Rhinoplasty

RHINOPLASTY

Rhinoplasty, sometimes referred to as a “nose job” or “nose reshaping” enhances facial harmony and the proportions of your nose. It can be done for medical reasons such as to correct breathing problems related to the nose or correct disfigurement resulting from trauma or birth defects. It can also be done for cosmetic reasons, which will change the nose’s shape and appearance.

Dr. NAYAN’S  APPROACH TO RHINOPLASTY

My personal philosophy of rhinoplasty focuses on one essential goal – a result that makes the patient happy. With this in mind, I take a conservative approach to rhinoplasty and seek a natural, un-operated look. I avoid over-aggressive resection maneuvers. I focus on maintaining structural support, and seek a natural “un-operated” appearance. I have provided before and after rhinoplasty photos in my websites that reflect my approach. Ultimately, success in rhinoplasty is based on well-developed judgment, wisdom, and accumulated knowledge and experience. Like most surgeries, rhinoplasty is both a science and an art. Skill comes from experience and wisdom, combined with a measure of talent. Explore this website and learn the possibilities. Contact us with questions, or to make an appointment. I look forward to seeing you!

The Process

At your initial appointment you will meet with Dr. Nayan and your face and nose will be examined. It is important, at this stage, that an accurate and complete analysis of the nose be performed to assess every aesthetic and functional defect. All your questions about rhinoplasty will be answered. The possible aesthetic or cosmetic changes, as well as functional improvements will be discussed. Pictures will be taken and you will be able to preview the possible cosmetic changes. The next step is for you to be assessed for anaesthesia. Another meeting to answer any last-minute questions will be scheduled shortly before your surgery. After surgery, you will remain in the recovery room until fully awake. You will be shifted in ward after nil per oral (NPO) is over. You will be discharged on 2nd postoperative day if everything is fine. You will be followed up after 1 week and then after 1 month, 3-6 months, and 1 year. First post-op visit is compulsory, other visits are optional.

General Pre-Surgical Rhinoplasty Instructions

  • Do not eat or drink after midnight on the day your procedure is scheduled. You should be doing fasting for 6-8 hours before surgery.
  • You are advised to take baths on the day or 1 day before surgery.
  • Make sure you have someone reliable who can drive you to the hospital and stay with you in the hospital for the first 24 hours after your surgery.
  • Do not wear make-up on the day your procedure is scheduled.
  • Quit smoking for two weeks before and after surgery and stop using blood-thinning medications, vitamin E, aspirin, or ibuprofen.
  • Wear comfortable clothing, preferably something that fastens in the front (Shirts), on the day of the rhinoplasty.
  • Do not wear jewelry, contact lenses and remove any piercings on the day of the procedure.
  • If you are a man, shave your moustaches and beards on the morning of surgery.

Do’s and Don’ts after Rhinoplasty

After rhinoplasty, your nose needs plenty of time to heal. Just as following your surgeon’s instructions before surgery played a big part in your safety and the outcome of the procedure. You should understand what to do and what not to do after rhinoplasty for proper nose’s healing. While specific instructions will vary somewhat from patient to patient, you might expect your surgeon to give you the following list of do’s and don’ts:

Do: Continue to Avoid Smoking

Generally, surgeons advise avoiding smoking for at least another two weeks before and after your rhinoplasty. Smoking can interfere with the safety of the surgery and can negatively affect the results. Nicotine slows down blood flow, which can make you more likely to scar. The drug also disrupts healing.

Don’t: Bump Your Nose

Your nose will be rather fragile as it heals after your surgery. One of the most important things to remember after rhinoplasty is not to bump it. That means avoiding any activities that can potentially bump the nose, such as any sports. It also means you may have to adjust some of your everyday habits, such as what you wear, what you eat, and even, in some cases, how you laugh. Pullover shirts and sweaters, for example, can accidentally move the nose or hit it. Usually, it’s recommended that you wear tops that button up or that don’t need to be pulled over your head, at least for several weeks after your surgery. If you wear glasses, you might have to switch to contacts for about a month, or find a way to wear them so that they don’t put any weight or pressure on your nose.

Do: Relax

One of the best things to do in the first weeks after rhinoplasty is to simply relax. You don’t have to be bed ridden. Use the recovery period to catch up on a few movies, TV shows or books. Feel free to take short walks as you recover, to help keep your blood flowing and to help reduce the chance of constipation.

Don’t: Head Back to the Gym Right Away

While taking walks is a good idea starting about a day or so after your surgery, you do want to stay out of the gym and avoid any strenuous exercise for about a month. Any activities that could potentially injure your nose, such as tennis, soccer, and baseball, should be avoided for about six weeks. The same is true of swimming. The chlorine in most pools can irritate your healing nasal passages.

Do: Keep the Head Elevated

Swelling is par for the course after rhinoplasty. While you can’t avoid it, you can do something that will minimize it or keep it from becoming worse. One of those things is to keep your head elevated at all times. When relaxing, try sitting in a recliner that’s set at a 45 degree angle. Place several pillows on your bed to keep your head propped up during sleeping. Cold sponging around your nose will help in reducing the swelling.

WHAT CAN I EXPECT AFTER SURGERY?

There will be a mild to moderate amount of pain and discomfort associated with the surgery. This should be easily controlled with oral medications. The pain and discomfort begins to decrease within 72 hours after surgery.

Bruising and swelling are not unusual after the surgery. These symptoms often worsen on the second day following surgery and then steadily improve thereafter; this is normal. The amount of bruising that occurs varies significantly from one person to the next. Most swelling occurs around the eyes, but some bruising may track down and discolor the cheek area.

Be aware of the fact that swelling from the surgery will temporarily make the nose appear broader and the tip more turned up and less refined than is desirable. You will often notice that the swelling on the bridge of your nose will improve more quickly than the swelling on the tip of your nose. All the swelling in your nose will greatly improve in the first few weeks after the surgery. Although much of the swelling will have resolved within a few months, your nose will continue to improve for up to one year after surgery.

Some bloody nasal discharge is to be expected after any nasal surgery which should be wiped gently with tissue paper.

External nasal splint and Sutures are placed on the outside of the nose, they are removed in 7 days after surgery.

Nasal stuffiness due to blood clots is the most annoying problem that you will face for 1 week after surgery.

Numbness in the tip of the nose, upper front teeth or roof of the mouth following surgery is to be expected because of temporary disruption of some of the nerves in the area.

Some temporary decrease or alteration in the sense of smell or taste is typical after surgery. This is, again, secondary to disruption of some nerves in the nose during surgery. These changes will begin to improve within the first 1 to 2 weeks after the procedure.

 

CALL THE DOCTOR PROMPTLY IF YOU NOTICE ANY OF THE FOLLOWING:

  • Development of a temperature elevation exceeding 100 degrees.
  • Unusual amount of bleeding from the nose. Any significant re-injury of the nose.
  • A significant progressive increase in pain which is not easily relieved by taking your prescribed medication

HOW DO I CARE FOR MYSELF AFTER SURGERY?

  • Cleaning: A Q-tip moistened with hydrogen peroxide or warm saline water may be swabbed in the nose, 2 to 3 times a day to also help reduce nasal crusting and then place a small dab of antibiotic ointment inside your nose 4 to 6 times a day, beginning on the first day after surgery.
  • Take the antibiotics and pain medication only as prescribed by the doctor.
  • To minimize swelling, you may use cool, clean compresses or ice wrapped in a dry cloth or disposable gloves. Apply these gently to your closed eyes four to six times a day for at least 1 week after surgery.
  • Sleep with the head elevated for the first week after surgery.
  • Do not blow your nose for two weeks after surgery
  • If you have to sneeze, sneeze with your mouth wide open as this will minimize any disturbance within the nose.
  • Massaging techniques will be explained by the doctor after the removal of external splint.
  • For the first month after rhinoplasty, you should not rest your glasses on the bridge of your nose.
  • It is important to either avoid the sun or use of sunblock (SPF 15 or higher) for 6 months after rhinoplasty.
  • Usually, your surgeon will use dissolvable sutures inside the nose which will disappear on their own within a few weeks. If non-dissolvable sutures are used on external incisions, they should be removed within 5 to 7 days after surgery (at the time of splint removal).
  • You should do no vigorous exercise and should avoid any significant physical exertion, lifting or straining for a minimum of 3 weeks after your surgery, as this activity could disrupt your wound healing and cause bleeding.

 

Tips for a Smooth Recovery

Here is a list of take-home instructions that can help to facilitate the healing process. Some few items of information that can help you understand what will be necessary for a smooth recovery are:

Cast

Once surgery is complete, a small a cast made up of POP (Plaster of Paris) will be applied over your nose for protection. This cast will generally be removed on 7th day after the procedure.

Position of Your Head

By keeping your head and nose elevated higher than your heart level around 450 high up (use two pillows to elevate your head up) will reduce some of the swelling after surgery.

Cold Compression:

Put some cubes of Ice packs inside the sterile gloves and use it over the swelling area around the orbit. Use it for 15 minutes every 2 hourly for 3-4 days till the swelling subsides gradually.

Intranasal Splints & Nasal Packing

With the many advances in rhinoplasty and nose surgery over the years, nasal packing after the procedure is typically not necessary. Instead of nasal packing, Dr. Nayan prefers doing Quilting Sutures in the septum using 4-0 vicryl. This Quilting sutures helps to prevent collection of blood in between the mucoperichondrial/ mucoperiosteal flaps. Thus, nasal packing is rarely done after Rhinoplasty.

Nasal Discharge

After surgery, there will be oozing of blood and mucus for 24-48 hours after rhinoplasty. This oozing of blood can be wiped by using soft tissue paper. Continue to clean the inside of your nostrils with Q-tips soaked in Hydrogen Peroxide/ lukewarm salt water followed by a light coat of antibiotic ointment (Mupirocin) to prevent dried blood from crusting until your first follow-up.

Congestion

Because of swelling after surgery, your nasal passages may be partially or completely obstructed. Nasal blockage might also be due to crusting of blood clots inside nostrils. Nasal decongestants (i.e. Rhinex/ Sinex) can be used to decrease your symptoms.

Dried Blood in the Nostrils

There will likely be some bleeding and oozing from the nose after surgery; however, this typically lasts only about 24-48 hours. To help prevent blood crusting, you can start cleaning the inside rims of your nostrils with Hydrogen Peroxide-soaked Q-tips. This can usually be accomplished effectively by using a gentle swirling motion. The Q-tips can be advanced as far as the cotton, and you should apply a thin coat of Mupirocin/Polysporin ointment after cleaning.

External Sutures

External sutures along with cast will be removed after seven days postoperatively. You can clean the incision areas with (H2O2) Hydrogen Peroxide-soaked Q-tips or lukewarm salt water and apply some Mupirocin /Polysporin ointment to the incision sites two to three times a day until all crusting disappears.

Massage Therapy:

After cast removal, Dr. Nayan will teach you some techniques of nasal massage for proper reshaping your nose. This massaging technique will also help in reducing the swelling of the nose.

Recovery from rhinoplasty is unique to every individual. While these tips and recommendations are applicable to most patients. You should follow the exact aftercare instructions provided by Dr. Nayan before and/or after your surgery.

RECOVERY TIMETABLE

Approximate recovery after rhinoplasty is as follows:

  • DAY 1: Return home (Discharge). Use cool compresses every 2 hourly for 15 minutes for 24 hours. There will be some swelling and bruising, mild pain and discomfort.
  • DAY 2-4: Maximum bruising and swelling.
  • DAY 5-7: External stitches and external nasal splint will be removed. Cleaning inside the nose by suction machine. Bruising will start going away.
  • WEEK 1-3: Massaging of the nose as instructed by the doctor. Nasal Douching (1 glass of water+ 1 teaspoon of salt+ half teaspoon of baking soda) rinsing with luke-warm water by 20 Cc syringe.
  • WEEK 2-4: Much of swelling has begun to go away. Breathing will be better.
  • 1 YEAR: Enjoy your final result.

Deciding on a Nose Job/ Rhinoplasty/ Septoplasty ???

If you are thinking about getting a nose job, set up an appointment with your surgeon to discuss it. During that meeting, talk about your goals and tell the doctor what bothers you about your nose and how you would like to change it. Keep in mind that there is no such thing as a perfect nose. Surgery, though, can enhance facial features and emphasize your unique and natural beauty.

A rhinoplasty surgeon can describe the facial features that make you unique and tell you how changes would enhance your appearance. The surgeon will evaluate the structures of your nose and other facial features. After this evaluation, the surgeon can tell you if your expectations are realistic. The surgeon will also consider your overall health and should discuss with you the risks, recovery time, and costs involved. There are various techniques for reshaping the nose. Once you decide to go ahead, your surgeon should describe exactly what he or she proposes to do.

Ideal candidates for Rhinoplasty are patients with:

  • Bulbous Nasal Tip
  • Asymmetric Tip
  • Upturned Nose
  • Droopy Nose
  • Crooked Nose
  • Deviated Septum
  • Broken Nose
  • Low Bridge
  • High Bridge
  • Dorsal Hump
  • Narrow Nose
  • Wide Nose
  • Wide or Flaring Nostrils
  • Nostril Collapse

 

What is the Cost of Rhinoplasty in Nepal ?

The cost of primary Rhinoplasty starts at Rs.70,000, but can increase to Rs. 1,50,000 when the surgery is particularly complex. If the Rhinoplasty surgery is a revision, the cost starts at Rs. 80,000 and can reach Rs. 2,00,000, if many cartilage grafts are required. The cost of Rhinoplasty is a factor of the surgical time. A simple Rhinoplasty takes an average of 2 hours, while a complex rebuilding of a badly damaged nose requiring rib cartilage can last for 5 hours. A quote for rhinoplasty will be honored for one year.

Rhinoplasty Expectations

Ethnic patients occasionally bring photos of celebrities to their initial consultation. This will cause the surgeon some concern. As a cosmetic surgery patient, you need to have realistic expectations in order to be happy with the result. Most of magazine photos have been airbrushed, the lighting professionally optimized and professionally applied make up. The goal is to embrace the cultural identity of any patient while remembering that beauty is cross-cultural. Creating subtle balance, enhancement, and refinement, without eradicating ethnicity, can produce a beautiful result.

People are pleased with the results of cosmetic nose surgery if undertaken with realistic expectations. The goal should be to feel better about yourself. Cosmetic nose surgery can be an effective way to let someone see in the mirror a face that better reflects the way they feel. 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.

Primary Rhinoplasty

The nose is the central feature on the face, therefore is very important aesthetically. Small nasal adjustments and refinements can result in a striking impact on appearance. “Primary rhinoplasty” is a “nose job” performed on someone who has not had previous nose surgery or nose injury. Although its prime objective is to change the appearance of the nose, it may be used to correct minor breathing problems or other internal functional problems. Either open or closed methods are used for rhinoplasty depending upon the severity and sites of deformity. For augmentation rhinoplasty graft materials used are septal cartilage, conchal cartilage, rib cartilage, temporalis fascia, fascia lata etc. We do not use synthetic materials like gortex, silicone etc in our patients.

Revision Rhinoplasty

Revision rhinoplasty is any further surgery following a primary rhinoplasty. Revision or secondary rhinoplasty is not commonly performed until a year has gone by following the first rhinoplasty. This is to allow the tissues to settle and all the inflammation, swelling and wound remodeling to resolve. Revision rhinoplasty can vary from a minor procedure done under local anaesthesia to a complex reconstructive rhinoplasty lasting all day. The goal of the procedure is to correct problems arising from previous rhinoplasty surgery and/or those problems which failed to be corrected during the primary Rhinoplasty.

The revision rate for rhinoplasty even for experienced rhinoplasty surgeons is around 5 %. If there is a major deformity it may be better to pursue your second surgery with someone experienced in revision rhinoplasty. Expectations are lower for further surgery. The best opportunity for the greatest improvement is the first time the nose is operated on. Success rates are less and the degree of improvement is reduced unfortunately with each additional surgery. The initial surgery has eliminated the clean surgical planes and introduced scaring. The need for grafting is common, natural tissues have been resected and are now missing. The surgical time is often greatly increased, the healing process is longer and the surgical maneuvers are more technically difficult. These are the main reasons for the lower degree of success in revision rhinoplasty.

Recovery Period

Following rhinoplasty, your nose is weakened and has reduced intrinsic strength. For support external nasal splint is used and nasal packing is done in case of bleeding.This fragile state gradually improves over many months after your surgery. There is seldom pain around the nose following rhinoplasty. Some general discomfort and pressure are more common. You should remain at home for a week. You will, likely, feel tired and uncomfortable, but not ill.

One week after surgery, your nasal cast is removed. You may be given nose exercises to perform for two weeks to maintain the shape of your new nasal bridge. Most people can return to their usual activities within two weeks after undergoing rhinoplasty. Strenuous physical exercise during which you sweat, or increase your blood pressure or heart rate, is discouraged for six weeks. It can delay, or even reverse, the disappearance of the swelling. If you experience any bruising, it is usually gone in two weeks. Surprisingly, if bruising does occur it is not usually on your nose. It, more commonly, appears under your eyes. Bruising is the result of the nasal bone osteotomies, or fracturing of the nasal bones. It is not the result of surgical manipulation of the nose skin and nasal cartilages.

Unfortunately, swelling tends to remain much longer than bruising, lasting up to six months. Swelling can mask the changes to the underlying structure of your nose after rhinoplasty. This is one of the most difficult things for patients following a nose job. Everyone wants immediate results and it’s hard to wait many weeks to see the new nose appear through the swelling. The nose continues subtle changes as the tissues shift and settle for a full year after rhinoplasty.

Success Rate and Complications

Rhinoplasty has a high success rate. The most important factor that influences success is probably your choice of rhinoplasty surgeon. The slim possibility of making the nose worse can be kept to a minimum by choosing an experienced rhinoplasty surgeon. After-effects can include numbness of the tip of the nose or, less frequently, the front of the teeth. It is rarely permanent. Post-rhinoplasty infection rate is low, occurring in less than 1% of cases, bleeding, slight scar in the columellar region (open approach), septal perforation, breathing problems and most commonly unsatisfactory aesthetic problems.

When the rhinoplasty for cosmetic enhancement has an unsatisfactory result, there can be several reasons. If you exclude poor surgery or an inexperienced rhinoplasty surgeon, the explanation is usually found in the nasal tissues. Surgeons work with four different materials during rhinoplasty — the overlying skin, internal mucous membranes, bone, and cartilage. All four tissues are altered during rhinoplasty. However they each heal differently and surgeons must have the skill and experience to understand the differences. The goal is to create harmony and a natural shape. It is as much an art as a science and takes years to master.

Nose cartilage has a memory and tends to return to its original shape. This inherent characteristic is the underlying cause of a large number of rhinoplasty failures. The more rhinoplasty techniques a surgeon has mastered. The more noses he has seen and treated, the less likely it is that this feature of cartilage will defeat the desired rhinoplasty outcome. A good surgeon will carefully access patient expectations at the initial meeting before surgery. This is important in avoiding disappointing results. Expectations must be realistic and achievable. The goal is improvement, not perfection.

Rhinoplasty Before & After Photos (Photo Gallery)

Image Description

Frequently asked questions about Rhinoplasty:

Q #1: When is the best time for rhinoplasty?

With any cosmetic procedure, it is crucial that the patient be old enough to thoroughly understand the procedure. This is not a procedure recommended for children. There is no set age at which procedure is appropriate.  Patients range in age from 15 to 50 years or older are best candidates. The best time for a rhinoplasty is when the patient decides it is time for a change.

Q #2: How do I know what my nose will look like?

When consulting about Rhinoplasty, a patient and the Rhinoplasty surgeon should always discuss the end goals extensively. You should always ask your surgeon to show before and after photos of rhinoplasty of other patients having nose similar to yours. This will help you to choose the good and experienced surgeon.

There are 2 major factors that contribute to the final results of a rhinoplasty: the skill of the Rhinoplasty surgeon and the patient’s existing nose structure. Each individual patient has unique characterstics that affect the end results of Rhinoplasty i.e thickness of skin over the nose and interior nasal architecture. Again, managing expectations and having realistic goals are extremely important aspects of the cosmetic surgery process. The patients should note down that their nose cannot be made into the shape and size whatever they like. Their noses will be corrected into best possible size and shape that suits their face.

Q #3: How long does it take to recover?

Following Rhinoplasty, patients will experience some swelling and/or bruising. You’ll have a stuffy nose for a few days, which gets better as the swelling subsides. You’ll wear a splint for one week after surgery in order to maintain your nose’s new shape and minimize swelling. Bruising usually resolves within 10 days of surgery, and the majority of the swelling (90%) will resolve itself completely in 4-6 weeks. However, for complete recovery, remaining 10% can take as long as 6-12 months.

Q #4: Are there complications associated with Rhinoplasty?

With any surgical procedure, there is a risk of complications. However, rhinoplasty is a safe surgery than any other elective procedure. In a few rare cases, patients may experience some numbing in the nasal tip, infection, septal perforation, synechiae, cartilage warping, bleeding, asymmetries. Complications of anaesthesia and may need Revision Rhinoplasty (1-5%).

Q#5: Is Rhinoplasty/Nose Job a painful procedure?

One of the biggest rhinoplasty myths is that it’s extremely painful. This procedure is not as painful as it seems in the surgical videos. The majority of patients don’t report any serious pain and instead just experience mild discomfort, which can be managed with pain medication if necessary.

Q#6: What are my options if I am not satisfied with the outcome?

Most rhinoplasties take about a year for the final results to be seen. You should have patience during this time since the skin, cartilage, and muscles will be healing. Most of the patients want immediate results. If you have realistic expectations then you need not have to go under Revision Rhinoplasty. You will be happy with your results after full recovery. In few cases, if you are not satisfied with your results then Revision Rhinoplasty can be done after 1 year of recovery period.

Q#7: When can I resume normal activity?

For the first few days, keeping your head elevated and relatively still will hasten recovery. You can join your normal day-today activities or computer work after 1 week of surgery.  Most patients can jump back into lighter exercise and movements two weeks after surgery with restricted activities (e.g., biking, yoga, gym, jogging). Wait until six weeks post-op before doing anything too strenuous or activities where you can get hit in the face like contact sports, including volleyball, basketball, soccer, etc.

Q#8: How Might I Look After Rhinoplasty?

This is one of the frequently asked questions by most of the patients who is considering rhinoplasty. With the help of 3D imaging software, Dr. Nayan can create life-like simulations of your face that are designed to give you an idea of how you might look once rhinoplasty surgery has been performed.

During your consultation, photographs will be taken to capture various angles of your nose and face. These images are fed into a computer and manipulated with 3D software to reflect your ideal aesthetic enhancement goals and show the potential outcome of the procedure as accurately as possible. This technology also makes it much easier for you to visualize the possible results and discuss them with Dr. Nayan.

Although no technology can predict the future with 100% accuracy, 3D imaging software helps to ensure you and Dr. Nayan have similar goals for surgery. This technology helps you to compare and contrast your proportions and give you a visual aid to assist you in making your decision.

Get in touch with us!

Kantipur hospital at 4-6pm, Tinkune, KTM
Ph.No: +977-9841362760
Email: nain_boldly@hotmail.com / nayanboldly@gmail.com