RHINOPLASTY, SEPTOPLASTY, TURBINECTOMY, & REPAIR OF NASAL FRACTURE
Surgeries of the nose- Rhinoplasty, Septoplasty, Turbinectomy, or repair of nasal fracture, are operations frequently performed by plastic surgeons. There is not a universal type of nose surgery that will meet the needs of every patient. These nose surgeries are customized for each patient, depending on his or her needs. Incisions may be made within the nose or concealed in inconspicuous locations of the nose in the Open Rhinoplasty procedure. In some situations, cartilage grafts, taken from within the nose or from other areas of the body may be recommended in order to help reshape the structure of the nose. Internal nasal surgery to improve nasal breathing can be performed at the time of the Rhinoplasty.
Nasal surgery like every surgical procedure involves a certain amount of risk and it is important that you understand these risks and the possible complications associated with them. In addition, every procedure has limitations. An individual's choice to undergo a surgical procedure is based on the comparison of the risk to potential benefit. Although the majority of patients do not experience the following complications, you should discuss each of them with your plastic surgeon to make sure you understand the risks, potential complications, and consequences of Rhinoplasty.
It is possible, though unusual, to experience a bleeding episode during or after surgery. Post-operative nasal bleeding is probably the most common complication of rhinoplasty. Although in majority of cases this is very minor in some instances it may require emergency treatment to stop the bleeding, drain the accumulated blood, and/ or transfuse blood. Hypertension (high blood pressure) that is not under good medical control may cause bleeding during or after surgery.
Taking any aspirin or anti-inflammatory medications for ten days before or after surgery, as well as, non-prescription "herbs" and dietary supplements can increase the risk of surgical bleeding.
Heparin or Coumadin medications that are used to prevent blood clots in veins can produce bleeding. If blood transfusions are necessary to treat blood loss, there is the risk of blood-related infections such as hepatitis and HIV (AIDS). Accumulations of blood under the skin may delay healing and cause scarring.
Infection is very unusual after surgery. Should an infection occur, additional treatment including antibiotics, hospitalization, or additional surgery may be necessary.
It is normal for a nose to stay swollen from 8-18 months after surgery. This can be worse in cases of revision or open rhinoplasty. Patients need to be patient during phase of nasal healing. Use of steroid injections and topical medications to hasten this process can potentially result in more harm.
All surgery leaves scars, some more visible than others. Although good wound healing after a surgical procedure is expected, abnormal scars may occur within the skin and deeper tissues. Scars may be unattractive and of different color than the surrounding skin tone. Scar appearance may also vary within the same scar. Scars may be asymmetrical. There is the possibility of visible marks in the skin from sutures. In some cases scars may require surgical revision or treatment.
Change in Skin Sensation
It is common to experience diminished (or loss) of skin sensation in areas that have had surgery. There is the potential for permanent numbness within the nasal skin after rhinoplasty. The occurrence of this is not predictable. Diminished (or loss) of skin sensation in the nasal area may not totally resolve after rhinoplasty.
The human face is normally asymmetrical. There can be a variation from one side to the other in the results obtained from rhinoplasty. Also, during the recovery phase, the two sides of the nose might swell, bruise, or scar to a differing degree, resulting in temporary or prolonged asymmetry. Nasal cartilage has a tendency to warp, therefore, there is a chance that warping of nasal cartilage graft or septum can result in asymmetry. Additional surgery may be necessary to attempt to revise asymmetry.
Skin Discoloration / Swelling
Some bruising and swelling normally occurs following rhinoplasty. The skin in or near the surgical site can appear either lighter or darker than surrounding skin. Although uncommon, swelling and skin discoloration may persist for long periods of time and, in rare situations, may be permanent.
Fluid accumulations infrequently occur in between the skin and the underlying tissues. Should this problem occur, it may require additional procedures for drainage of fluid.
You will experience pain after your surgery. Pain of varying intensity and duration may occur and persist after rhinoplasty. Chronic pain may occur very infrequently from nerves becoming trapped in scar tissue.
Itching, tenderness, or exaggerated responses to hot or cold temperatures may occur after surgery. Usually this resolves during healing, but in rare situations it may be chronic.
Nasal Septal Perforation
Infrequently, a hole in the nasal septum will develop. The occurrence of this is rare. Additional surgical treatment may be necessary to repair the nasal septum. In some cases, it may be impossible to correct this complication.
Nasal Airway Alterations
Changes may occur after a rhinoplasty or Septoplasty operation that may interfere with normal passage of air through the nose. This could arise from recurrent septal deviation, recurrent turbinate hypertrophy, scar formation, or cases of internal or external nasal collapse. Although this does not occur frequently, it can be corrected by surgery.
Dry nose/ Empty Nose Syndrome
After undergoing nasal airway obstruction surgery, there might be a temporary or prolonged period of excessive dryness of the nose leading to nasal irritation, crusting, or even minor bleeding. This occurs as a result of alteration in the nasal airway flow. In most cases it is temporary, and can be managed by use of nasal irrigation and lubrication. In rare cases it might be permanent.
Distortion in External Nasal Appearance
Distortion in the projection of the nose may result from a Septoplasty. If this occurs, additional surgery would be necessary to correct this problem.
Residual Septal Distortion
It may not be possible to completely resolve distortions within the nasal septum with surgery.
Snoring disorders may be caused by a variety of factors. Septoplasty may not relieve the propensity of some individuals to snore. Rhinoplasty does not affect snoring.
Skin Contour Irregularities
Contour irregularities may occur. Residual skin irregularities at the ends of the incisions or "dog ears" are always a possibility and may require additional surgery. This may improve with time, or it can be surgically corrected.
Most surgical techniques use deep sutures. You may notice these sutures after your surgery. Sutures may spontaneously poke through the skin, become visible or produce irritation that requires removal.
Cartilage grafts may be needed if the goal of surgery is to change the projection of the nasal tip. These grafts can be obtained from donor locations within the nose (nasal septum), from other parts of the body, or from tissue banks. Complications including nasal septal perforation may occur from the procurement of cartilage graft material. More than one location may be needed in order to obtain sufficient amounts of cartilage.
Extrusion of Cartilage or implants
In cases when nasal implants, cartilage, or bone grafts are used, there is a risk that they might be rejected or expelled by your body. In this instance they can gradually extrude through your incisions or nasal skin. Smoking, trauma, substances that can hinder healing (i.e. steroids), and multiple nasal surgeries can increase the chance of such complication.
Fracture disruption or delayed wound healing is possible. Some areas of the nose may not heal normally and may take a long time to heal. Areas of skin may die. This may require frequent dressing changes or further surgery to remove the non-healed tissue. Smokers have a greater risk of skin loss and wound healing complications.
Damage to Deeper Structures
There is the potential for injury to deeper structures including nerves, tear ducts, blood vessels, and brain during any surgical procedure. The potential for this to occur varies according to the type of rhinoplasty procedure being performed. Injury to deeper structures may be temporary or permanent.
In rare cases, local allergies to tape, suture materials and glues, blood products, topical preparations or injected agents have been reported. Serious systemic reactions including shock (anaphylaxis) may occur to drugs used during surgery and prescription medications. Allergic reactions may require additional treatment.
Both local and general anesthesia involve risk. There is the possibility of complications, injury, and even death from all forms of surgical anesthesia or sedation.
Substance Abuse Disorders
Individuals with substance abuse problems that involve the inhalation of vasoconstrictive drugs such as cocaine are at risk for major complications including poor healing and nasal septal perforation.
Although good results are expected, there is no guarantee or warranty expressed or implied, on the results that may be obtained. You may be disappointed with the results of rhinoplasty surgery. This would include risks such as asymmetry, loss of function, structural malposition, unacceptable visible or tactile deformities, unsatisfactory surgical scar location, poor healing, wound disruption, and loss of sensation. It may be necessary to perform additional surgery to attempt to improve your results.
In rare circumstances, your surgical procedure can cause severe trauma, particularly when multiple or extensive procedures are performed. Although serious complications are infrequent, infections or excessive fluid loss can lead to severe illness and even death. If surgical shock occurs, hospitalization and additional treatment would be necessary.
Cardiac and Pulmonary Complications
Surgery, especially longer procedures, may be associated with the formation of, or increase in, blood clots in the venous system. Pulmonary complications may occur secondarily to both blood clots (pulmonary emboli), fat deposits (fat emboli) or partial collapse of the lungs after general anesthesia. Pulmonary and fat emboli can be life threatening or fatal in some circumstances. Air travel, inactivity and other conditions may increase the incidence of blood clots traveling to the lungs causing a major blood clot that may result in death. It is important to discuss with your physician any past history of blood clots or swollen legs that may contribute to this condition. Cardiac complications are a risk with any surgery and anesthesia, even in patients without symptoms. If you experience shortness of breath, chest pains, or unusual heart beats, seek medical attention immediately. Should any of these complications occur, you may require hospitalization and additional treatment.
Female Patient Information
It is important to inform your plastic surgeon if you use birth control pills, estrogen replacement, or if you believe you may be pregnant. Many medications including antibiotics may neutralize the preventive effect of birth control pills, allowing for conception and pregnancy.
Intimate Relations After Surgery
Surgery involves coagulating of blood vessels and strenuous activity of any kind may open these vessels leading to a bleed, or hematoma. Activity that increases your pulse or heart rate may cause additional bruising, swelling, and the need for return to surgery and control bleeding. It is wise to refrain from strenuous exercise and sexual activity until your physician states it is safe.
Subsequent alterations in nasal appearance may occur as the result of aging, weight loss or gain, sun exposure, pregnancy, menopause, or other circumstances not related to nasal surgery. Future surgery or other treatments may be necessary.
Mental Health Disorders and Elective Surgery
It is important that all patients seeking to undergo elective surgery have realistic expectations that focus on improvement rather than perfection. Complications or less than satisfactory results are sometimes unavoidable, may require additional surgery and often are stressful. Please openly discuss with your surgeon, prior to surgery, any history that you may have of significant emotional depression or mental health disorders. Although many individuals may benefit psychologically from the results of elective surgery, effects on mental health cannot be accurately predicted.
There are many adverse reactions that occur as the result of taking over-the-counter, herbal, and/or prescription medications. Be sure to check with your physician about any drug interactions that may exist with medications which you are already taking. If you have an adverse reaction, stop the drugs immediately and call your plastic surgeon for further instructions. If the reaction is severe, go immediately to the nearest emergency room. When taking the prescribed pain medications after surgery, realize that they can affect your thought process and coordination. Do not drive, do not operate complex equipment, do not make any important decisions, and do not drink any alcohol while taking these medications. Be sure to take your prescribed medication only as directed.
Most health insurance companies cover surgical operations to treat acute nasal injuries causing nasal obstruction. Coverage for future reconstructive procedures following nasal injuries can vary, depending on your health care insurance company's policies. Most insurance plans exclude coverage for cosmetic, secondary or revisionary surgery. Please carefully review your health insurance subscriber-information pamphlet.
ADDITIONAL SURGERY NECESSARY
There are many variable conditions that may influence the long term result from rhinoplasty and/or septoplasty surgery. Secondary surgery may be necessary to obtain optimal results. The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee or warranty expressed or implied, on the results that may be obtained. In some situations, it may not be possible to achieve optimal results with a single surgical procedure.
Follow all physician instructions carefully; this is essential for the success of your outcome. It is important that the surgical incisions are not subjected to excessive force, swelling, abrasion, or motion during the time of healing. Personal and vocational activity needs to be restricted. Protective dressings and splints should not be removed unless instructed by your plastic surgeon. Successful post-operative function depends on both surgery and subsequent care. Physical activity that increases your pulse or heart rate may cause bruising, swelling, fluid accumulation and the need for return to surgery. It is wise to refrain from intimate physical activities after surgery until your physician states it is safe. It is important that you participate in follow-up care, return for aftercare, and promote your recovery after surgery.
The cost of surgery involves several charges for the services provided. The total includes fees charged by your doctor, the cost of surgical supplies, anesthesia, laboratory tests, and possible outpatient hospital charges, depending on where the surgery is performed. Depending on whether the cost of surgery is covered by an insurance plan, you will be responsible for necessary co-payments, deductibles, and charges not covered. Additional costs may occur should complications develop from the surgery. Secondary surgery or hospital day surgery charges involved with revisionary surgery would also be your responsibility.
Dr. Younai is a Board Certified Plastic & Reconstructive Surgeon with experience in all aspects of Facial Cosmetic Surgery including that of the Nose, Sinuses, Eyes, Ears, Chin, Cheek, etc. He is skilled and experienced in all techniques of Rhinoplasty and Sinus Surgery, and strives to create the nose that is natural looking and harmonious with the rest of your face. During your consultation he will discuss all details including: if you are a good candidate, surgical options and techniques, potential risks and complications of surgery, pre- and post-operative instructions, recovery course, as well as what to expect after surgery. At that time Dr. Younai will also show you before-and-after pictures of other patients with Rhinoplasty and Facial Cosmetic Surgery, who might be similar to you.
Dr. Younai performs Cosmetic and Restorative Nasal Surgery at the California Center for Plastic Surgery. He receives patients from the Northern as well as the Southern California region. Some of these cities include Beverly Hills, Los Angeles, Santa Monica, Hollywood, Burbank, Sherman Oaks, Encino, Calabasas, Woodland Hills, Thousand Oaks, Westlake Village, Pasadena, Glendale, Valencia, Palmdale, Fresno, and Oxnard.