What to expect before and after rhinoplasty

Before Rhinoplasty

The most important pathway to a successful rhinoplasty is finding the right surgeon for you and this begins with a face-to-face extended consultation with your rhinoplasty surgeon of choice. Communication is key and you should leave your consultation feeling confident that your surgeon has given you an honest appraisal of your problem and that the solution proposed is right for you. If any imaging is used as a tool to plan your surgery Mr Greensmith believes that this imaging should only be performed by an experienced rhinoplasty surgeon who knows how the nuances of your nose may translate into an achievable goal that can be simulated on a computer. It is not satisfactory for a nurse educator to perform imaging on a patient in order to plan surgery without an intimate knowledge of nasal anatomy and the full range of rhinoplasty technical expertise of a surgeon. Patients deserve the assessment and opinion of an expert .

An initial rhinoplasty consultation with Mr Greensmith involves at least 45 minutes of face-to-face time with Mr Greensmith. Ideally you should seek a referral from a family doctor as your procedure costs may be partly claimable through your health insurance fund and /or medicare.

You are encouraged to arrive 15min to 30 min ahead of time for this to allow adequate time for your registration paperwork and 2d and 3D photographs which will be used in the consultation. Arriving early and allowing plenty of time means you will be more relaxed and able to absorb the information conveyed to you in the consultation. On arrival our reception staff will help you with the registration paperwork and then arrange a professional series of 2d and 3D Vectra photographs in our private on site photo studio. Your photos will be stored in your file and on our secure server to protect your privacy. You will be required to specify in writing how you may allow your photos to used used beyond the medical record ( e.g. to educate other doctors, patients in seminars or on the internet ) but it his your prerogative to decline any further use of your images.

After photographs you will see Mr Greensmith for at least 45 minutes. During this time he will ask you about your medical history, reasons for seeking a rhinoplasty procedure and your goals and desires for your rhinoplasty. Next he will closely examine both the outside and inside of your nose. The internal nasal examination is important to assess potential causes of breathing problems.

Next Mr Greensmith will undertake a detailed imaging simulation of your potential rhinoplasty result using his experience in rhinoplasty in combination with both his findings when examining your nose and your goals. He will frankly and honestly point out if there are major limitations to your goals which may require you to re-set your goals. It is important to remember that the 3D Vectra system is a powerful tool and should only be used as a guide for you and Mr Greensmith to clearly communicate what you would both like to aim for and does not represent an absolute guarantee of what can be achieved.

If you reach agreement on these goals Mr Greensmith will provide you with copies of your imaging to take home and consider further.

Throughout the consultation at no time should you feel rushed and you will have plenty of time to ask questions. Mr Greensmith will then run through the basic details of how the surgery and hospital stays works as well as important details about recovery.

Following the completion of the consultation you will be encouraged to spend plenty of time to consider your options further without feeling pressured. A good rhinoplasty is worth waiting for and you should never rush into it or feel that you are being rushed into it by anyone.

Having considered things in your own time if you then would like to book surgery with Mr Greensmith you will need to book through his Personal Assistant Ms Lee Dowling on 9508 0506 or leed@melbplastsurg.com.

Even if you decide to book surgery should also consider whether you would like a second consultation before your surgery to answer further questions. It is normal to forget quite some of what is said in medical consultations so do not hesitate to ask Mr Greensmith’s staff by telephone, email or by booking an additional consultation with Mr Greensmith.

After Surgery and the Recovery Period

Rhinoplasty may be performed either as day surgery or as a 1 overnight stay procedure. If you are eligible for day surgery in the opinion of Mr Greensmith you must remember that this is only possible if you have a responsible adult to take you home from hospital and to be at home with you that first night. By law hospitals will not let your travel home on public transport or in a taxi. After the first night in most cases you can then drive yourself to you next appointment with Mr Greensmith (although for the first visit it is better for someone to drive you if you will require pack removal ).

After surgery you will not feel much pain but more a general discomfort if you have some packs in place .Most people do not find rhinoplasty very painful. Packs are not always used but may be placed in the nostrils to lightly compress the internal lining of your nose to reduce bleeding afterwards.Remember that for the first 1-3 nights after surgery with packs in place and the requirement to sleep propped up and use icepacks you will not have the best sleep for a few days. Mr Greensmith does not recommend sleeping tablets during this period.

The First Visit after Surgery

If packs have been used they require removal in Mr Greensmith’s office by his experienced nursing staff and under Mr Greensmith’s supervision. After pack removal you will be allowed to rest quietly for 30 mins to ensure no bleeding occurs. In addition our nurse will instruct you how to clean the incision line/stitches  and in the use of decongestant spray ( FESS salt water spray used twice a day in each nostril for at least 6 weeks after surgery ) and nasal recovery spray ( FLO Noseoil used twice daily in each nostril for 6-12 weeks after surgery to aid the recovery of the internal lining of your nose ). You will also be instructed about any further taping required and the use of any anti-inflammatory gel ( Voltare/Norufen gel ) to the nasal bridge.

The Second Visit after Surgery

This is usually 7-10 days after your surgery ( 12-14 days in the case of more complex rib graft rhinoplasty ) . At this visit the special plastic holding splint on your nasal bridge is removed along with any covering tapes. Your skin may feel and look a bit oily after being cover for so long but this will settle quickly. At the point you will be bale to see you new nose and it is an exciting time for patient and surgeon. Remember however that while your nose will look great it will still be a little swollen particularly at the tip. At this stage it is only 80-90% of the final result and it will take 6-18 months to for these nose to slowly evole to its final form ( less in thinner skin , more in thicker skin ) . You may also feel quite congested for the following weeks or months. Initial minor asymmetries of nostrils, the tip or bridge are almost always due to asymmetrical swelling at this point and will settle over 6-12 months. No experienced rhinoplasty surgeon will even consider revisional surgery in the first 6-12 months after surgery for this reason as most apparent small problems will settle without surgery. Thankfully this is rarely required.

Longer Term Followup

Mr Greensmith aims to followup all his patients after rhinoplasty at 6 weeks, 6 months and 18-24 months after rhinoplasty. Visits beyond the 6 week period are not covered in initial costs and you may need to referral from a family doctor for subsequent visits. Further post operative photographs are taken at some of these visits.

What if a revision is required ?

In the unlikely event a minor revision is needed in the years after a rhinoplasty ( revision rates range from 2-5% and noses keep changing as we get older ) then Mr Greensmith is as motivated (or more so) as his patients  to ensure a patient’s nose looks the best it can possibly look and will do everything within reason to help reduce potential additional cost. In most cases costs for minor revisions are minimal or negligible if the patient has private health insurance cover. Mr Greensmith will not agree to revise a rhinoplasty if the asymmetry is so small that correction by surgery would not be realistic or feasible. In a small group of patients use of small amount of safe and proven cosmetic “wrinkle filler”such as Restylane ( Hyaluronic Acid )injected into a small depression in the office can be enough to semi-permanently or permanently fix minor asymmetries.




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