Rhinoplasty updates from Dr. Francis R Palmer, III Beverly Hills Plastic and Cosmetic Surgeon.

Rhinoplasty continues to be one of the most popular plastic and cosmetic surgery procedures so I decide to update my readers with some Rhinoplasty and revision Rhinoplasty basics.

The purpose of your Rhinoplasty is to create a more refined, sleek nose. It is not to get a perfect nose.

There are many ways to refine the nasal tip, bridge and width of the nose from rasping the nasal bones, to placing sutures between wide layers of upper lateral cartilages, to removing excess subcutaneous tissue, shaving/removing cartilage and breaking the bones. Experience will dictate which the plastic surgeon chooses to apply in your particular Rhinoplasty.

Primary (first time) Rhinoplasty is easier to perform than a revision Rhinoplasty which has more tissue scar formation and the unknown abnormalities of the existing nasal anatomy resulting from the previous Rhinoplasty. Each subsequent Rhinoplasty creates more scar and further disruption to that nasal anatomy. This is why a Revision Rhinoplasty has a different set of goals (make the nose look normal first then more attractive if possible), has a greater degree of uncertainty (don’t know what was done to the nose during the previous Rhinoplasty surgeries) and is a quantum level more difficult to perform. Generally, this is not a time to be overly aggressive….which could lead to disaster.

Healing from a first time Rhinoplasty is something like this.
I don’t use any nasal packing. I frequently do use a nasal cast made of plastic and tape over the nasal skin. The first day post-op, I see the patients and clean out the nostrils using Q-tips and peroxide. I instruct patients to place ice over their eyes to reduce swelling and bruising, avoid strenuous activity and avoid taking Vit C, E, aspirin and other blood thinning agents and supplements. You should also avoid getting the cast really wet as it may come off.

Cast is removed after 1 week post Rhinoplasty and the skin of the nose is gently cleaned with alcohol. If a tip cartilage graft was placed during an open Rhinoplasty, reinforced tape is applied around the graft to further stabilize the graft. This is removed in another 3-4 days. The patient is informed that swelling can and will occur and it won’t be even from side to side or from top to bottom of the nose. Ice is used over the eyes and the sides of the nose and patients are advised to sleep on U-shaped pillows for 1 month. Once again, strenuous activity and direct contact (bumping, hiting) the nose is to be avoided for 1 month.

Patients are generally seen at 1 month post Rhinoplasty and are then instructed on how to manipulate the nasal tissues to remove residual swelling that can exist from 6 months (first time Rhinoplasty to almost 2 years in difficult revision Rhinoplasty). Patients are encouraged to be seen every month to follow their progress…and to intervene with kenalog injections if required to reduce the scar formation in the nose.

Full activity can be resumed after 1 month however, if it’s hot or you work out the nose will swell. Ice the nose and this typically resolves the following day. Swelling lessens over the months as does this tendency to swell after working out.

Read more about Rhinoplasty here: http://www.beverlyhills-plasticsurgery.com/Rhinoplasty.html

Dr. Francis R Palmer, III