pain can be controlled with medication. Plan on staying in bed with your head elevated. You'll notice swelling and brusing around your eyes, reaching a peak after two or three days. A little bleeding is common for the first few days following surgery, and you may experience some stuffiness for several weeks.








Getting back to normal...!

You should be up and about in a day or two, but plan on taking it easy for the first week after surgery. Be especially gentle with your face and hair, since your skin will be both tender and numb, and may not respond normally at first. Dr. Monteiro will give more specific guidelines for gradually resuming your normal activities. They're likely to include these suggestions: Avoid strenuous activity, including exercise, sex, and heavy housework, for at least two weeks.

At the beginning, your face may look and feel rather strange. Your features may be distorted from the swelling. Some bruising may persist for two or three weeks. Most patients are back at work about ten days to two weeks after surgery.

Your new look...!
After surgery, patients have a straighter bridge, a well-defined nasal tip, and an improved angle between the nose and upper lip.
   


The chances are excellent that you'll be happy with your rhinoplasty -especially if you realize that the results may not be immediately apparent. Even after the swelling and bruises are gone, your nose will continue to heal for several months.

In general, most or all of the incisions in rhinoplasty are hidden in the inside of the nostril. While external incisions hidden in the creases where the nose meets the cheek can be used to narrow the nose, incisions on the bridge or tip are not usually used in cosmetic surgery of the nose, and scars will not be apparent.