Rhinoplasty is an operation that changes the shape and appearance of the external nose. Often, internal surgery to improve breating or sinus conditions are done at the same time but those are not components of a rhinoplasty or “ nose job” a purely cosmetic operation.
The rhinoplasty operation is indicated when the nose is too large, the tip is too bulbous, there is a bump or hump on the bridge. The nose may requiring straightening because it is crooked, often subsequent to an injury. A common, unsatisfactory feature, particularly in the age of head-on cell phone “ selfie” photos is that the tip depresses with smile. In such photos, the nose looks longer and often the tip appears widened.
Rhinoplasty is right for you if you do not like the appearance of your nose. It’s that simple. In some cases, patients seek revision rhinoplasty. Luckily, unlike other Nature-delivered body factors, such as being too tall or too short, the rhinoplasty operation can solve the problem. And, remember, it is not about what others think, it’s your nose, on your face. You are the only decision-maker.
During rhinoplasty, you can expect to be asleep during your rhinoplasty with no pain and no awareness. That is the mission of the anesthesiologist; to provide a safe, light anesthetic which is essentially complimentary and supportive of the local anesthetic that I inject immediately after you go to sleep from the first intravenous blast of propofol. It is an ideal combination of a light general anesthetic and complete protection against pain. The protection against pain overlaps even into the recovery room and perhaps early hour of recovery at home.
The expectations for surgical rhinoplasty vs liquid rhinoplasty will differ. We feel the preparation for the actual anesthetic is very important in that we want patients to be free of elevated pulse and blood pressure, which is a product of preoperative anxiety. When a patient arrives at the surgery center and is placed in a proper gown and tucked into the holding area bed, they are given an appropriate dose of Valium. Valium is a marvelous sedative and relaxant and creates an ideal state for the initiation of the anesthetic.
The anesthesia itself is based on intravenous propofol, which takes 3 seconds from the time of injection to hit the brain and that is the cue for my injection of the local anesthetic. During the rest of the case the maintenance anesthetic is propofol with additional drugs such that the drugs are reversed in anticipation of the end of the operation. It is quite elegant for the anesthesiologist to time the so-called “landing time,” meaning the end of the operation akin to an airplane touching down such that as the operation is just completed and the dressings in place, the patient will begin to wake up.
Rhinoplasty has three recovery phases. The first is the five day period afterwards during which time the external protector is in place. During that same period, if major internal nasal reconstruction was performed, e.g. nasal septoplasty, turbinate resection to improve breathing and prevent sinus problems, the medication-soak tampon is in place and so is the KOTLER NASAL AIRWAY, which provides for clear breathing while the tampon-packing is in place. The next five day period is the period in which everything is “ off and out”, meaning no packing, no airway and no external protector in place. Since we perform the closed rhinoplasty, there is no pink, visible and ripening external scar as a “ tip-off” that surgery has been performed. The external and internal swelling is receding rapidly from day five to ten. Usually, by day ten nearly all the swelling and bruising is gone and you like what you see in the mirror. The final recovery phase begins at day ten. Now, there are no longer restrictions on strenuous exercise; you can return to your usual workout routine. No limits on your physical activity except, obviously, contact sports such as soccer, football, rugby. This third phase is called the “ripening phase”: the nose’s appearance gets better and better and better. Akin to the maturation of fine wine; Nature makes it even better. That third phase typically lasts to the 100 day-after-surgery. Approximately three months, which is also the magic number for all operations, anywhere on the body. While there may be some further refine in the next nine months until the one-year anniversary is reached, the nose looks excellent at that three- month period.
The important thing to remember is that unlike other operations on hidden portions of the body, such as tummy-tuck or even chest surgery, the rhinoplasty’s evolution is visible. As you look into the mirror each day, as all do, for the first two phases, up to day ten, you wonder “ When will the swelling and bruising go away?” Well, it is going away but hard to discern on a day-by-day basis. Count on Nature; it’s reliable. The sun rises and the sun sets at predicted times. Nature will take over and do a good job following our surgery.
The consultation is extremely important. Consider it a matchmaker. Two matches must be made. The first is that you feel comfortable with the doctor and his or her office staff. Every element of service and patient care should “ feel right”. It begins with the first call or e-mail contact with the office. You can sense if the staff is first class: knowledgeable, helpful and courteous. A strong service mentality is the mark of the great practices. When you arrive for consultation, your time is to be valued so no hours in a waiting room. No, that’s a bad sign. Because while delays in any medical office can occur, you must be notified in advance of your arrival time. Very important now since there are limitation on how many people can occupy the reception area. If the office is running late, if you know that you can stay at work or whatever and be productive. At the consultation, two major factors must be in place.
First, you must have computer imaging. That answers the number one question every patient harbors: “Doctor, what will I look like? I wonder about the result.” That’s why a consultation without computer imaging, to me, is worthless. If the cosmetic surgery cannot share his vision of what is proper, natural and achievable, how can you make a decision to go forward? Contrary to common sense. If you commissioned an architect or interior designer to improve your home, would you sign the contract without a computer rendering of the result of their work? And, remember, at the imaging session, you desires and thoughts to into the computer rendering. You need to be comfortable with the image of the “ new you” the doctor is presenting. The doctor must be frank about his or her ability to deliver such a result. There must be a meeting of the minds. That’s why computer imaging is the super-important second match.
There is one more feature of a superior consultation that revolves around questions you may have. The key to having proper and meaningful answers is time with the doctor. One on one. Not rushed. Any question is fair game. The sequel to my first book, SECRETS OF A BEVERLY HILLS COSMETIC SURGERY, The Expert’s Guide to Safe, Successful Surgery, was a Cliff’s Notes for the consultation. A workbook with all the smart questions to ask. That book, also quite popular on Amazon, was The Essential Cosmetic Surgery Companion, Don’t Consult a Cosmetic Surgeon Without This Book! For cosmetic surgery procedure, it listed the savvy questions to ask. It even had diagrams and blank spaces for notes. Feel free to download, from this website, a free PDF copy. It covers preparation, anesthesia, recovery, medications and will keep the consultation on track. Remember, you must have EVERY question answered. Apart from fees and scheduling, your answers must come from your doctor. Of all the staff in the office, the one member you should spend the most time with is : the doctor.
It is safe to get a nose job if you have no significant medical problem. This is ascertained, of course, through a detailed history and physical and, of course, consultation with your own personal physician.
Rhinoplasty is an operation performed either through external or internal incisions to change the shape of the nose.
The cost of rhinoplasty is dependent on the number of imperfections that need correction, the time necessary in the operating room to achieve a proper result, and the expertise of the surgeon. Generally, the most experienced and accomplished surgeons, the superspecialists, actually are efficient in their work such that the expense for the operating room and anesthesia doctor are less than those of less experienced, less specialized doctors who typically take much longer to perform their surgery.
All surgical procedures will have some element of postoperative pain. The answer to postoperative pain is medication. Surgeons anticipate the proper level of medication for the condition and should the pain medicine not be satisfactory the surgeon should be available to substitute a more appropriate medication immediately.
Insurance does not cover a cosmetic procedure such as rhinoplasty. Insurance does cover a breathing or sinus operation, which may be done at the same time. Such operations are correction of a deviated septum, reduction of enlarged turbinates which cause airway blockage and perhaps opening of the sinuses, which have had previous infections. It is efficient to perform both the functional and cosmetic surgery at the same surgical sitting. The economy is that of time, and therefore dollars. Likewise, one anesthetic and one recovery. You want to check with the doctor’s office regarding their participation with insurance company programs and how a claim for insurance will be submitted on your behalf.
In our practice, we stand with the patient and provide all administrative support for the billing of an insurance company, when appropriate, for a functional operation. The patient need not complete any forms that the insurance company requires, as we have specialists that provide that service. We will also participate in an insurance company appeal should the payment be improperly processed.
Rhinoplasty is the operation performed on the external nose. It may include any or all of the following: Changing the shape and position of the nasal bones, straightening deformed nasal bones and cartilage, narrowing the tip, elevating the nose from the lip, releasing the muscle that causes undue downward rotation of the tip of the nose.
Nasal septoplasty is an internal nasal operation to straighten an imperfect or crooked partition that separates the left and right nasal passages and may be responsible for obstructed breathing.
It is safe to get a nose job if you have no significant medical problem. This is ascertained, of course, through a detailed history and physical and, of course, consultation with your own personal physician.
Yes, many people are better served by having a permanent, non-surgical rhinoplasty. A non-surgical rhinoplasty is not a substitute for safer surgery because it is not capable of changing all of the things that surgery can. However, for many patients, depending on their points of dissatisfaction it is an excellent alternative to surgery because it is an office procedure, has no down-time, and is a fraction of the cost of surgery.
Rhinoplasty is a very successful operation when performed by the most-specialized, most-experienced facial cosmetic surgeons who further specialize in Rhinoplasty exclusively. There are very few but Dr. Kotler is that “superspecialist” in both Surgical Rhinoplasty and Permanent Non-surgical Rhinoplasty. Why not consult with a doctor at the top of the specialty totem pole?
We offer personal, in-office consultation, including computer imaging. After all, shouldn’t you see the predicted result of your procedure before making a decision? Also available to you is a Virtual Consultation with Dr. Kotler via FaceTime, WhatsApp or Zoom. Zoom’s great because family or friends can join the consult.
Call us today, at (310) 278-8721. We’ll arrange that consultation. A great first step because all your questions will be answered. And, no doctor is more qualified to answer those questions than Dr. Kotler.
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