RHINOPLASTY — FAQs
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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.
