FAQ – Rhinoplasty

I had rhinoplasty and now feel congestion. What should I do?

Fortunately, novel techniques can virtually resolve any nasal congestion even those created after rhinoplasty. In most cases, ongestion can be resolved using medications. However, some cases need surgery. Therefore, method of treatment must be determined based on examination and cases of congestion.

What results should I expect if I got hit in nose after rhinoplasty?

It depends on how hard your nose has been hit and also the interval from surgery to the time when your nose has been hit. Few days after surgery, even small impacts can affect the results. Over time, cartilage and skeletal tissues will become stronger. Small impacts will only cause pain while great shocks can still be damaging. It is not that your nose will be more vulnerable to fracture compared to normal noses, but an impact that can cause fracture in a normal nose, will result in more extreme fractures in noses that underwent surgery.

How long should I wait after rhinoplasty before I can wear glasses?

You should wait 1 month and a half after your surgery before wearing glasses. If you must, use a tape to suspend glasses from your forehead. You can wear lenses immediately after your surgery.

How long should I wait after rhinoplasty before I can exercise?

You can resume your daily routines (walking, using computer, cooking) 3 to 4 days after rhinoplasty. You can also start jogging and walking in water 2 weeks after your surgery. Rigorous physical activities, like physical conditioning, will cause no problem if done 2 months after surgery. However, you should be careful about protecting your nose against any impact during physical activity.

Will I experience bleeding after surgery? If so, what should I do?

Secretion of serum (transparent blood) from nose will be normal in 24 hours following surgery. This may last up to three days for some patients. Post-surgery bleeding is quite unlikely and often can be stopped using meshes or dressing. In case of bleeding, avoid blowing your nose and use cleansing liquid to wash your nose. Avoid using any painkiller except for acetaminophen or codeine, as painkillers may worsen bleeding.

How long will it take for post-surgery bruising to disappear?

Most people do not experience much bruising after surgery. Bruising, if any, will usually disappear within 7 to 10 days from surgery.

What causes bruising after rhinoplasty and what should I do to prevent this?

A large portion (75%) of bruising after rhinoplassty depends on patient’s blood pressure during surgery. Anesthetists and anesthetics also play a major role. Some bruising after surgery depends on patient. More bruising will be experienced by those patients who have excessive stress prior to rhinoplasty or do not follow instructions for post-surgery cares. Surgeon and surgical techniques also contribute to bruising. All these factors can be taken into account during pre-surgery counseling session.

Will my nose run after rhinoplasty?

Nasal discharge will be observed in patients who had allergy prior to rhinoplasty or who will develop one in post-surgery stage. These are not related to rhinoplasty and can be dealt with using medications. Therefore, no nasal discharge will normally occur after rhinoplasty.

How does rhinoplasty affect my olfaction (smelling)?

Smelling will be weakened as long as breathing is hindered to some extent by swollen nose. Once the swelling disappears, you will be able to normally sense smells. In patients with nasal congestions, smelling will be improved once the deviation is corrected and the nasal turbinates are reduced.

How should I clean inside y nose after surgery?

Nostrils must be cleansed using a large amount of special cleansing liquid at least four times a day. This should continue until the mucus can be easily discharged through normal breathing and without blowing the nose. A 10 CC syringe or cleansing device can be used for this purpose. ARYO provides devices that can be easily utilized by most patients.

Why do some surgeons recommend prolonged taping?

Most patients get very sensitive after surgery and worry about even the smallest changes in how their nose looks like. Patients will be even more concerned if their families or friends note some problems. Taping will conceal many problems that otherwise could be observed due to swelling. This will result in patients’ greater satisfaction. In general, nose tapes should be there for 1 to 3 months max. After that, most patients can conveniently deal with the swelling. Then, why do some surgeons insist on prolonged taping? I believe that surgeons in such cases will benefit from prolonged taping. Taping temporarily shapes the nose (just as a fat person who uses tightlacing to temporarily make a fit appearance). Taping will cause the nose look curvy, turned-up, and in tiptop shape while covering its flaws. Therefore, by recommending prolonged taping, a surgeon will convince his/her patients and their relatives that he/she has done a great job. As long as someone has a tape on their nose everyone around them will ask them how they can contact the surgeon. This is a great motivation for surgeons. On the other hand, small bumps and delicate aspects of the skeletal structure of the nose will not be notices until the swelling disappears. A surgeon who is afraid of patient’s complaints after rhinoplasty tends to cover up potential flaws and delay such complaints. When the tape is removed after a long while, the patient will think that any bump or flaw appearing after tape removal is the result of his/her carelessness, particularly if his/her nose has been hurt during this period. It is worth knowing that most lecturers at international congresses and seminars on plastic surgery oppose prolonged taping.

What are side effects of prolonged taping?

Prolonged taping does not usually have any side effects. But as taping for a short time is helpful in removal of nose swelling, prolonged taping prevents complete removal of swelling, leading to 10-20% swelling remained on the nose. To better see this, you can tape your finger and remove it after an hour. You will see that your healthy finger will be a little swollen up. Due to inhibition of complete delivery of blood into the nose, prolonged taping may result in zits, pimples, or shiny skin.

Is taping the nose effective in correcting some problems?

Most people believe they can correct some issues by taping their nose. However, this is not the case as it is usually the other way around. In other words, incorrect taping may lead to such problems as nasal congestion, displacement of cartilage augmentation, and other issues. The overall shape of nose is determined by surgical operations and unfortunately taping will not resolve problems caused by flawed surgical techniques.

Does taping the nose after rhinoplasty affect its results?

Bloating is quite common in mornings, particularly under the eyes (because of concentrated interstitial fluid), but it will soon be removed as lymphatic vessels discharge this fluid. This situation will be intensified after rhinoplasty. In other words, there is swelling on the nose intensified by morning bloating. On the other hand, the nose will look somehow bigger because of delayed discharge of interstitial fluid due to disordered function of lymphatic nodes. Taping the nose after surgery will prevent excessive swelling of the nose. We know that patients and their relatives would not like to see a swollen nose (this is why some patients prefer to have mesh on their nose rather than letting other see the wound itself). Taping the nose will created a pleasant look for patients and their relatives and in some cases, is even a source of pride in our society. Therefore, taping is intended to control swelling and to create an acceptable appearance for patients during the few weeks following surgery.

Are nose tapes helpful in preventing dropped nose tip?

The answer is no, based on the answer to the question above. Tapes should be used for a shorter period of time for those patients who are allergic to tapes. Sometimes we recommend using tapes only for 1 to 2 weeks. But they will not experience greater dropping than other patients.

Can keeping one’s head down lead to dropped nose tip?

I believe dropped nose tip is more of an outcome of surgeon’s effort than it can be caused by patient’s post-surgery cares. Most surgeons prefer to relieve themselves of any responsibility by providing their patients with strict instructions for prevention of dropped nose tip. My experience has shown me that this is often the result of bad surgical techniques, even if I see this in my own patients. Different factors are involved in causing dropped tip. In summary, an imperfection in skeletal structure that supports the nose can lead to dropped tip. Given the following causes of dropped nose tip, keeping one’s head down is not connected to this problem: 1- People who always keep their head up are just as likely as those who bow their head to develop a dropped nose tip. 2- The weight of nose, when looking to one’s front, is not much different from its weight when you keep your head down. 3- Dropped nose is a result of a gradual process not an immediate effect of keeping one’s head down. 4- Dropped nose is as likely in people who use tapes to keep their nose up as in people who do not use tape on their nose. Fortunately, there are new techniques to prevent dropped tip to some extent.

Will nose tip drop after rhinoplasty?

Some patients are more vulnerable to tip drop due to the particular structure of their nasal cartilage and muscles. Fortunately, this can be prevented in most patients by making use of certain surgical techniques. If nose tip drops despite all these efforts, the patient may need a secondary surgery.

How will talking and laughing affect results of rhinoplasty?

Normal talking and laughing use some nasal muscles, move nose tip, and change the size of nostrils. After surgery, however, the movement of nose tip and nostrils will be reduced due to swelling in muscles connected to nose. So, laughing and talking will not affect the results. But it is recommended to avoid laughing or talking if you feel pain at some parts of your nose when you do this.

What is the time interval from rhinoplasty to post-surgery examinations?

You should see your doctor at least once a week during the next month following your surgery. For patients not living in the capital city, these intervals will be expanded as the case may be. Next examinations will take place 3, 6, and 12 months after the surgery.

How long should I wait after surgery before I can take a bath?

Patients are recommended to take a bath next day after surgery and to thoroughly wash their head and face. No problem will be caused by washing nose plaster or splint. Washing the location of stitches three times a day with water and soap will help removal of wound and traces of sutures.

Is plaster used for rhinoplasty? When is the plaster removed?

Currently, a plastic device is used instead of plaster. It is lighter and causes less discomfort. It has no effect on the outcome and will be usually removed 5 days after surgery.

What is the appropriate time for removing stitches?

Usually, stitches are removed within a week from surgery. Absorbable sutures will not need to be removed.

How painful will be the days following a rhinoplasty?

People have different thresholds of feeling pain and they complain differently about post-surgery pains. About 5-10% of patients will feel extreme pains and will need painkillers. 20-30% of people will experience relative pain and will sometimes need painkillers. Others will feel small or no pain and may need no drug. I recommend taking painkillers by all patients 3 to 4 days following rhinoplasty even if they don’t feel any pain because it will take some time for the medicines to kick in and the patient may feel uncomfortable during this period.

Will there be a mesh used inside the nose after rhinoplasty?

I think most patients will not need a mesh inside their nose. In case of not using a mesh, the patient will be able to freely breathe immediately after surgery, giving him/her a pleasant feeling. However, some surgeons may use such meshes for their patients.

Will rhinoplasty increase the risk of allergy and sinusitis?

There is no link between rhinoplasty and allergy. Studies have shown that allergies in some patients have been mitigated after rhinoplasty, while other experienced heightened allergy. In general, rhinoplasty has no effect on allergy. In cases where sinusitis is caused by nasal congestion or deviation, correction of deviation during rhinoplasty will mitigate sinusitis as well. However, in general, rhinoplasty does not affect sinusitis. So, people with allergy and sinusitis will need medical treatment after rhinoplasty.

I have septum deviation but no nasal congestion. Will it be necessary to correct septum deviation during rhinoplasty?

If septum deviation makes post-surgery congestion more likely, it should be corrected. Doctors should note this in pre-surgery examinations.

Is it possible to correct septum deviation at the same time as rhinoplasty?

Yes. I suggest that people with nasal septum deviation who want a rhinoplasty do both at the same time. Not only this is more cost effective, but also, scientifically speaking, extra cartilage removed during septum deviation correction can be used in rhinoplasty. In this way, both surgical operations will be performed using only one anesthetic operation.

Can people with sinusitis or polyps apply for rhinoplasty?

It is totally ok to treat sinusitis and polyps while performing rhinoplasty. However, these patients may need medical treatment after surgery.

What are advantages and disadvantages of using synthetic implants (nasal augmentations)?

A synthetic cartilage can be prepared, for those patients whose nose doesn’t have enough cartilage for recovery, by three techniques. Cartilage may be removed from the patient’s ear or rib. Cartilages from brain death donators are also available in the market. Finally, synthetic cartilages are also available and can be used for this purpose. Most surgeons recommend using cartilage from patient’s own body. The advantage of using prosthetic cartilages is reduced time and effort required in surgery. In addition, as prosthetic cartilages are well-shaped, they can be used for making a more beautiful nose. The main disadvantage of synthetic cartilages is the risk of infection and projection of prosthetic parts from skin. Although these materials can be safely used for other parts of face (for example, cheeks and chin), but the delicate skin of nose and small thickness of its subcutaneous layer make side effects more likely. Unfortunately, such side effects may lead to disastrous destruction of nose. This will go beyond the surgeon’s control and cannot be reserved by making use of science and technology. I strongly recommend that you shouldn’t accept any form of such prosthetic materials until they have been used at least for 15 years on volunteers and proven safe.

How long will it take for the nose to take its actual shape?

Usually the final shape will emerge 12 to 18 months after surgery (changes may still occur in some cases after this period).

Does corticosteroid injection for removal of nose swelling have any side effects?

Corticosteroids are like double-edged swords. They can be very useful in treating nose swelling with no side effects, if used properly; that is, small doses at large intervals. Improper use, however, may lead to deformation, skin problems, and other issues.

How long will post-surgery swelling last after rhinoplasty?

Swelling will increase for three days after rhinoplasty. It peaks on the third day and then starts to disappear. Swelling, for the most part, will disappear within 2 to 4 weeks after surgery. However, complete removal of swelling will take, in average, 3 to 6 months for bony noses and sometimes 12 months for fleshy noses. In some cases, corticosteroid injection can be used for faster removal of swelling.

How long should I wait after rhinoplasty before I can get pregnant?

Pregnancy has no effect on results of rhinoplasty. Therefore, there is no restriction on pregnancy following rhinoplasty. But it should be noted that during pregnancy more swelling will be experienced on nose as in other parts of the body. However, pregnant women are recommended to reschedule rhinoplasty or any other unnecessary surgeries until pregnancy is over.

What time interval should be considered between rhinoplasty and dental operations or orthodontic treatment?

Dental operations or orthodontic treatments cause no interference with rhinoplasty. You can even do both at the same time.

What are the costs of secondary surgery (if needed)?

For patients who came to me for their primary surgery, I will ask for no additional fee of surgery. But they should pay for hospital/clinic expenses and consumables. For patients who went to other surgeons for their primary surgery, I will often ask for a fee equivalent to a primary surgery (these expenses, however, may be adjusted depending on the work needed).

What is the best time interval from the primary to the secondary surgery?

It is recommended that patients wait until the swelling is gone and the nose takes its final shape. Although secondary surgery may be performed within 3 to 6 month, it is better to wait for 12 months. It should be noted that outcome of secondary surgery will be better if this 12-month interval exists between the primary and secondary surgeries.

What is the procedure of secondary surgery (if needed)?

Compared to primary surgery, secondary surgery usually needs less efforts and less time. In addition, the patient may come back to his/her normal life a short while after the surgery. However, in case of serious side effects (for example, when rhinoplasty has been performed by a non-professional) secondary surgery may require greater effort compared to primary surgery.

Which drugs are prohibited for patients before rhinoplasty?

Drugs that disrupt blood clotting (blood diluters) and herbal medicines should not be used for a period of few days before surgery. You should inform your doctor about any medicine that you take.

How probable is the need for a re-surgery?

In general, 10% of patients who undergo rhinoplasty may need another surgery. The need for re-surgery can be reduced by proper pre-surgery counseling, proper design before surgery, and mindful care after surgery, etc.

For how long after rhinoplasty would I be hospitalized in a clinic or hospital?

A few hours after the surgery, the patient will be discharged once he/she regains consciousness and is able to walk. This usually takes 4 hours and patients do not need to stay at hospital overnight.

What are side effects of rhinoplasty? What should be done to treat them?

Nasal congestion, deformation on different parts, asymmetric nostrils, and bleeding after surgery are among the most common side effects of rhinoplasty. No surgeon can guarantee that his/her patient will not experience such side effects. However, fortunately many of these side effects can be prevented and corrected through secondary rhinoplasty.

Will my voice be different after rhinoplasty?

For many people, rhinoplasty does not affect their voices. In cases like nasal congestion in which the patient has a nasal voice, rhinoplasty is expected to solve the problem and give the voice back its natural quality. Some patients may also experience temporary changes in their voices due to nasal congestions few days following the surgery. For singers, no change often occurs in their normal voice (normal talking) but changes in their singing voice is likely. Therefore, singers should know this in advance.

Which one is used in rhinoplasty: local anesthesia or general anesthesia?

Both techniques may be used in rhinoplasty. One technique is often used depending on the work needed to be done on the patient, patient’s choice, surgeon’s opinion, and other factors. Most surgeons prefer general anesthesia. This is particularly more helpful for anxious patients.

Why do surgeons not do it on their own nose?

This question is often asked by patients as a joke. Currently, many surgeons (especially women) have tried nose job. Given that most applicants for rhinoplasty are women, and they often do it when they are 20 to 30, men of older ages are expected to be less motivated to apply for rhinoplasty.

What time or season is more suitable for rhinoplasty?

Results of rhinoplasty do not depend on the season in which the surgery has been performed. You may do it in winter or summer. You should do it when you have enough time (about one week) to rest so that the surgery does not disrupt other things you do (for example, work or exams).

How old should I be in order to be able to undergo rhinoplasty?

Rhinoplasty should be performed after full development of nasal bones and cartilages. In the past, many surgeons recommended the age of 18 (many still believe that 18 is the appropriate age for rhinoplasty). However, studies have shown that the nose full development stage is reached at the age of 13 for women and 14 for men. But I recommend that rhinoplasty should be performed at the age of 16 or later.

Is it possible to perform rhinoplasty using laser beams?

Laser is not used in rhinoplasty, although it can be used to create the initial opening but it doesn’t change the final outcome of the surgery. Some may claim that they perform laser rhinoplasty to take advantage of lack of knowledge among patients in order to have more patients or raise the payment by patients.

Do nose reshaping devices (nose up) work?

These devices have not been scientifically tested and their effectiveness has yet to be proven. Although it is claimed that the device has been approved by the Ministry of Health, it should be noted that the approval goes to its safety as its effectiveness has not been confirmed. On the other hand, the manufacturer is not willing to guarantee or provide a return policy. To be honest, I have never seen anyone reporting positive results by using this device. Many people have turned to rhinoplasty after finding this device ineffective. I also observed instances of strong vertigo caused by vibrations produced in this device. These vibrations cause vertigo by inducing motions in otoliths (granules in inner ear). In addition, the device may dangerously cause blindness in individuals predisposed to retinal detachment (for example, those with extreme myopia).

Is rhinoplasty effective for fleshy noses?

In the past, these patients would not get a good result from rhinoplasty. Therefore, they often believe that rhinoplasty is not effective for fleshy noses. However, this is not true as new techniques are helpful in achieving very good results for these patients. It should be emphasized, however, that nose swelling will not go for a long time after surgery and these patients sometimes need more than one year to get a good result (samples photos of these patients are provided in the photo album). In addition, people with fleshy nose should compare the result of their surgery not with other individuals who have bony nose, but with their own pre-surgery photos.

What are the differences between boney and fleshy noses?

Extreme growth of bones inn bony noses gives the nose an undesirable look. Most people with bony nose have a bump on their noses in profile view while the full-face view indicates no problem. Most people with bony noses may be quite satisfied with the results and the post-surgery swelling will be quickly removed. The skin of fleshy noses is often thick making the nose appear large in size. Most people with fleshy noses complain about their wide nose on their full-face view while they may actually like the profile view of their face. Figure 3 shows an example of bony nose while a fleshy nose is depicted in Figure 4.

What methods can be used for rhinoplasty?

In general, rhinoplasty techniques can be classified into two major categories: open and closed rhinoplasty. In open rhinoplasty, a small opening is created at the lower part of the nose tip and the procedure follows by lifting the nose skin. In closed rhinoplasty, no such opening will be created, as all cuts will be inside the nostrils. It should be noted that some openings may be created next to nostrils (in both open and closed rhinoplasty) to reduce the size of nostrils regardless of the technique used in surgery.

Why do some surgeons not use pre-surgery images?

Using standard pre-surgery images is a basic principle of cosmetic surgery. A major portion of accidents are caused by violation of driving regulations. It is interesting to know that even the most skilled and well-experienced drivers may cause dangerous incidents if they do not follow such regulations. It is the same for rhinoplasty. Violation of basic principles will lead to disastrous outcomes which are primarily harmful for the patient. It is worth knowing that analysis of pre-surgery images will take time, and some surgeons will expose their patients to the risk of dissatisfaction with the outcomes of the surgery by putting their comfort before required efforts.

How can pre-surgery images prevent post-surgery side effects?

A major problem after a nose surgery is patent’s dissatisfaction with the outcome. A patient may be dissatisfied with the outcome if he/she wanted a curved nose but instead got a flat nose after surgery, or even if his/her nose looks normal and has no problem in terms of breathing. It should be noted that in some cases 1-2 millimeters of variation in nose measurement may lead to dissatisfaction. So, pre-surgery imaging can be helpful in determining and measuring the changes required in the nose. On the other hand, inaccurate images do not depict some minor problems. The surgeon may not see these issues during the surgery due to swelling, and therefore the patient will be dissatisfied as the problem has not been solved. Figure 2 illustrates an example of pre-surgery image, designs, and calculations of required changes.

How important is pre-surgery imaging?

For accurate examination of nose, different images are taken from different angles prior to surgery. It should be noted that some defects (for example, nasal deviation) cannot be observed or may be underrepresented in actual views, while they can be finely observed in images. Standard images convert three-dimensional features into two-dimensional ones, making evaluations more accurate. Such images require medical images that make it possible to measure nasal dimensions. In fact, these images act like a map that directs the surgical procedures. Due to nasal swelling during rhinoplasty, the surgeon should refer to these images to get a good grasp of what the nose looked like prior to surgery. Figure 1 presents a sample of standard images. Research has shown that patient dissatisfaction is more likely for doctors who do not use standard images or do not perform imaging prior to surgery. On the other hand, using medical imaging in fact shows the doctor’s respect for the rights of the patient. In other words, the doctor indicates his/her commitment to show the patient differences caused by the surgery.

What tests and examinations will be performed prior to surgery?

All patients will be required to take a simple blood test in order to assess possible leukemia. ECG and thoracic imaging will be requested for patients above 40 years of age. Other tests may be required for patients with a history of specific diseases or those who take particular drugs. Tests for blood clotting, hepatitis, and AIDS are not often conducted as these may only increase the costs with no impact on the surgery.

What should I focus on during the pre-surgery consultation?

We, the doctors, just like you, can have all characteristics (good or bad) of humans. We may be honest to our patients or try to deceive them into a surgery. We all enjoy being rich and famous, but we may put our honesty before these. Or we may hire well-paid employees to recommend us, a doctor who can do miraculous things, to clients. We are all susceptible to errors and miscalculations. But by making use of tools and technology and by making greater efforts, we can prevent errors. Or we may let our lethargy and laziness make these errors perpetual. As a patient, during a pre-surgery session, you should note the following: 1- Assess your doctor’s skills. A surgeon should be able to meet the patient’s reasonable expectations using his/her knowledge and skills without causing harm to the normal functioning of the nose. It doesn’t matter if you like how other patients’ nose look like; what matters is to help the patient achieve what he/she reasonably expected (different patients have different expectations). For better examination, you should see pre-surgery photos of other patients. You should also seem them at least 6 months after their surgery and after the tape has been removed off the nose. 2- Assess your doctor’s honesty. An honest surgeon would ask you to think well before surgery, not to rush it, to see the outcome of his/her previous surgeries, and to see other doctors if you want to. On the other hand, some surgeons may rush you into it (to take away your time for thinking before you can reconsider surgery). They may also stop you from seeing other doctors by boasting about their performance and downplaying the work of other surgeons. 3- Some clients have a very beautiful face with a slightly deformed nose. In this situation, a small effort will clearly lead to a very good-looking nose. On the other hand, some people have major problems on their nose which require rigorous efforts that will only partially solve the problem. You are expected to be reasonable and not to compare your nose with others’. Talk about major problems, as small issues will not be observed by others and, in addition, in some cases they are not modifiable. 4- There is no standard time for consultation sessions as this varies from one patient to another. A 20-minute session will do it for some clients while other may need more than one hour. However, all client’s questions must be answered and all his/her expectations must be heard. If you feel your doctor is reluctant to spend enough time on consultation, you might as well worry that insufficient time would be spent on surgery 5- Don’t forget to have standard photos prepared before the surgery and to ask your surgeon to make a nose design. This is like buckling up while driving. Although it cannot prevent all potential damages in an accident, it will for sure make damages less intense. Such a design will reduce post-surgery side effects to some extent. 6- You may bring in people whose nose you think looks great. This will help you communicate your expectations to your doctor. However, you should remember that everyone has a unique form of nose, just as our fingerprints are unique. And therefore you may not be able to find an identical nose. 7- You should know that it is you that decide for the surgery. Rhinoplasty is an optional surgery since you can live without it. So don’t rush it. You may put it off for another month or even several years. It is important to have the surgery at the right time and with proper knowledge.

Will pre-surgery consultation take only one session?

The consultation should leave the patient with no unanswered question. It is recommended that consultation take more than one session to give the patient sufficient time to think over and ask his/her questions.

How can I prepare for rhinoplasty?

In the pre-surgery consultation stage, your nose will be assessed aesthetically based on standard measures of beauty. You will state your expectations and your surgeon will examine your nose in order to determine whether such expectations are achievable. Novel medical software will be used to prepare a design for those who decided to have a nose job to help them have a clearer picture of how their nose will look like after the surgery.