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A Patient’s Guide to Rhinoplasty

Inside this guide: Dear Patient,

Welcome 1 We are delighted that you have chosen to explore When to consider a 1 rhinoplasty (nasal reshaping) with Dr. Naidu. This rhinoplasty guide was written to help you understand the risks and benefits of rhinoplasty. Please read the following informa- Anatomy of the nose 2 tion in its entirety prior to your visit, as this will make your time with us more productive. If you have any questions Procedural steps 2 about anything contained in this material, please print out Additional procedures 2 the relevant sections and we will be happy to discuss them with you at the time of your consultation. If anyone else Surgery and 3 will be involved in your decision-making, we ask that you Recovery 3 bring him or her with you to your visit. We look forward to meeting you! Risks of surgery 4

Following surgery 4

For more information 5

About Dr. Naidu 5

When to consider a rhinoplasty

The shape of your nose is usually the result of heredity, but its appearance may also be altered secon- dary to trauma or prior surgery. Rhinoplasty, or nasal reshaping surgery, can improve the appearance and proportion of your nose. Surgery of the nose may also correct impaired breathing caused by structural abnormalities. Rhinoplasty can change the size of the nose, nasal width, nose profile, nasal tip, nostril size, and help to correct nasal asymmetry and deviation. It is a highly individualized pro- cedure, and should be undertaken for yourself, not to fulfill someone else’s desires. You are a good candidate if you are at least 16 years of age, physically healthy, and do not smoke. You should have realistic goals in mind. Page 2 A Patient’s Guide to Rhinoplasty NINA S. NAIDU, MD, FACS

Anatomy of the nose

Although the nose externally appears to be a relatively simple organ, it is in fact a complex instrument that serves several functions in the , including respiration, filtration, humidification, temperature regulation, and protection. The three main components of the nose con- sist of the osseocartilaginous vault (dorsum), the lobule and tip, and the nasal base. The dorsum of the nose is made up of both bony and cartilaginous elements. The lobule and tip are made of and soft tissues, and the base of the nose consists of the alar base, nos- trils, and columella.

Procedural steps

Surgery of the nose is per- The nasal structure is reshaped, closed. A splint is placed over formed either using a closed either by shaving down the the nose for one week. Your procedure in which the inci- cartilage and , or in some initial swelling will subside sions are hidden inside the cases, by augmenting the within a few weeks, but it may nose, or through an open pro- framework with additional take up to one year for you to cedure, in which an incision is cartilage. If you have a devi- see your final results. During made across the columella, ated septum, it is corrected at this period, you may notice which is the narrow strip of this time as well. Once the gradual changes in your nose. tissue that separates the nos- nasal structure has been Swelling may come and go, and trils. The soft tissues of the sculpted to the desired shape, may be worst in the morning nose are gently raised, allowing the nasal and tissue is re- for the first year following sur- access to the nasal structures. draped and the incisions are gery.

Additional procedures

In some cases, additional pro- operating time, anesthesia, and cedures may be recommended surgical risks. at the same time as your nasal surgery. Some patients will benefit from a small chin im- plant at the same time as their rhinoplasty, which can help to balance the profile. Additional procedures incur additional A Patient’s Guide to Rhinoplasty NINA S. NAIDU, MD, FACS Page 3

Surgery and Anesthesia

Surgery is performed on an bloodwork, and in some cases outpatient basis, either in the preoperative clearance from hospital or in an ambulatory your primary medical doctor. surgery center. The surgery The evening prior to surgery, lasts 1 1/2 –2 hours, and is you should not eat or drink usually performed under gen- anything after midnight. This eral anesthesia. Many patients ensures that you will have an worry about the risk of general empty stomach prior to sur- anesthesia, but it is very safe gery, which is very important and it assures that you will be for your anesthesiologist to completely comfortable during care for you safely. You must surgery. Prior to surgery you have a responsible adult avail- will be required to obtain able to escort you home after medical photographs, routine surgery.

Recovery

Following surgery, you will Patients are seen in the office for any discomfort. The initial awaken in the recovery area. one week following surgery. At swelling will resolve within 6 Once you are fully alert, you that time your splint and any weeks after surgery, but you will be transported to the step- external sutures will be re- will not see your final result for down area where you will be moved. All internal sutures up to one year after surgery. given something to eat prior to will dissolve on their own. You may notice that your discharge. You will have a swelling resolves along the Walking is permitted the day of splint placed on your nose at dorsum of your nose before surgery, but strenuous activity the conclusion of the proce- the tip. You may also have and sex should be limited until dure. The nurses in the recov- clear discharge from the nose three weeks following surgery. ery area will provide you with for one year following surgery, Most patients do not complain detailed instructions on caring which is a normal response of of severe pain following this for your nose immediately fol- your body to the procedure. surgery, but note some heavi- lowing surgery. A responsible ness or throbbing in the nose. adult will need to be available Pain medication is prescribed to escort you home. Page 4 A Patient’s Guide to Rhinoplasty NINA S. NAIDU, MD, FACS

Risks of Surgery

All surgery carries risks. The Scarring: If you have an be altered. open procedure, you will most frequently reported com- Septal perforation: Rarely, a have a small in the colu- plications after rhinoplasty hole in the may mella. This typically fades surgery are as follows: develop. Additional surgical very well within the first 6 Bleeding: A small amount of treatment may be necessary, weeks after surgery, but rarely bloody discharge is normal the and in some cases it may be it may be more prominent. day of surgery. Significant impossible to correct this com- bleeding requires an immediate Pain: Most patients report plication. mild discomfort following return to the operating room Skin discoloration and swell- surgery. A small number of to stop the bleeding vessel and ing: A small number of patients patients may have permanent evacuate any . may experience prolonged pain. : Infection following swelling and bruising over the rhinoplasty surgery is rare and Blood clots: Blood clots may nose. Patients with thicker skin can usually be treated with oral form in the legs, or travel to typically have prolonged swell- . To help prevent the , following surgery. ing. This is a potentially fatal this, you will be given an anti- Anesthesia risks: Although , and therefore biotic prior to surgery, and a general anesthesia is very safe, preventive measures, includ- prescription for an all patients are screened for any ing the use of leg compres- after surgery. personal or family history of sion devices during surgery, Poor healing: This anesthesia reactions. are taken with every patient. may occur in patients with very Visible sutures: Rarely, sutures Numbness: Most patients thin skin, in smokers, or fol- may become visible or produce will note some numbness lowing an infection. This com- irritation, requiring removal. plication may require additional over the nose after surgery surgery. which typically resolves. A Revisional surgery: A small small number of patients may number of patients may require Nasal asymmetry: Some pa- note persistent changes in revisional surgery. This is typi- tients may note asymmetry of sensation. cally not performed prior to a the nose or skin contour ir- year after the initial procedure. regularities following surgery. Nasal airway alterations: Significant asymmetry may The normal passage of air require surgical correction. through the nose may Following surgery

After surgery, you will notice seen at one week, six weeks, swelling which will resolve three months, six months, and gradually over the course of one year following surgery. one year or longer. You may Should you have any issues or also have some clear drainage concerns between your visits, from the nose during this time, you will be accommodated at which is normal. You will be your earliest convenience. For more information about rhinoplasty surgery

Additional sources of information about rhinoplasty surgery can be found online at the following sites: Nina S. Naidu, MD, FACS: www.naiduplasticsurgery.com American Society of Plastic : www.plasticsurgery.org

About Dr. Naidu

Nina S. Naidu, MD, FACS is Dr. Naidu completed her un- Medical Center; Manhattan Board Certified by the Ameri- dergraduate studies at The Eye, , & Throat Hospital; can Board of Johns Hopkins University and Lenox Hill Hospital; and the and is a Clinical Assistant Pro- obtained her medical degree Center for Specialty Care. fessor of Surgery at Weill Cor- from Cornell University Medi- nell Medical College. Her prac- cal College. After completing NINA S. NAIDU, MD, FACS tice focuses on aesthetic and her general surgery and plastic 160 EAST 72ND STREET NEW YORK, NY 10021 of the surgery training at New York , breast, and body, with a Presbyterian – Weill Cornell PH: 212-452-1230 special emphasis on breast Medical Center, she performed F: 212-452-4654 augmentation, abdominoplasty an additional year of fellowship (tummy tuck), and rhinoplasty training at the University of (nasal reshaping) . Pennsylvania. She is an active member of the American Soci- ety of Plastic Surgeons and is a Fellow of the American Col- lege of Surgeons. Dr. Naidu maintains privileges at several Photo: Victoria Wills prominent New York hospitals including New York Presbyte-

rian Hospital – Weill Cornell