It is important to note that common frequently asked questions relate to the cost of elective procedures, such as cost of cataract surgery, or about new types of body sculpting procedures, such as Zeltiq.

Q. What is Nose Job / Rhinoplasty ?

Rhinoplasty is a surgical procedure performed to modify the size and shape of the nose in order to give it a more pleasant look. Harmonize your nose and show off a really proportionate face. Rhinoplasty also called nosejob.

Rhinoplasty may also be performed to reduce the dorsal hump, modify the nasal tip, narrow the nostrils, reduce the width of the nose, change the angle between the nose and the upper lip, and straighten or narrow the nasal bridge.

Q. who is a best candidate for rhinoplasty/ nose job ?

Any individual either male or female after 16 years of age, who is interested in cosmetic improvement in the shape of the nose, can undergo this procedure. Following are the usual indications,

⇒ For cosmetic reasons i.e. enhance the shape of their nose.
⇒ To correct a crooked nose or deformity as a result of injury
⇒ Have difficulty breathing as a result of nasal passage obstruction

Q. What does Rhinoplasty do ?

It corrects un-aesthetic characteristics in noses that are too long or too big, bulbous, with a hump or with a 'hanging' tip. It narrows the nostrils, if they are too wide. It corrects deformities such as those acquired as a result of accidents. It helps correct certain breathing problems. It can give the nose a more masculine or feminine look, according to the standards of proportion and harmony prescribed for each sex.

Q. What is an ideal age for undergoing nose job operation ?

Rhinoplasty operation is done after completion of natural growth of the nose that is usually fifteen years in girls, sixteen years in boys. There is no maximum age limit, but I usually will not recommend this surgery after fifty years of age. I wonder if somebody visits me for rhinoplasty after fifty, but I will have their through psychological counseling before performing the surgery..

Q. What is the procedure of rhinoplasty or nose job ?

The procedure of Rhinoplasty takes about 1 - 2 hours. Rhinoplasty is usually performed on an outpatient basis. Incisions/ cuts for Rhinoplasty are made depending on the reshaping job that needs to be performed. The skin of the nose is separated from its underlying bone and cartilage which are cut and trimmed to obtain the desired results. The skin is then redraped over the bone and cartilage. Incision(s) is sutured and nose packs are placed to minimize the chances of bleeding. These incisions become imperceptible soon after the surgery.

Q. What anaesthesia used for Rhinoplasty?
Local anesthesia and complementary sedation, or general anesthesia.

Length of surgery:
One or two hours

Hospitalization:
There is no need to be hospitalized; it is done on an outpatient basis. Some times 24- 48hrs hospital stay, it depends on the type of correction required for that individual.

Q. What are different types of Rhinoplasty procedure ?

Reduction Rhinoplasty:
Bone or cartilages are removed in an effort to change the shape of the nose. This is done for humped noses, where there is an excess nose height seen.

Augmentation Rhinoplasty:
It is done for the low bridge noses or saddle noses. These clients seek enhancement of their nose height. It is done by adding cartilage, bone, or implant material on the dorsum of their nose. I personally prefer natural material which exists within their nose.

Closed Rhinoplasty:
Improves the contour of the nose by making the incisions inside the nose and removing, shaving or repositioning the cartilage and bone.

Open Rhinoplasty:
Improves the contour of the nose by making the incisions inside the nose along the nostrils and across the columella(vertical strip), and removing, shaving or repositioning the cartilage and bone.

Q. Will only Rhinoplasty help me with breathing problem ?

No, there is a special procedure called Septoplasty for that. Septoplasty is a nasal operation that is used to straighten or reshape the septum. It is performed on patients who have difficulty breathing as a result of a mal-positioned septum. Septoplasty will not change the shape of the nose, and can be performed alone or in addition to Rhinoplasty. When we perform both at a time it is called septo-rhinopalsty. Turbinate Surgery is nasal surgery that is used to improve breathing by opening the nasal air passages.

Q. What are the precautions to be taken after surgery ?

Bed rests for 24hrs, shun nose blowing, sneeze if occurs do it with open mouth, and avoid Injury to the nose is usual precautions required.

Q. How long will I have to stay at hospital and when will i attend my duties ?

The patient is kept under observation to keep a watch for bleeding or any other post-operative complications that might become manifest in the next couple of hours after Rhinoplasty. It depends on the type of correction required, if I do only tip work, base correction and implant placement person need to stay in hospital for about 6-12 hrs, you can attend light duties after 48 hrs. If I do the bone framework correction you may need to stay in the hospital for1- 2 days and rest at home for 5days. The nasal splint remains externally in place for seven days to hold the nasal bones in place, as well as help reduce swelling and bruising lasts for two to three weeks. One can return to work or college by 7 days as well as resume light exercise.

Nasal packing (if used) stays in the nostrils for one to two days. Stitches inside the nose dissolve by themselves. Stitches left outside the nose are removed in three to five days.

Q. What is the progress and when do I expect final results of the surgery ?

You will be allowed to see your nose on the sixth or seventh days when I open the external plaster on the nose. One can appreciate the early result on the day of pack plaster removal only. It must be taken into account that it is not possible to make any definite judgments about the results of a Rhinoplasty before 6 or 8 weeks. We may say that in these cases patience is a virtue that is rewarded with a harmonious and proportionate nose that completely changes the overall appearance of the face in a very favourable way. Patients who have been able to achieve an adequate understanding with their surgeons have obtained very positive results, and today they are happy and satisfied with the changes that day you can perceive the change which is a definite betterment. Some swelling which persists for further few more weeks will subside gradually. Surprisingly after external Rhinoplasty you can perceive the improvement in the results for further six months.

Q. Are there any dangerous eventualities after nose job surgery ?

There are two types, aesthesia related and surgical procedure related. In a properly worked up case with a technically well-executed surgery will not result in any dangerous eventualities. Present day good general anaesthesia unlikely to lead to any complications.

Q. How long will I have to be away from work ?

Depending on the nature of correction it may vary from 2days to one week. After one week you can attend the duties with minimal discomfort.

Q. How painful is the operation ?

Pain is tolerable; it is controlled after surgery with the help of analgesics in the form of
tablets.

Q. What are the common adverse effects after nose job surgery ?

One can divide side effects in to immediate and delayed. Immediate side effects include, pain, swelling, slight bleeding and discomfort in the nose. Eye swelling, watering and headache due to blocked nose after surgery is common and it subsides after 3-4 days. A delayed effect persisting swelling is possible which resolves with time. Failure to accomplish the goal is usually due to unrealistic expectations of the patient or over assurance by the surgeon.

Results after nose job can be compared with a step ladder, in which one can climb few steps after surgery but not to the expectations of top step. Results depend on the type of deformity of the nose, severity of the deformity along with surgeon�s technical artistry and expertise. So most important factor is the proper understanding regarding the nature of the deformity, realistic expectations about results will land up in satisfying patient after surgery.

Q. What about the use of implants for the nose ?

Implants are used on the depressed noses to improve the height of the nose. There are
many varieties of implant materials available, of which most commonly used are Silicone
and Medpor. Both are inert materials i.e. body will not reject the material when it is
inserted in the tissues. They are well tolerable by body without producing reactions.
Especially implants are better acceptable on thick skinned noses. Rarely implants may get
infected or rejected by the body either immediately or over a period of time. Regarding
aesthetic result implant proved adequate bulk and shape to the nose.

Q. I'm going to get my nose done soon and my doctor also recommended getting a chin implant because he says my nose will still appear 'big' because my chin recedes. Do people get both these procedures at the same time ?

This is a very common recommendation from a cosmetic surgeon. A weak chin can make even an ideal nose look larger than it actually is. Chin augmentation is a relatively minor procedure when implants are used, although it does have some risks of its own, such as lower lip numbness. A more extensive procedure would be to detach a piece of the lower jaw at the chin and move it forward and reattach it to the jawbone. Either type of chin augmentation can be done at the same time as a rhinoplasty. Chin augmentation is often performed by a maxillofacial surgeon, who may be a medical doctor or a dentist.

Q. I have thick nasal skin and a surgeon I spoke with said that I may not be able to see much detail with my rhinoplasty. Is this true ? Should I see another surgeon ?

For many patients with thick skin, the skin is thinned out in the surgery as the tip is worked on, which can help with definition. But many patients with thick skin actually do better with rhinoplasty. Very thin skin, shows every little imperfection.

Q. I have done nose job but I want to do it again.

⇒ Revision Rhinoplasty

These are terms used to denote a repeat rhinoplasty due to either a complication of previous surgery or inadequate improvement in the result

Various deformities found in these clients are

• Persisting deviation
• Nose height problems, either more or less
• Tip problems
• Nostril problems, like unequal size, large, small etc
• Functional problems, related to breathing

Reason for deformities :

• Inadequate assessment before surgery
• Poor planning lead to wrong result
• Bad execution also leads to wrong results
• Surgeon is not having an experience in performing rhinoplasty on individuals of particular ethnic origin
• Inexperienced rhinoplastic surgeon in performing operations on complex noses
• Sometimes implant problems, like extrusion, migration, infection etc.

Most common reason for revision rhinoplasty is unrealistic expectations by the client, so rhinoplastic surgeon should study the psychological nature and expectations of the results by the client before performing the rhinoplasty.

Dr. Venkataramana has an experience of performing revision rhinoplasties, very choosy in operating on these clients.

A through history of the case

• Regarding previous surgery
• Revealing factors for unhappiness
• Psychological assessment
• Future outcome of the redo surgery
• Expectations of the results

In case all the factors are favorable then he will take up the case for secondary rhinoplasty.