Posts Tagged "Rhinoplasty"


Facial plastic surgery such as facelift, rhinoplasty (nose job), fat grafting, brow lift, and eyelid lift involves postop bruising and swelling that may prevent anyone to join social activities for a couple of weeks.

Take note that healing from such procedures takes many forms—e.g., social recovery, physical recuperation, and return of normal sensation.

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For many patients, the hardest part of the recovery is not really the postop discomfort, which can be easily controlled by painkillers, but the interruption in their social activities.

The list below explains the length of social recovery after a specific type of facial plastic surgery and what kind of postop symptoms one should expect during the initial healing phase:

  • Facelift. Five to seven days after surgery, the swelling and bruising will rapidly improve that most patients can return to their social activities by eight day, although usually with the “assistance” of camouflage make-up and/or fashion accessories such as sunglasses and scarves.
  • Rhinoplasty. The postop bruises are the most apparent around the eyes and will take a week to subside to a significant degree. However, social recovery greatly varies from patient to patient, with some people able to look “more acceptable” within a week, while others have to wait for two to three weeks especially if they have a thick nasal skin.
  • Fat grafting. This involves injecting a small amount of fat into the area that needs more volume, leading to mild swelling and bruising that can last for seven days, although some patients may have to wait for another week to appear “socially presentable.”
  • Eyelid surgery. This involves a rather straightforward recovery with the use of very fine incisions made within the natural upper eyelid crease and close to the lower lash margin. For this reason, most patients can have “dinner with friends” after about five days, although big sunglasses remain helpful to hide any residual swelling and bruising, and to protect the scars from harsh elements.
  • Brow lift.   With endoscope or small camera probe, the procedure will only need several small incisions that can lead to about a week of social recovery; however, the initial healing phase could take longer with the standard technique in which one continuous incision from ear to ear, behind the hairline, is used.
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Facial plastic surgery such as rhinoplasty (nose surgery), facelift, eyelid lift, and brow lift require candidates to be at their optimal health. The idea is to avoid or at least minimize the risk of complications such as infection, poor wound healing, and bleeding.

Prior to facelift surgery, it is crucial that you are near your ideal weight and is not expecting significant weight changes in the future. This guiding principle will help you achieve predictably good results that can last an average of five-and-a-half years, as suggested by one study.
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Take note that facelift removes some of the hanging skin and reshapes the tissue, including the deeper structures of the face in an attempt to eliminate the sagging appearance and deep wrinkles—two problems that are not only tied to aging but also to significant weight fluctuations.

Failure to maintain a healthy weight after facelift could lead to recurrence of sagging skin and facial wrinkles. While revisions can correct these problems, Beverly Hills plastic surgery expert Dr. Tarick Smaili warns that another surgery may lead to a more extensive use of incisions and subsequent scarring, and higher risk of overly tight, unnatural appearance.

The same “guideline” also applies to other forms of “isolated” facelifts such as mid facelift, forehead lift, cheek lift, lower facelift, and neck lift.

Your weight also matters if you are having facial liposuction to eliminate the appearance of double chin, jowling, or rotund cheeks. This procedure, which removes a very small amount of excess fat to create a more chiseled countenance, could lead to unpredictable results if performed on someone who is overweight or obese.

Meanwhile, weight gain or loss in the future will not influence the result of your rhinoplasty or nose job since it is based on the underlying bony structure of the face, although it remains highly ideal that you are near your ideal weight prior to surgery.

The reason?

Obesity is linked to a significant risk of complications following any type of surgery. According to studies, obese patients are more likely to experience wound infection (1.7 times), heart attack (five times), UTI (1.5 times), and peripheral nerve injury (four times) than non-obese individuals.

In addition, studies have shown that obese patients have altered responses to some medications, making it extra difficult for anesthesiologists to come up with the right and safe dose.

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Los Angeles plastic surgery expert Dr. Tarick Smaili shares his views on why you should be honest about your previous and current medications, including the use of recreational drugs and herbal supplements, prior to surgery:

“Some patients are apprehensive to tell us about their use of medications, particularly recreational drugs, fearing that revealing this sensitive information could be used against them in the future. However, people should realize that nobody has the right to demand their medical records without their permission.

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I always remind my patients that everything we talk about will remain confidential, which is part of medical ethics all board-certified plastic surgeons must follow.

Take note that all prescribed and over-the-counter medications, herbal supplements, homeopathic remedies, and recreational drugs must be known by your surgeon beforehand because they could lead to a wide array of complications such as increased bleeding, poor healing, interaction with general anesthesia, lethargy, unusual blood pressure or heart rate during or after surgery, and aggressive scarring.

For instance, patients seeking rhinoplasty—or more commonly referred to as nose job—must be honest about their use of recreational drug such as cocaine, which is known to cause septal perforation or hole inside the nose. While reconstructive surgery could fix the problem, they must avoid this drug for at least a year.

For some patients, professional drug rehab is necessary prior to rhinoplasty since it is crucial to avoid permanently the use of potent vasoconstrictor such as cocaine, which is known to dry out and cause nasal mucous membrane to die.

Your anesthesiologist should also know if you have a history of drug abuse; failure to reveal this crucial information could lead to serious complications and unpredictable interaction with anesthesia and other medications.

However, even the seemingly harmless herbal supplements must be known by your surgeon. It has been well documented that some of them could increase bleeding and delay healing, such as vitamin E, green tea, ginseng, feverfew, horse chestnut, cayenne, garlic, passion flower, flax seed oil, willow bark, and dong quai. However, discontinuing them two to three weeks is usually enough to flush out their effects.

Many treatments for anxiety, depression, and other related conditions might also interact with medications taken during and after surgery. For instance, St. John’s wort is known to speed the breakdown of some drugs, thus reducing their effectiveness.

Blood-thinners such as aspirin and non-steroidal anti-inflammatory drugs are also contraindication to plastic surgery because they inhibit normal clotting of blood. The general rule of thumb is to avoid them two to three weeks prior to an operation.”

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Rhinoplasty or nose-reshaping surgery is a highly technical procedure since countless variables are taken into account, although the most pressing issue is to create results that are consistent with the patient’s gender, ethnicity, anatomy, and motives and expectations—which are not always in line with one another.

Rhinoplasty for mixed race patients is particularly complex, although one guiding principle is to improve the nose in a way that it looks proportional to the facial features and their relationship from one another—i.e., width of the mid face or cheeks, and distance or space between the eyes.

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The first step to achieve satisfying results from rhinoplasty, or any type of elective plastic surgery, is to perform strict patient selection. The goal, according to leading Beverly Hills plastic surgeon Dr. Karan Dhir, is to rule out medical conditions that could lead to poor outcome and complications, unrealistic goals and expectations, and psychological issues.

Nasal analysis is also crucial since the degree of improvement is largely affected by the skin thickness, the amount of cartilage and its possible donor site (e.g., septum or wall between the nose, behind the ear, or rib), and the overall condition of the nose, explains Dr. Dhir.

The celebrity plastic surgeon says it is not uncommon for mixed race patients to have thick nasal skin, which could make it more difficult to achieve refinement especially at the tip compared with thin skin commonly found in European nose.

Due to the less plasticity of thick skin, over-resection of the cartilage (which is the underlying structure that supports the lower two-thirds of the nose) will almost always lead to amorphous or bulbous appearance and/or nostril collapse.

Thin skin, meanwhile, can tolerate more refinement because it can redrape well to the new contour. Nevertheless, it remains important to preserve the structural integrity of the nose so the results will not change over time (although it will age the same way as an unoperated nose).

Another guideline that could be applied to mixed race patients is to avoid over-narrowing of the nose, especially at the tip. Doing so could result in a Greek-like nose that may look out of sync amidst their ethnic facial features.

Over-aggressive removal of cartilage could also result in collapsed nostril, pinched appearance, overall unnatural look, and function-related problems that are hard to correct.

To prevent unsatisfactory results, which are often caused by poor communications between surgeons and patients, a growing number of rhinoplastic doctors are using 3D imaging technology that allows their patients to preview the outcome of each surgical approach and to provide their own input as well.

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Rhinoplasty, or cosmetic nose surgery, is not just about improving the outside appearance of the nose. An equally important goal is to preserve normal breathing functions, which is possible with proper patient selection, honest communication between a surgeon and his patient, and careful planning.

Proper patient selection is the first step to achieve desirable results. Aside from being physically fit, the right candidate for rhinoplasty or any elective plastic surgery should have realistic motives and expectations. For this reason, a prudent surgeon will turn down patients seeking secondary or tertiary procedure even their result is attractive by normal standard just because it does not conform to their unrealistic goals.

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Patients who have had several rhinoplasties generally have a significant amount of scarring or skin contracture that is further aggravated by another surgery. Aside from higher risk of breathing disturbances, it is expected that the degree of cosmetic improvement would be limited, making another procedure no longer ideal.

Correct surgical planning also plays a crucial role in the prevention of postop complications such as breathing problem and unnatural appearance or deformity. Inland Empire plastic surgery expert Dr. Tarick Smaili says over-resection of the nasal cartilage is one of the most common causes of breathing disturbances.

Over-resection of the cartilage, which is the main structure supporting the lower two-thirds of the nose, is often the tool of “over-enthusiastic, inexperienced” surgeons whose only goal is to deliver the cosmetic goals of their patients without considering the architectural integrity of the nose.

In some cases, over-resection of the cartilage delivers the desired outcome short term, only to result in deformity (twisted nose, collapsed nostrils, droopy tip, etc.) and/or breathing problems later down the road because the structural integrity has been compromised.

Over-resection commonly occurs in reduction rhinoplasty in which the goal is to create a nose that looks proportionate to the rest of the facial features. To avoid a wide range of complications, it is important not to remove too much cartilage and to always take into consideration the changes that could occur due to natural aging of the face.

Reduction rhinoplasty should address bumps on the bridge, droopy tip, and/or excessively flared nostrils without affecting the architectural integrity of the nose.

Rhinoplasty is believed to be one of the most difficult plastic surgeries due to the involved anatomies and how they limit the amount of improvement. Further complicating things is the expectations of patients and doctors that are not always corresponding.

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