You may visit your surgeon as many times as you wish, to have all of your questions answered. At your final preoperative visit, your final questions will be answered and you will confirm that you have understood the procedure to be performed, that this material has been explained to you, that you have read and understood these information sheets, and that you accept the risks by signing the informed consent forms. You will be given prescriptions for pain pills and nasal sprays, along with instructions for their use. Certain laboratory tests will also be required within two weeks of surgery. If you are over the age of 50, you will have to obtain a cardiogram at your doctor’s office or any licensed laboratory. You may have blood drawn by our office nurse during your final preoperative visit, or, if you prefer, at your family doctor’s office or any laboratory (e.g. Kaiser Hospital, etc.).

As with all other elective procedures, the patient should avoid ibuprofen (Advil®), all Aspirin® products and excessive amounts of vitamin E (the small amount contained in most multi-vitamin preparations is not harmful) for two weeks before surgery, as these inhibit the clotting mechanism and increase your chances of unnecessary operative bleeding. All patients will be asked to stop smoking at least a month prior to surgery in an effort to maximize your body’s ability to heal the incisions following the operation.

Usually, your anesthesiologist will call you the night before surgery to discuss the anesthetic care plan with you. But if you miss the call or your anesthesiologist does not call you, do not worry as you will be able to discuss your anesthesia and have all your questions answered in the morning, at the Laguna Hills Surgery Center, prior to your procedure. It is imperative that the patient make prior arrangements for transportation to and from the Surgery Center and to have a responsible adult stay with you for the first 24 hours after the operation. Patients may elect to spend the first night with a registered nurse.

Most of the incisions for reducing or recontouring the external nose are made inside the nose. Occasionally, an incision will be made across the base of the columella, the strut between the two nostrils. The nasal skin is lifted away from the cartilage and bone and the excess tissue is removed or repositioned. Instead of resecting tissue, occasionally it will be necessary to place grafts or implants into depressed areas to reshape the nose satisfactorily. Such grafts may be taken from the septum, the ear, or occasionally, from a rib. As mentioned, most nasal implants are made from silicone rubber.

The nasal tip cartilage will be refined and the nose shortened if necessary .The excessive skin left by the reduction of the underlying bone and cartilage is elastic and usually readapts itself to the new framework quite well.

An important aspect to the predictability of a desired result is the thickness of the patient’s skin and underlying tissues; thick skin will not drape out as well post-operatively over the new framework as will thinner skin. Conversely, while minor irregularities of the cartilage or bone can be expected to be hidden by thicker skin, they may become clearly visible in the thin-skinned individual.

A chin augmentation or reduction may be performed either through an external (beneath the chin) or internal (inside the lower lip) incision. Your surgeon will discuss the various methods, which may be used to enlarge or reduce the chin.

The operative time is approximately one and a half hours in length. The operation is usually performed under a light general or deep sedation. An anesthesiologist will be present to administer the general anesthesia and to assist with monitoring to ensure your safety. The procedure is performed in an ambulatory surgery center or hospital.

After surgery, a conforming splint is usually applied to the nose. The patient must place ice packs over the eyes for the first two days to reduce swelling and minor discomfort. Suitable pain medication and nasal sprays will be available. One of the sprays is plain salt water and can be used as often as desirable to wash mucous or crusts out of your nose, or simple to moisten the inside surfaces. You can use this spray as often as you would like, and conversely, if your nose feels fine, you do not have to use this spray. The other spray, Afrin®, is an over-the-counter nasal spray which can be used to decongest the nose. This is a powerful medication and should not be used more than twice a day. Afrin® may be used for the first two weeks, and its use should then be discontinued.

During the initial period after surgery, every patient will experience a trickle of blood and mucous at the back of the throat. Make every effort to spit these fluids out and not to swallow them. Blood is irritating to the stomach and may induce nausea.

The nasal protective splint will be removed by your surgeon, at the time of the first post-operative visit, approximately a week after the operation. The majority of patients do not require nasal packing. However, a packing in the nose is occasionally required to help control the bleeding or to help hold tissues in place. During the period that the nose is packed, the patient will have to breathe through the mouth. The patient may have the feeling of a minor cold anywhere from one to twelve weeks after surgery due to the attendant congestion of the nasal passageways. Patients undergoing correction of an impaired airway will feel an improvement, but cannot expect air to flow as well through the reconstructed nose as through an open mouth. The eyelids will be discolored and swollen for a period of approximately seven to fourteen days after surgery. Residual bruising may be covered with cosmetics. The office aesthetician can assist you with makeup application if requested. Occasionally, the whites of the eyes will become temporarily bloodshot-this could last for many weeks, but always resolves spontaneously.

The upper lip may feel stiff and unnatural for a varied period of time. Some numbness may be noted in the upper lip and over the tip of the nose for a period of up to six months. If a chin augmentation or reduction is also performed, varying degrees of lower lip numbness or asymmetry may also occur, although such permanent changes are extremely rare.

Although the major effect of the nasal operation will be evident in a week, minute improvements continue to occur over a period of six to twelve months. These changes will occur so gradually that the patient will not be aware of them.

The final outcome depends upon the age of the patient, the type of skin and the patient’s healing ability. The older the patient, the thicker the nasal skin, and the broader the nose, the longer the residual swelling will remain. In such cases, it will be more impossible to achieve a thin, chiseled nasal appearance.

To request a consent form, please contact us.

Although most patients have very satisfactory results, complications may occur following nasal surgery. Dripping blood from the nostrils is expected after surgery. If there are any questions regarding excessive or persistent post-operative bleeding or discomfort in excess of that controlled by pain pills, the surgeon should be contacted. Some bleeding may occur for up to four weeks after the operation. The patient must resist every urge to pick the nose with fingers or Q-tips to minimize the possibility of dislodging a crust and causing more bleeding.

Other complications can include a narrowed passageway with difficulty breathing, nasal asymmetry or thickening over the top of the nose due to internal scarring and possible leaning of the nose to one side due to drift or displacement of the fractured bones. There may be areas of permanent numbness of the nose and/or lip.

The operation to recontour the nose is associated with a significant incidence of dissatisfaction. In a significant percentage of patients, a second operation may be necessary to reduce scarring beneath the skin, to reposition the nasal fragments or to remove a persistent dorsal bump. On rare occasions, it may be necessary to perform a secondary procedure to correct a chin asymmetry or to remove an implant. Such additional operations will result in additional fees to the patient.

It is not possible to advise you of every conceivable complication. The foregoing was not intended to frighten or upset you, but to insure that your decision to have this operation is made with your awareness of the risks.

Coiffure procedures can be carried out while the splint is still in place, but it is essential that the splint be kept dry.

It is very important to stress that the bandages must be kept dry. The patient must avoid warm, steamy environments (hot baths, showers, hot tubs, saunas, etc.), which may cause the nasal dressings to fall off prematurely. The nasal splint will be removed one week after surgery, following which normal bathing may be resumed.

The nose is an extremely delicate structure and adequate time must be allowed post-operatively to ensure proper healing. Social activity and exercise should be limited for the first week following surgery. Swimming (requiring submerging of the nose) should be avoided for two to four weeks. Contact sports should be avoided for six weeks. Exercise such as running may be resumed whenever the patient is comfortable doing so.