Out of town rhinoplasty patients typically choose this arrangement because they could not find a local plastic surgeon they are “comfortable” with.
Despite the challenges facing out of town rhinoplasty patients, with proper planning and some due diligence most people can have a gratifying experience from this.
Dr. Tarick Smiley, a board-certified plastic surgeon who has performed thousands of rhinoplasties, has provided basic tips for patients needing to travel for nose surgery.
- Find a reputable plastic surgeon.
A good rule of thumb is to find a board-certified plastic surgeon (i.e., American Board of Plastic Surgery member) who performs rhinoplasty and its ancillary procedures (reconstructive type such as septoplasty) on a regular basis.
- Avoid traveling by plane 1-2 weeks postop.
The changes in air pressure, the physical stress of rushing from one airport to the next with a heavy luggage in tow, and the side effects of narcotic painkillers can make long travel inadvisable, or even dangerous.
Traveling by plane too soon could also lead to persistent swelling (which of course affects breathing and healing), nosebleeds, and other things that could prevent the patient from achieving optimal results.
However, patients can travel sooner by car (about 5-7 days) provided that their sutures and splints have already been removed, and they have a designated driver. They should never drive by themselves because the effects of narcotic painkillers include extreme lethargy and poor coordination.
- Make arrangements for follow-up visits.
Most surgeons require 1-2 follow-up visits within two weeks postop to ensure that their patients are healing nicely. For this reason, they may have to stay in the immediate vicinity of their surgeon’s office (e.g., a nearby hotel).
Many surgeons even require follow-up visits up to 6-12 months, depending on patient availability. Sometimes, a video chat could suffice particularly when long travel is not possible or is rather too inconvenient.
- Build rapport with a local doctor.
Finding a local doctor prior to surgery can help patients feel more secure after they leave their surgeon’s “premises.” It is important to note that serious complications such as infection, should they occur, mostly happen in the first three weeks of surgery.
Implants in rhinoplasty, or nose reshaping surgery, can be made from silicone or silastic, Gore-Tex, Medpore, or biologically derived materials such as rib cartilage from a rib bank. While they can produce good results long term, the consensus among surgeons is to always consider the patient’s own tissue as the first choice.
Autologous materials or living tissues, which are derived from the patient’s septum (wall between the nostrils), behind the ear, or rib, have a lower rejection and infection rate compared to synthetic implants. But sometimes, one’s cartilage is too weak and soft to produce the desired and most stable results.
Patients of Asian and African descent typically have weak cartilage, and individuals needing a revision rhinoplasty after the initial surgery depleted their cartilage supply could achieve better results with implants.
Interestingly, Asians and Africans—two ethnic groups who often require synthetic implants in rhinoplasty—are typically good candidates because their thick nasal skin minimizes the risk of extrusion and visibility. Caucasians, meanwhile, generally have thin skin that could expose them to such risks.
In patients with thin skin and have depleted or weak cartilage, implants in rhinoplasty should be combined with soft tissue thickening graft such as Alloderm or temporalis fascia to avoid or at least minimize risk of extrusion and visibility.
Leading Orange County plastic surgeon Dr. Tarick Smiley says rhinoplastic patients today have many options in terms of synthetic implants and autologous materials; in fact, these are sometimes combined to achieve the most stable and most desirable results.
In the past, silicone or silastic implants were the only choice. While some surgeons still use them up to this day, others deliberately stay away from them due to the higher rate of infection, protrusion, shifting, and visibility.
However, newer implants in rhinoplasty are designed to promote tissue ingrowth. For instance, Medpore and Gore-Tex are porous materials that they literally become part of the nose; hence, the risk of shifting and rejection is significantly diminished.
While Medpore and Gore-Tex allow tissue ingrowth, silicone implant does not allow such process to occur. The body simply creates a scar capsule around the material where to a certain degree it can shift or move inside.
Studies have already proven the reasonable safety and predictability of Medpore and Gore-Tex, making them a viable alternative to autologous materials or living tissue. However, smokers, diabetic patients, drug abusers (particularly cocaine users), and individuals with reduced immunity function are poor candidates for any type of synthetic implants in rhinoplasty.
How a septoplasty is performed depends on the anatomies and underlying problems. Nevertheless, its goal is to correct the misaligned or deviated septum or the wall separating the two nostrils, thus improving one’s breathing functions and even quality of life.
Dr. Karan Dhir, one of the leading Beverly Hills plastic surgeons, says septoplasty as a stand-alone procedure takes 30-90 minutes to complete, although it could be longer when combined with rhinoplasty in which the “outside” appearance of the nose is improved as well.
Septoplasty and rhinoplasty (or nose job) are commonly performed together if there is also a desire for cosmetic improvement. Also, it gives the surgeon the opportunity to use the nasal cartilage (or “main structure” supporting the nose) instead of getting it from other donor sites such as the bowl of the ear or rib.
As a stand-alone procedure, septoplasty rarely changes the outside appearance of the nose unless there is a very visible deviation prior to surgery.
Most septoplasties use incisions in the nostrils so there is no risk of visible scar. During surgery, doctors will make a cut on one side of the nose to lift the mucous membrane around the deviated septum.
The deviated septum is then straightened and any barrier or protruding nasal bone or cartilage is removed, trimmed, or filed. Once the necessary adjustments are made, the mucous membrane is positioned back.
Most patients will need stitches to support the new contour or hold the septum and membrane in place, although others will only require cotton, soft plastic sheets, or splints to keep them in position.
The success of any type of nose surgery (both reconstructive and cosmetic procedures) is largely determined by the surgeon’s level of skills. Ideally, it is performed by someone who has double board certifications in facial plastic surgery and ENT (ear, nose, and throat).
In most cases, septoplasty results in a straightforward recovery, with pain easily managed by prescribed medications. However, aspirin and aspirin-like products must be avoided for about 1-2 weeks to prevent healing problems, persistent swelling, and bleeding.
Instead of the actual pain, patients often think that nasal stuffiness is the most bothersome symptom, which could take up to six weeks to dissipate. However, controlling the amount of swelling (through head elevation, ice packs, and low-sodium diet) is one way to improve breathing function.
Ice packs have also been shown to control pain, although the general rule of thumb is to use them not more than 20 minutes at a time to avoid cold burns and injuries.
In general a revision rhinoplasty, or secondary “nose job,” is more technically demanding than a primary procedure because the baseline of the nose has already been altered. The presence of scars further complicates things, making the skin thicker and harder to work with.
Because of the challenges of revision rhinoplasty, renowned Los Angeles plastic surgery expert Dr. Tarick Smaili emphasizes the importance of choosing the right doctor—i.e., someone who is board certified and has been doing the procedure on a regular basis that has given him an in-depth knowledge of the “roadblocks” ahead.
One of the most common reasons for revision rhinoplasty is to correct the “noticeably” asymmetric nostrils, which not only result in unnatural appearance but possibly breathing problems.
Most cases of asymmetric nostrils are caused by over-aggressive removal of the cartilage, which provides the form and support. But with a structure whose stability has been compromised, various problems can arise immediately after surgery or at a later date.
The “universal” approach is to preserve the structural integrity of the nose, which is done through correct grafting techniques. A graft is any tissue taken from one area of the body—such as the bowl of the ear, septum or wall between the nostrils, a piece of rib or hip, etc.—and is then used to improve the appearance and function of the nose.
Aside from the repair of collumela or wall separating the nostrils, many patients with asymmetric nostrils following a nose job will also need the alar or the lateral surface of the external nose—i.e., the area that flares out forming the nostrils—to be restructured with grafts.
But for some patients, a more viable approach is to undergo a septoplasty, a nose surgery wherein the columella is straightened, thus eliminating the crooked appearance and breathing problems.
Another possible solution is to use spreader grafts, which are particularly helpful when there is a depression on the upper lateral cartilage, leading to one side of the tip to “dip” or the nostril to appear smaller than the other side.
Because revision rhinoplasty patients are already dealing with disappoints, it is more important than ever to use 3D computer imaging technology that allows a more open discussion between them and their plastic surgeons. According to studies, this tool can increase patient satisfaction rate because it paves way for better communications.
Meanwhile, recovery after a revision rhinoplasty generally takes longer than a primary nose job’s, with the residual [unnoticeable] swelling taking up to two years to fully dissipate.
The number of men having plastic surgery is on the rise, with a recent survey showing that they accounted for 13 percent of all cosmetic surgical enhancements, or about 205,000, last year alone.
The survey, which was conducted by the American Society of Plastic Surgeons, has shown that rhinoplasty or nose surgery, eyelid surgery, and facelift were included on the top five list of the most commonly performed procedures in men.
Celebrity LA plastic surgeon Dr. Tarick Smaili says the growing popularity of male plastic surgeries, particularly those aiming to create a more youthful and more balanced face, is due to the declining stigma on surgical enhancements.
Another contributing factor, according to a recent survey, is the growing job insecurity. In an attempt to look more competitive and youthful, male patients are commonly citing this reason for having cosmetic plastic surgery.
But since there are certain aesthetic characteristics that typify the masculine face—including “heavier” and lower brow, more horizontally-oriented forehead, thinner lips, and bigger nose compared with women’s—Dr. Smaili says facial plastic surgery should always take into consideration one’s gender, in addition to other factors such as the rest of the facial features, ethnicity, and motives and expectations.
When treating male patients who want to have a more youthful visage through facelift, Dr. Smaili warns that excessive tension on the skin can lead to fake results, or worse, a more feminine appearance.
While too much tension on the skin has detrimental effects on both genders, over-correction is particularly detrimental to men because it not only feminizes the face, but also leads to unnatural side burns, hairline, and ear (pixie ear deformity or “stuck-on” appearance).
Compared to women, male facelift generally requires a more conservative jaw line contouring to preserve their masculine appearance. Some “seasoned” plastic surgeons even retain a few wrinkles to create a somewhat mature, but still attractive male face.
By being on a conservative side, the leading LA plastic surgeon says it is easier to achieve more natural results and avoid the dreaded windswept and perennially surprised appearance.
In brow lift surgery, Dr. Smaili says being conservative is also beneficial to men. The idea is to create a more horizontally-oriented, “heavier” brow to preserve the masculine appearance.
A more curved, arched brow, on the other hand, only works for female brow lift surgery.
There is also a stark difference between male rhinoplasty and female nose surgery. According to a recent study, an attractive male nose is a bit bigger and wider, and has an angle of rotation close to 90 degrees to give it a stronger, straighter tip.
On the other hand, creating a more upturned nose has a feminizing effect which must be avoided when performing a male rhinoplasty, explains Dr. Smaili.