1) I want my nose to look like Brad Pitt’s? Your nose is very specific to your face. Dr. Lopez’s goal with rhinoplasty is to create a nose that blends into your face and does not take attention away from the beauty of your eyes. Therefore, Brad Pitt’s nose may not look right on your face. Dr. Lopez will thoroughly evaluate your nose and discuss with you the your optimal rhinoplasty result..
2) I have a large hump on my nose, can that be fixed? The hump (convexity) on your nose is usually made of bone and cartilage. Dr. Lopez is able to lower both the cartilage and bone if necessary. Again, your nose must be in harmony with your face as well as the rest of your body. Tall individuals look better with a small convexity or straight profile rather than a scooped out appearance. Shorter individuals can look better with a bit of scoop to the nose. Men in general also look better with a bit of a convexity, i.e. the “Grecian Nose”.
3) If my nose is made smaller, where does the extra skin go? Over time the skin will contract and take the shape of the underlying bony/cartilaginous structure.
4) My nose is crooked, can that be fixed? A crooked nose can be because the bone has been broken and is no longer in the midline, or because the cartilage in the middle of the nose (middle vault) has a concavity or both are off. To fix crooked nasal bones, Dr. Lopez makes cuts in the bones to reset the bones in the midline. In order to straighten out the middle part of the nose, Dr. Lopez may need to use cartilage to fix the concavity.
5) My nose ticks out too far and I have a weak chin, will fixing my nose make my chin look stronger? In general no. A weak chin that does not project out enough usually can be made to look much better with a chin implant. This will also improve the rhinoplasty result as the face will be in better harmony.
6) Will I still look like “me” after surgery? Many of my patients report that when they return to their normal life, their friends comment, “You look great. Are you getting more sleep?” or “You look less stressed and tired”. Dr. Lopez will not drastically change the way you look, just enhance it.
7) Where are the incisions for a rhinoplasty? In an open rhinoplasty Dr. Lopez makes a very small incision in the skin at the base of the nose in the midline. This incision heals extremely well and is nearly imperceptible once healed. The remainder of the incisions are within the nose.
8) What is an open (external) rhinoplasty? An open (external) rhinoplasty involves making a small inverted V-shaped skin incision in order to raise the nasal tip skin up and be able to visualize the tip cartilages. The advantage of the open approach is the increased exposure that Dr. Lopez is able to get in order to produce your optimal result. The disadvantage is that the nose will be swollen longer when compared to the closed (endonasal) approach.
9) What is a closed (endonasal) rhinoplasty? In a closed (external) rhinoplasty there are no external skin incisions. Dr. Lopez will use this technique when a lot of work does not need to be done to the tip or middle vault. The advantage of the closed approach is that the swelling subsides quicker. The disadvantage is the decreased exposure the surgeon attains when trying to manipulate the middle vault or tip.
10) How much pain will I have? Most patients who have a rhinoplasty say how surprised they are that the pain is less than they anticipated. Understandably, after any surgical procedure, some discomfort can be expected. All patients are provided with prescriptions for pain medication. Patients sometimes use the prescription medication two to three days after surgery and then switch to Extra Strength Tylenol.
11) Will I be awake during surgery? Patients are asleep during the surgery with general anesthesia. Patients do not hear or feel anything and are comfortable during the operation. Patients wake up very soon after the surgery is completed. All patients must have a responsible adult to stay with them through the night following surgery. Patients may not drive for following their procedure if they are taking pain medicine or their vision is impaired.
12) Do I go home after surgery? Most rhinoplasties are done on an outpatient basis. Because you will go home after receiving sedation, you will need to make arrangements for a responsible adult to drive you home, to stay with you overnight and to drive you to our office for your first postoperative appointment. Patients having surgery must stay in the immediate San Antonio area overnight.
13) Will I bruise and swell afterwards and how long will it last last? Unfortunately it is impossible to do surgery without causing swelling. Dr. Lopez does everything possible to minimize the amount of swelling that occurs. Generally, postoperative swelling begins to resolve at the end of the first week. Bruising is extremely variable. Patients that have a tendency to bruise will generally bruise for about 10 days. Patients that don’t tend to bruise may have minimal if any bruising. Complete resolution of bruising and swelling may take two to three weeks. However, bruises may be camouflaged fairly easily at seven to ten days with a concealer stick.
14) How long should I stay in San Antonio following surgery? Most patients stay in San Antonio about seven to ten days following surgery. After that it’s ok to fly or travel long distances.
15) When can I return to work? Most of Dr. Lopez’s patients take about two weeks off of work. After two weeks, most of the residual bruising and swelling can easily be camouflaged with make-up.
16) When can I exercise? Dr. Lopez prefers that aerobic activities be avoided for two weeks after surgery. In addition, heavy weight lifting or more strenuous workouts should be avoided for three weeks postoperatively. It is extremely important to avoid bending, lifting or straining during the early postoperative period as these activities can increase swelling and delay healing.
17) At what age can I have a rhinoplasty? You should not have a rhinoplasty until your face and nose have stopped growing. Usually the age is around 16 for a female and 17-18 for a male. Once your shoe size has been stable for a year, that is a good indication that you can have a rhinoplasty.
18) When can I have a revision rhinoplasty? Dr. Lopez performs a lot or revision rhinoplasty operations to correct or enhance the work of the previous surgeon. In general the nose will continue to change over the first year following a rhinoplasty, so Dr. Lopez prefers that patients wait a year after their original surgery to have a revision.
19) Is revision rhinoplasty more difficult? In general yes. Once the nose has been worked on scar tissue distorts the normal tissue planes. In addition, grafting material such as the nasal septum may have already been used. Often times ear cartilage or even rib cartilage is necessary to correct the deformity. Make sure that the surgeon you choose has a lot of experience with revision rhinoplasty.
20) What is the septum? The nasal septum is a cartilaginous and bony structure that divides the nose into two nasal cavities. Dr. Lopez often uses the septal cartilage to strengthen the nose and improve the appearance and function of the nose.
21) If you take ear cartilage will that change the shape of my ear? Dr. Lopez uses ear cartilage often and it does not change the shape of your ear or the function of your ear. At 6 months from surgery even with your hair up nobody will know that you had ear surgery.
RHINOPLASTY PREOPERATIVE INSTRUCTIONS
22) Should I do anything before to prepare for surgery? You will have a preoperative appointment with Dr. Lopez and his staff to go over the preoperative instructions.
23) Why do I need a preoperative appointment? This is an essential appointment to prepare you for your upcoming surgery. Dr. Lopez will take preoperative photographs at the visit as well as go over the procedure again to ensure that everyone is on the same page. All questions that you have will be answered on that visit as well. You will often times be given your prescriptions on the preoperative visit day.
24) What else can I do to do to prepare for surgery? Dr. Lopez likes to have patients that have well controlled blood sugar to drink three eight ounce glasses of pineapple juice for at least one week before surgery. Pineapple juice can help minimize the postoperative swelling. Patients that use tobacco will be asked to stop for six weeks before and six weeks following surgery. Tobacco has properties that impede wounds from healing. Dr. Lopez will encourage tobacco users to not resume smoking at all after surgery; in fact many of his patients have used the surgery as their impetus to quit smoking.
25) What about my daily medications before surgery? In general you will be allowed to take most of your daily medications. Medications that thin the blood such as ibuprofen, vitamin E, and herbal supplements need to be stopped two weeks before surgery. You can continue to take a multivitamin. Aspirin needs to be stopped three weeks before surgery. Dr. Lopez will provide a “Medication List” that reviews all medications and supplements to avoid prior to surgery.
26) Do I need any special prescriptions before surgery? Dr. Lopez will generally give you a prescription for an antibiotic, a pain medicine, antibiotic ointment, as well as an anti-swelling medication.. Dr. Lopez does prefer patients to start Arnica, a natural herbal substance, the day before surgery in order to minimize bruising. He also asks you to start Vitamin C before surgery.
RHINOPLASTY POSTOPERATIVE INSTRUCTIONS
27) What does it feel like when I wake up from surgery? When you wake up you will have a small cast on your nose and small packs within your nose. The packs will not allow you to breathe through your nose. We will make sure you are not nauseated or queasy. Our nurses will be right there with you as you wake up from surgery.
28) What medications do I take following surgery? Dr. Lopez will ask you to take the following medications starting the day of surgery: 1- An antibiotic- generally Keflex for one week 2- Pain medicince- vicodin or percocet to take as needed 3- Antibiotic ointment- to place on the incision sites at least three times a day. 4- Antiswelling medication- for patients that are not diabetic a medrol dosepak will be given. 5- Vitamin C 1 gram for 1 week before and two weeks following surgery to promote healing. 6- Arnica- place under the tongue three tabs three times a day before meals for two weeks.
29) When do I begin taking the medications? Patients take their pain medication as needed. Begin taking vitamin C one week before surgery. You can begin taking Arnica the day before surgery. The antibiotic and swelling medications begin when you arrive home following surgery. Unless you are notified otherwise, resume all daily medications when you arrive home from surgery.
30) Are there any foods to avoid following surgery? No. Dr. Lopez encourages you to eat a well-balanced diet. You may notice that saltier foods can cause you to swell for a longer period of time.
31) When can I shower? You can shower once the second dressing is removed. Make sure that you pat dry the incisions well after the shower and apply the antibiotic ointment.
32) When is my first postoperative appointment? You will be asked to see Dr. Lopez on the second day following your rhinoplasty. At that appointment Dr. Lopez will remove the nasal packing. Some patients describe the packing removal as a mild discomfort, but Dr. Lopez still recommends taking a pain pill 1 hour before your appointment. You will need someone to drive you to this appointment.
33) What happens after the first postoperative visit? After your first visit, take your medications as directed and keep your incision clean and moist. We will ask you to use a Q-tip to cleanse them with peroxide once a day and apply an antibiotic ointment three times a day to keep the sutures soft. Dr. Lopez will want to see you 6-8 days after the surgery for removal of the cast and suture removal. Suture removal may be uncomfortable, so Dr. Lopez recommends taking a pain pill 1 hour before your appointment. You will need someone to drive you to this appointment if you are taking pain medication.
34) Are there any instructions about regular daily activities? Sleep with head of the bed elevated or use two to three pillows for one week. Facial fullness, headache and disrupted sleep are very normal postoperative symptoms and will decrease as the healing process occurs. Absolutely no bending, lifting or straining. If you have little children, bend at the knees or sit on the floor and let them climb on to your lap.
35) When can I blow my nose? You are not allowed to blow your nose for one week. Avoiding nose blowing minimizes bleeding and swelling following surgery.
36) Can I wear my glasses or contacts after rhinoplasty? It’s best to allow a day or so before using your contact lenses following rhinoplasty. It’s not uncommon for patients to tell us that giving their eyes a temporary rest from the contact lenses feels good for the first two to three days following rhinoplasty. It’s OK to rest your glasses on the nasal cast. However, one week following rhinoplasty the cast is removed. At that time we will show you how to use the Frame-Ups® to prevent your eyewear from resting directly on your nose. We strongly recommend that you use the frame-ups for postoperative week #2 – which is the week following cast removal.
37) How long does the healing take? Healing and evaluation of the final result takes one full year. However, after three months, most patients have about 90% of their final result.
38) How can I minimize the swelling and bruising? Most of Dr. Lopez’s patients will have a little bruising. He minimizes bruising by having patients stop all blood thinners well ahead of surgery as well as using Arnica before and after the procedure. The cold packs around the eyes should be used every 20 minutes while awake after surgery to help prevent swelling and bruising. The cold packs should be used for the first 72 hours. You do not need to wake up to use the cold packs. A good night’s sleep is vital to healthy healing. Patients are also asked to sleep with their head at least at 45 degrees to minimize the swelling.
39) When will I look normal? You will be presentable at two to three weeks. You will look great at six weeks and even better at six months as things settle and expressions become more natural. At three weeks you know you are well on the way to recovery and most patients resume routine activities around two to three weeks following surgery. Final results are evaluated at one year.
40) How often do I need to return for postoperative visits? Dr. Lopez likes to see his patients 3, 6, and 12 months after the procedure to ensure that the healing is going as expected.