Details: Rhinoplasty

The nose may be thought of as a skeleton of bone and cartilage providing support for the overlying skin, muscle and soft tissue. The characteristics of these components are unique to each patient. Alterations are typically performed only on the bone and cartilage. Excessive reduction of the nasal bone and cartilage is a common surgical error, resulting in nasal collapse and loss of function, which in turn gives the nose an "operated" appearance. Many examples of these "operated" noses are evident in the media. Preservation and augmentation of the nasal structure to prevent these complications is emphasized in the textbook Open Structure Rhinoplasty – A Case Study Approach, which Dr. To co-authored with Dr. Calvin Johnson.

What are the goals of rhinoplasty surgery?
Dr. To’s goal in rhinoplasty surgery is a well-structured, functional, attractive and natural appearing nose that "fits" the patient’s face.

What is the "down time" for a rhinoplasty?
Bruising and swelling around the operated area may be present for up to a week, however patients are typically able to return to work about a 4-5 days after surgery.

How painful is the procedure?
Many patients experience very little pain after surgery. Medication for pain is prescribed, however some patients require nothing more than Tylenol for the majority of the post-operative period.

What sort of anesthesia is used?
Rhinoplasty is done with intra-venous sedation and local anesthetic or under general anesthesia. Patient safety and comfort is the primary consideration, so be sure to discuss this issue with Dr. To.

What sort of pre-operative evaluation is necessary?
Routine medical clearance from the patient’s primary care doctor and standard laboratory tests are required. It is also necessary for patients to avoid certain medications, asprin, herbal remedies and alcohol for the 10 days prior to surgery.

Where are the incisions placed for rhinoplasty?
Most of the incisions are located in the nose, hidden from view. If necessary, an external incision is placed on the columella, the structure at the base of the nose, between the nostrils. This incision typically heals very well and soon becomes almost unnoticeable. Dr. To will show you examples of incision placement during your consultation.

What is the typical post-operative course for rhinoplasty?
After surgery, tape and a small external cast is placed on the nose. Internal splints may be placed if necessary. Nasal packing is usually not required. Nasal sutures are removed 3-5 days after surgery and external cast is removed after 6-8 days.

What are the limitations of rhinoplasty?
Realistic expectations about what can be achieved with rhinoplasty are very important. An open and honest line of communication between the surgeon and patient is paramount. Improvement rather than perfection should be expected. Extreme changes in the nasal appearance are typically not recommended or achievable. Occasionally a chin implant may be recommended to improve the profile and balance the chin with the nose. Dr. To will address your concerns and discuss goals and limitations during your consultation.

Is rhinoplasty covered by insurance?
Surgery that is done for purely cosmetic reasons are typically not covered by insurance, however if rhinoplasty is performed for nasal airway obstruction due to an anatomic problem or trauma, insurance may cover a portion of the cost.

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