Plastic and Reconstructive Surgery

Rhinoplasty / Septal Resection

The following is information regarding nasal reconstructive surgery with and without internal septal surgery which is important to review, understand and discuss with family and/or friends before choosing to proceed with this surgery.

GOALS OF NASAL SURGERY
The goal of nasal surgery is to improve nasal symmetry, improve nasal alignment, create a more ideally proportioned nose and to improve the harmony between the nose and other facial structures. When internal septal surgery is performed, the goal is to remove nasal airway obstruction and improve nasal breathing. In any given patient, these goals may be only partially met.

LIMITATION OF THE PROCEDURE
The external appearance of the nose can only be reshaped to the extent that underlying bones and cartilage can be remodeled and repositioned. It is not possible to take another person’s “nose” and place it on you. Therefore, photographs or computer images cannot duplicate a surgical procedure. By understanding your concerns and realistically outlining the surgical possibilities, an attempt is made to approach your desires for nasal shape. However, crooked noses tend to drift back despite efforts to realign the bones and cartilages, asymmetries may be improved, but tend to persist after surgery. Small irregularities are common after surgery. The nasal skin, especially in the tip area, will swell following surgery. The thicker the nasal skin, the longer the persistence of the swelling. Swelling generally persists for 6-12 months following surgery and initially may mask the total result of the operation. The appearance of the nose tends to change postoperatively for many months with progressive improvement. Secondary procedures may be required in some patients. The surgery is designed to improve nasal aesthetics and facial balance. It will not improve interpersonal relationships.

ALTERANTIVES TO THE PROCEDURE
Without surgery, an obstruction to nasal breathing due to a mechanical obstruction will persist. Surgery designed to alter nasal aesthetics is cosmetic and should have no effect on the nose. Small irregularities in nasal contouring have been treated with various injectable agents (collagen, fat). However, these are short term improvements and tend to disappear with time.

SURGICAL TECHNIQUES/ANESTHESIA/RECOVERY
Nasal surgery, with or without septal resection, is performed in the operating room under either a general anesthetic or a local anesthetic with sedation. The choice of anesthesia will be determined after discussion with both the anesthesiologist and the surgeon. In most instances, the procedures can be performed as an outpatient. However, in some cases, an overnight stay is recommended. In any cases, the surgery is performed completely through incisions within the nose, which are not visible externally. In many patients, a small incision is made across the columella (dividing partition between the nostrils at the base of the nose) to gain better access to internal structures. Occasionally, an additional incision may be required on the side of the nasal bridge to more directly control the nasal bone repositioning. Through these incisions, nasal cartilage are reshaped and repositioned and the nasal bones are reduced or
repositioned. In some patients, cartilage grafts taken from either the nasal septum or the ear are used to augment areas, which require additional tissue.

When the nasal septum require surgery, incisions are made inside the nose and portions of the obstructing septum are removed while the remaining septum is repositioned to allow improved airflow through the nostrils. In most instances, the bones of the nose need to be surgically repositioned following contouring the height of the nose. These bone cuts may produce localized bruising and black and blue discoloration of the lower eyelids. The nose may be packed with Vaseline gauze following surgery. An external splint is molded over the nasal bones to support them during the healing process. It is imperative that you refrain form heavy exercise for 3-5 weeks following surgery. Normal activities of daily living may be resumed within a week of surgery with the exception of heavy lifting and athletic exercise. Contact sports should be avoided for three months following surgery. If sutures are placed in the skin on the outside of the nose, they are usually removed within one week after operation. It is important to realize that following recontouring of the nasal bones and cartilage, it may take form 12-18 months for the skin of the nose particularly in the nasal tip area for at least one year following surgery. The characteristics of the own skin will also affect the final result.

RISKS/COMPLICATIONS
The most common complication following this surgery is postoperative bleeding. Some bloody drainage is common for several days following surgery and requires small dressings underneath the nose. If nosebleeds persist for more than 10 minutes or recur frequently, it may be necessary to repack the nose. Infection is very rare following this procedure and usually responds to antibiotic treatment either as an outpatient or in the hospital. In approximately 10-20-% of cases, minor secondary revisions are required to smooth out surface irregularities. This is usually possible in the office under local anesthesia.

In some instances, due to scarring or other wound healing problems, there can be alterations in structural support with changes in nasal shape. In such instances, further surgery may be required for correction. Bone, cartilage, or synthetic implants can migrate or change shape or position. Should this occur, additional procedures may be required. Some numbness of the nasal skin is not unusual for 6-12 months following surgery. Sun exposure needs to be limited and the skin protected with sunscreen. Scars (either of the external incisions or of the internal incisions) may require revision. When septal surgery is performed some airway obstruction may persist. Temporary black and blue discoloration of the eyelids is common. In some patients, however, the breakdown of the blood pigments within the skin causes a darkening of the lower eyelid or upper cheek skin which may be permanent.

Even though the risks and complications cite above occur infrequently, they are the ones that are peculiar to the operation or of greatest concern—other complications and risks can occur, but are even more uncommon. Any and all of the risks and complications can result in:

• Additional surgery
• Hospitalization
• Time off work
• Expense to you

On occasion, surgical revisions may be indicated following the original surgery. If planned or performed within one year after the original surgery and if insurance does not cover these revisions, there will be no charge by the surgeon, but a facility fee will be charged by the hospital for use of the operating room, as well as a fee from the anesthesiologist.

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.

COMMENTS
If a smoker—must be off cigarettes for 3 weeks before surgery and 3 weeks after surgery. There is a much greater risk for scarring, poor healing, hair loss and skin loss in smokers.

If there is any item on this consultation sheet that you do not understand, mark it and call the office. An explanation or additional information will be provided. Share the information that we provide to you with interested family members and/or friends. Our aesthetic coordinator, Connie Chudoff is available for any questions at 856-325-6768.