Arnoldo Fournier M.D., F.A.C.S. ©
Some people experience health problems resulting in allergies or breathing difficulties due to a nose wall obstruction. I many cases the wall obstructs the air to flow properly during inhalation. Such health problems can be solved with a Rhinoplasty or Nose Surgery.
Furthermore, if you are not content with your nose’s size, shape and form, and wish to improve it the best you can, you are a perfect candidate for Rhinoplasty or Nose Surgery as well.
In order to go under a Nose Surgery, women should be over 17 years of age, and men should be over 18 years of age. At such ages, facial features have fully grown. An exception is made when children or adolescents have suffered some kind of nasal accident.
Rhinoplasty can enhance your appearance and your self-confidence, but it won’t necessarily change your looks to match your ideal, or cause other people to treat you differently. You and I will review your photographs and will determine the nose’s front, the size and shape of the nostrils, and the nose’s profiles. Together, we will evaluate and decide the changes that will be made to the nasal contour. As a result, I will perform the surgery and will please you in every way I can.
The surgical details, such as procedure and the recovery will be cleared up during a consultation at my office.
BEFORE THE SURGERY EVERY PATIENT MUST:
- Send photographs taken from a straight angle that include your frontal, left and right side views. I also need you to send me a fourth photograph that is take a low angle showing your nostrils.
- Schedule an appointment with Dr. Arnoldo Fournier at his office. During this visit you can ask him any questions you might have about the surgery.
- Have a complete medical check up, an electrocardiogram and laboratory blood and urine tests; including a complete whole blood count, partial tromboplastin time, prothrombin time, platelets, and HIV. If you are over forty five years old, a lipid blood profile is also needed with total Cholesterol, HDL and LDL, their ratio, and triglycerides. Tests are valid for three months prior surgery.
- Take antibiotics such as Augmentin 500mg, (one capsule three times a day with each meal) Cipro or Ceclor 500mg (one capsule twice a day with a full breakfast and dinner); two days before surgery, the day of the surgery, and seven more days after the surgery.
- Inform Dr. Arnoldo Fournier your daily vitamin and medication intake.
- Notify Dr. Arnoldo Fournier if you have developed a cold or the flu a week prior your surgery date.
- Please avoid: aspirin, more than 500mg of Vitamin E, ginkobiloba, ginseng, or any blood thinners two weeks prior your surgery. Also avoid alcohol intake, and passive or active smoking for one month before and one month after the surgery. Remember that nicotine and alcohol delays and might even complicate your healing processes. Six weeks before surgery suspend and AVOID estrogen or progesterone derivatives or any female hormones.
THE DAY OF SURGERY
- Please brush your teeth, but do not eat or drink coffee or tea.
- Please do not wear make-up, remove your contact lenses or dentures before the surgery. Do not put any moisturizer on your eyes or face.
- Please remove your nail polish.
- The evening and the morning prior your surgery, clean the operative area with soap and water.
- Please do not bring any jewelry or valuables to the Hospital.
- Please wear a robe, housecoat or warm up suit that buttons or zips in the front and flat shoes after the surgery. No tight-fitting clothes.
- Someone must drive you home, to your Hotel, or to the Recovery Home you choose to stay at.
* Postoperative instructions regarding activity, medications and office visits will be given following your surgery.
I perform most surgeries under local anesthesia and sedation. Furthermore, some Nose Surgeries are done under general anesthesia and must stay for at least one night at the Santa Rita Hospital.
Depending on your necessities, I will do several incisions inside the nostrils, to file the nasal bone and reduce the hump, to cut the nose’s cartilage to diminish the nose’s tip or to place graft and lift the nose’s profile.
Generally, there are two techniques, or methods for performing a rhinoplasty: “closed” and/or “open” techniques. The “open” technique involves placing a small surgical incision between the two nostrils while the “closed” method does not require an external incision, but rather, within the nose. Both rhinoplasty techniques have their respective advantages. For example, the “open” technique provides me with better visibility of the internal structures of the nose, but requires external incision.
On the other hand, the “closed” method does not require an external incision, heals more quickly and does not disturb the nasal tissues as much as the “open” technique. In many major or severe rhinoplasty cases, the “open” method may be used. Typically, swelling is more prominent and takes longer to subside in using the “open” rhinoplasty technique as opposed to the “closed” method. Furthermore, the resulting scar associated with the “open” technique is quite small and fades rapidly. Following rhinoplasty surgery, and regardless of which surgical technique is used (i.e. “open” vs. “closed”), a splint is applied and the nose is lightly packed with surgical gauze. Anticipate some swelling, bruising, puffiness, reddening, and stiffness following rhinoplasty surgery. These conditions may persist for weeks, however, most rhinoplasty patients are able to resume normal to light activity within a few days. Keep in mind that it will take several months before the nose is completely healed and allowing a complete return to full physical activity.
During the recovery process, it is not uncommon to experience minor bleeding. As a result, it is important to change the gauze bandages a few times each day during the first few days following rhinoplasty surgery. Furthermore, to relieve the pain, discomfort, headache, etc., associated with rhinoplasty, I may prescribe pain medication. Also, applying cold compresses to the treatment area will reduce associated pain and swelling. By not “blowing” one’s nose, as well as taping eyeglasses to the forehead so that they do not rest on the bridge of the nose, a successful rhinoplasty outcome will be more readily attainable.
While rhinoplasty surgery will result in enhancing the appearance of the nose for most rhinoplasty patients, occasionally, a secondary rhinoplasty surgery may be required to achieve an optimal outcome. A previous rhinoplasty does not necessarily preclude a patient from having another.
Directly following rhinoplasty surgery, it is not uncommon for the patient to feel moderately dissatisfied with the appearance of their nose. At this time, the nose is still swollen, concealing a significant amount of the detail and modification achieved through the rhinoplasty surgery. In some rhinoplasty cases it may take over a year before one can accurately judge the permanent outcome of the rhinoplasty surgery due to the constant changing and healing of the nasal tissues, blood flow, skin thickness, etc.
AFTER THE SURGERY
In the days following surgery, when your face is bruised and swollen, it’s easy to forget that you will be looking better. In fact, many patients feel depressed for a while after plastic surgery-it’s quite normal and understandable. Rest assured that this stage will pass. Day by day, your nose will begin to look better and your spirits will improve. Within a week or two, you’ll no longer look as if you’ve just had surgery.
As a patient, you must rest for at least 14 days after the surgery. During this time, a cast will be protecting your nose. The cast must be changed every two or three days to clean and control the post surgical recovery.
Part of the swelling will last for three weeks to five weeks. It is characterized by a numb tip, hardness, and by sensitiveness to pressure. It normally reduces dramatically (about 40%) three weeks after the surgery. For a full recovery, (other 60%) the patient’s swelling will reduce very slowly between twelve to eighteen months. It is important to understand, that after a Rhinoplasty the results seen after a long time. By no means, medicines would reduce the swelling.
Other results seen normally after the surgery are nose obstruction and pain pressure. To diminish the obstruction, please apply Vaseline inside the nostrils five to eight times a day, and Otrivin Gel three times a day. The nostrils must be lubricated at all times. In case of pain, please take Acetominophen every six hours. If you have trouble sleeping, please take on tablet of Benadryl (25mg) or in extreme cases take one tablet of Lorazepan before bedtime.
Still, healing is a slow and gradual process. Some subtle swelling may be present for months, especially in the tip. The final results of rhinoplasty may not be apparent for a year or more.
In the meantime, you might experience some unexpected reactions from family and friends. They may say they don’t see a major difference in your nose. Or they may act resentful, especially if you’ve changed something they view as a family or ethnic trait. If that happens, try to keep in mind why you decided to have this surgery in the first place. If you’ve met your goals, then your surgery is a success.
- Please avoid aspirin, ginkobiloba, ginseng, alcohol intake and passive or active smoking for one month after the surgery. Remember that nicotine and alcohol delays and might even complicate your healing processes.
- Please avoid exercising for six to seven weeks after the surgery.
- Please avoid bending forwards or backwards, direct sunlight, stress, hot water or blowing your nose for four to six weeks after the surgery.
- You can wear contact lenses as soon as you feel like it, but glasses are another story. Once the splint is off, it’ll have to be taped to your forehead or propped on your cheeks for another six to seven weeks, until your nose is completely healed.