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Nasal Surgery


Nasal Surgery (rhinoplasty) is a procedure performed to improve the nose in one or both of the following ways:

  • Cosmetic: To improve the external appearance of the nose.
  • Functional: To improve nasal breathing difficulties.

Dr. Friedman customizes rhinoplasty to each patient, depending upon the specific internal and external nasal problems and the patient's desires. There is not a universal type of rhinoplasty that will meet the needs of every patient. The best candidates for surgery are looking for improvement, not perfection, in the appearance of their noses.

In some patients, deviation of the nasal septum may cause the nose to appear crooked and/or may interfere with breathing through the nasal passages. Septoplasty to straighten and/or remove a portion of the septum may be performed to improve these problems. Surgery performed to improve nasal breathing is generally covered by insurance. However, reshaping of the nose is considered cosmetic surgery and is not covered by most insurers.

Dr. Friedman performs rhinoplasty under general anesthesia on an outpatient basis. The procedure is performed in his AAAASF-accredited surgical facility, the West Plano Plastic Surgery Center, which is located on the campus of Texas Health Presbyterian Hospital of Plano. He strictly uses physicians—not nurses or technicians—to administer your anesthesia.

Incisions are located inside the nose with the exception of a quarter-inch incision between the nostrils on the underside of the nose. The small external incision (open rhinoplasty) enables better control over nasal reshaping. If the nasal bones are to be refined by fracture, 3 mm (one-eighth inch) incisions are used along the upper outer nose. The incisions generally heal with inconspicuous scars.

Pain is usually mild and well-controlled with prescription pain medication. Most patients return to light activities within 3 to 5 days. External nasal splints (if used) and stitches are removed 1 week after surgery. Heavy straining should be avoided for about 4 weeks. Improvement in nasal shape is generally apparent shortly after surgery, but final results may take 12 to 18 months.

When you visit our office, Dr. Friedman will discuss your particular problems and concerns. He will give you a realistic expectation of what you can expect from surgery. We will also show you a variety of "before and after" photos of rhinoplasties performed by Dr. Friedman. If you wish to speak to other patients who have undergone nasal surgery, we will be happy to provide phone numbers.

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Q & A: Nasal Surgery

What specific problems can be improved with rhinoplasty?

Typical rhinoplasty goals include reduction of nasal hump, narrowing of the nose, elevation of the nasal tip, and/or reduction of fullness from the nasal tip. If you have problems breathing from the nose, this may also be addressed at the time of rhinoplasty.

Am I a good candidate for rhinoplasty?

To be a reasonable candidate for rhinoplasty, you must have significant cosmetic problems (such as a hump or an excessively wide nose) that can be improved with surgery. If you have a subtle problem, surgery may not be worthwhile. Similarly, you must have realistic expectations regarding the potential surgical results. Most patients achieve improvement with rhinoplasty, but no one achieves perfection.

What is a “closed” versus an “open” rhinoplasty?

A closed rhinoplasty involves incisions inside the nostrils without an external incision. An open rhinoplasty involves the same nostril incisions with a small incision across the columella (the skin between the nostrils). Many plastic surgeons, including Dr. Friedman, believe that an open rhinoplasty provides greater flexibility and more surgical options, as the nasal framework is directly visualized during the procedure. The columellar scar is very small and is generally quite subtle (see photos).

Do you have to “break” my bones?

Over 50% of patients undergoing rhinoplasty benefit from planned nasal fractures. These are performed to narrow the width of the upper nose, help straighten a deviated nose, or to reduce the chance of a flat nasal bridge after removal of a large nasal hump. If the nasal bones are fractured, a splint is worn for one week after surgery. Some bruising of the lower eyelids usually occurs.

Will I need nasal packing?

Dr. Friedman does not use nasal packing for rhinoplasties. If you are undergoing septal surgery, internal nasal splints may be placed for 3 to 4 days. If you are strictly improving your nasal shape, no internal splints or packs are used.

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Nasal Surgery: Instructions

One week before surgery

  1. Do not take aspirin-containing products, as these may increase your risk of bleeding. Use extra-strength Tylenol for any headaches or other minor pains.
  2. Please notify Dr. Friedman's staff if you become sick with a fever, significant cough, etc. If necessary, your surgery can be rescheduled to a time when you are feeling better.
  3. Do not smoke at all or use a nicotine patch for at least two weeks (and preferably 4 weeks) prior to surgery and 4 weeks after surgery. Smoking interferes with wound healing and increases your risk for anesthetic and surgical complications.
  4. Arrange to have a relative or friend drive you home after surgery and stay with you for the evening. You cannot drive yourself home.

The evening before surgery:

  1. Do not eat or drink anything for at least 8 hours prior to your scheduled surgery time.
  2. Make some jello and/or soup for after surgery. Have some juice in your refrigerator.
  3. The anesthesiologist will contact you by phone to discuss your medical history and to answer any questions.

Before you leave home:

  1. Remember not to eat, drink, or smoke. This includes no chewing gum, mints, etc.
  2. Make sure someone is available to drive you home. Put a pillow and blanket in the car.
  3. Wear loose, comfortable clothing. Avoid heavy make-up, jewelry, or contact lenses. Please do not use any lotion, baby oil, perfume or powder. LEAVE ALL VALUABLES AT HOME!

Day of surgery: at the facility before surgery

  1. Dr. Friedman will talk to you before surgery to answer any last-minute questions
  2. You will meet the anesthesiologist and surgical nurses.

Day of surgery: at the facility after surgery

  1. You will be taken to the recovery area to wake up after surgery. Dr. Friedman will go to the waiting room to speak to your family/friends.
  2. Approximately 1 hour later, your family can visit you. Once you are feeling well enough, you may go home.

At home after surgery:

  1. Have someone stay with you for the first night. You may be weak and drowsy.
  2. Take the antibiotics, steroid medication (to decrease swelling), pain medication (as needed), and anti- nausea medicine (if needed) that Dr. Friedman has prescribed for you.
  3. Keep your head elevated at all times. Sleep on your back (not your stomach or side).
  4. Apply over-the-counter antibiotic ointment twice daily to the small incision on the underside of the nose. You may gently wash this limited area, but otherwise keep your nose clean and dry.
  5. Keep an ice pack or frozen peas over your nose and eyes intermittently for the first 24 hours after surgery (especially if Dr. Friedman fractures your nasal bones).
  6. Avoid lifting, pushing, pulling greater than 5 pounds. Avoid straining.
  7. You may wear contact lenses. If you wear glasses, you may have to tape them to the skin between your eyes for the first week, as excessive nasal pressure should be avoided.
  8. Take at least 10 deep breaths every hour. This will help keep your lungs expanded.
  9. Do not be a couch potato. To reduce the risk of blood clots in the legs, have someone help you to get up and walk anytime you need to eat or use the bathroom. While you are in bed, repeatedly flex your ankles (moving your toes up and then down) and/or have your family massage your calves.
  10. If you experience a prolonged fever (oral temperature greater than 101) or significant nasal bleeding, contact Dr. Friedman. Feel free to call our office or to page Dr. Friedman for any other problems or concerns.

Instructions for your first postoperative visit (about one week after surgery)

  1. Incision care

    The stitches, flesh-colored nasal tape, and the nasal splint (if present) will be removed. You will continue use of antibiotic ointment over your incisions twice daily for about 3 more days. Following this, you may begin scar massage with Mederma, Vitamin E, or Aloe Vera twice daily. Continue scar massage for about 3 months.

  2. Activity level

    1 week after surgery: you may resume casual walking but must not engage in vigorous exercise that increases your blood pressure or heart rate. You may resume driving once you are off of your pain medication and can see clearly. Avoid freeways until you are comfortable with city driving.

    3 weeks after surgery: you may gradually resume regular exercise.

  3. Sleeping position

    Please sleep with your head elevated. You may sleep on your back or part way over (pillow under your shoulder and hip). Do not sleep on your side until about 3 weeks after surgery.

  4. Massage

    You should begin gentle massage to the nose one week after surgery. This will help reduce swelling and any areas of firmness. You may apply lotion to your hand and massage in an upward and outward direction. You will notice that the upper nasal swelling resolves much faster than the lower nasal swelling.

  5. Water exposure

    You may begin light showers but should avoid scrubbing your incisions. Avoid immersing your face in a pool, lake, or ocean for 4 weeks.

  6. Medications

    One week after surgery, you may resume use of any medications or supplements that you discontinued prior to surgery. However, for at least 3 weeks, you should avoid Motrin, aspirin, and any other product that may thin your blood.

  7. Smoking

    Do not smoke for at least one month (and preferably much longer) after surgery. Smoking may increase your risk of infection, lung problems following anesthesia, and wound healing problems.

  8. Sex

    You may resume intercourse about 3 weeks after surgery.

  9. Makeup

    You may begin use of makeup one week after surgery. Sunglasses or a camouflage makeup (available at most department stores) may be helpful to hide any bruises. Do not place makeup directly over your incisions until 3 days after the stitches are removed.

Please feel free to ask Dr. Friedman or his staff about any additional questions or concerns.

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© 2018 Ronald M. Friedman, M.D., P.A.

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