1. What type of anesthesia is required for rhinoplasty?

Rhinoplasty surgery can be performed under three types of anesthesia, and sometimes four. The simplest anesthesia will be completely local anesthesia using a solution of lidocaine and Marcaine. This local only anesthesia is typically used for minimal revision rhinoplasty surgery, or very minimal nasal dorsal surgery. The next level of anesthesia is in the form of IV sedation, where the patient is given light-to-moderate IV sedation to fall softly asleep, and then they are injected with local anesthesia. Procedures using this type of anesthetic are comparable to patients having a tooth removed. The next form of anesthesia used for rhinoplasty is called MAC anesthesia, which is administered by a board certified anesthesiologist or nurse anesthetist. The patient is given sedation, and once they are asleep, they are injected with local anesthetic. In this situation, the patient may be given oxygen through a little tube that crosses over the lips of the patient. The final form of anesthesia places a tube through the vocal chords and into the lungs to facilitate breathing. This is called an endotracheal tube, which most people think of as standard sleep anesthesia. The anesthesiologist controls the medications given through the IV as well as those passing through the gas into their lungs. These patients are also injected with local anesthetic for further coverage, but also to assure that there is less bleeding through the surgery. The epinephrine that is in the local anesthetic helps to decrease blood loss throughout the surgery, helping the surgeon to have better vision.


2. What is revision rhinoplasty?

Revision rhinoplasty is performed on patients who have already undergone one rhinoplasty or nasal surgery in the past. Revision rhinoplasty is typically performed by more select surgeons because this surgery requires more complex surgical intervention.


3. What are open and closed rhinoplasties?

An open approach requires an incision at the base of the nose between the nostrils, the skin called the columella. I typically use this approach when I do my rhinoplasties. Rarely do we ever perform a revision rhinoplasty in a closed approach because there is less ability to get the scar cartilages exposed and have appropriate accurate surgery performed. A closed rhinoplasty can be performed on a nose that has never undergone surgery before, or for minor revisions. In this situation, the incision lines are performed entirely inside the nose, and there are no external incision lines.


4. Are x-rays taken before undergoing rhinoplasty?

This surgery does not usually require x-rays before surgery. With that said, in my practice, because I perform a significant number of revision rhinoplasties, it is very common for a patient to undergo a CT scan of the nose and nasal sinuses prior to surgery. Also, patients who have complex nasal problems tend to also have complex sinus problems. These surgeries are oftentimes performed at the same time or in a stages approach, and therefore, a CT scan is required.


5. What specifically can be achieved with rhinoplasty?

Rhinoplasty surgery is a very exciting surgery because of the fact that large nasal bumps can be removed, wide tips can become smaller, difficulty in breathing can be alleviated, and multiple modifications can be performed to give the patient a very pleasing result.

Generally speaking, the male nose is not as sculpted as the female nose, and so the goal for male patient is usually to lift the tip up. The female rhinoplasty is typically a more complex surgery because the nasal skin is less thick. I often talk to my patients about bringing in photos of people that have desirable facial structures and nose shapes so that we can discuss what is realistic in terms of the patient' s expectations. A modified nose can either dramatically or minimally change the look of the patient, and it is important that the surgeon understands exactly what the patient wants in order to achieve the greatest result.


6. What can I expect during a rhinoplasty consultation?

During a rhinoplasty consultation, I typically will start out with asking about the patient's sinus and allergy symptoms and history, because it is just as important to know the medical health of the nose as it is to understand the external appearance. When I finish evaluating the history of the patient' s nasal passages, then we talk about the cosmetic appearance of the nose and what the patient would like to change. If the patient has a history of nasal issues then in my practice we will perform a nasal pharyngoscopy, which is an endoscopic look inside of the nose using fiberoptic technology. Upon completion of the examination, we then take pictures of the patient' s face in a front view, side views, and a picture to view up the actual nostrils. These pictures allow me to evaluate extensively prior to surgery and with the patient we can discuss the angles and the surgical outcome goals.


7. How much time will I need to take off from work?

Rhinoplasty surgery requires a minimum of five days off from work, but ideally the patient would take seven to ten days. If the surgery is performed as an open technique, sutures will be removed on day four or five. If the nasal bones need to be shifted or adjusted and a cast is applied, the cast should be removed anywhere from five to ten days. Sometimes, internal nasal work requires septal splints, which sit against the nasal septum and hold it as an internal cast during the first 7 to 14 days. In our practice I try not to stuff the patient with nasal packs, but some patients will require nasal packs to be placed and left in from anywhere between 2 to 12 hours.