NOSE JOB SURGERY PREPARATION DETAILS RECOVERY AND COST
Preparation-Admission-Anaesthesia-Surgery details-Recovery-How much it Costs.
Preparation for Surgery
- Take a few days away from work prior to your rhinoplasty surgery. You will also require one or two days after the surgery for post surgery consultation, but there is no real reason to stay away from your work for more than a day or two after 'noseplasty' surgery.
- If you are a smoker it’s most important that you stop smoking at least six weeks prior to the surgery and that you do not resume smoking until your nose has totally healed. (Check with your surgeon). The importance of this is that smoking delays healing and it can also make you prone to infection.
- You must stop any and all vitamins, herbs, supplements, psychotropic medications, anti-depressants, gingo, curry, garlic, ginger, anti-inflammatory medications, salicylates, blood thinners, anti-coagulants, pain medications, and headache medications two weeks before admission ONLY after the permission of your regular doctor. You must report to the surgeon and anaesthetist at consultation all medications, hormones, vitamins, health supplements and natural health products you are using. Any of these products can cause bleeding or other complications during the surgery. Do not stop any medication prescribed by a medical practitioner unless you first discuss it with your prescribing doctor. You must inform your surgeon and anaesthetist of prescribed medications or supplements you may be taking.
- Males are required to please shave off their beard and moustache prior to surgery. This is important in order to reduce the possibility of infection. NosePlasty Clinic will not proceed with surgery if you have a moustache or beard.
- If female please remove nail polish/varnish (especially the dark colours) and all facial creams and eye shadows. The dark colour nail polish can interfere with our digital reading equipment during the surgery.
- Have someone to pick you up after the surgery (transport and accommodation can be pre-arranged by NosePlasty Clinic reception.) As you are not given general anaesthesia you will be fully functional within fifteen minutes after surgery, but as a safety precaution we insist that you do not drive until the next day and only if you are not taking sedatives or pain killers!
Admission for Surgery
- Rhinoplasty surgery at NosePlasty Clinic is scheduled to be performed in an up market, registered, licensed, surgical venue. The surgical venue used in South Africa is situated in a beautifully secluded, wooded estate which is surrounded by acres of tree lined greenery. Because the clinic is in a nature reserve the atmosphere is clear and pristine with no pollution. In other countries (the EU, Austria and Greece) the surgical clinics that the NosePlasty surgeons operate in are situated in similar up-market areas).
- We strictly enforce the policy that sick people are not treated in the surgery therefore there is no danger of dreaded, severe, bacterial infections (like MRS an Clostridium), which are commonly found in most hospitals. (A bacterial infection of the nose after surgery can destroy the best rhinoplasty result.) Cosmetic surgery clients are not sick. All they want is to improve their appearance, with a caring, professional, personal approach and very often with anonymity. If you have any infections (even a head cold) please inform the admission staff before you are admitted for surgery and also prior to any consultation and you will be rescheduled.
- Admission to the surgical venue takes place when you arrive at the Clinic. You will be escorted to the surgery by our staff who will take you to the foyer of the theatre. A qualified nursing sister will take you into the surgical theatre and ask you to lie down on the surgical table, where the specialist anaesthetist will check your premedication, medical history and status and if all is well, will hook you up to all the monitoring devices, preparing you for intra-venous medication. The surgical facility is fully equipped with the world’s most modern medical, leading edge technology in nasal cosmetic and surgical equipment. There is no compromise in the standard of equipment that is made available to the anaesthetists and surgeons.
Anaesthesia* and Conscious Sedation.
- The surgery is performed under painless conscious sedation anaesthesia with local anaesthesia to the regional nerve supply of the nose. There is no general anaesthetic, no tubes in the throat, no fuss and no hectic rush. A fully qualified registered, specialist anaesthetist whose experience includes anaesthesia for heart surgery patients administers the conscious sedation medication. The sedation is administered in minimal doses aided by a computerized system. Continuous electronic monitoring of the level of consciousness is performed with electro-encephalography and pulse, blood pressure and blood oxygen levels are also simultaneously monitored. The general sedation injection and the local anaesthetic to the nose is painless and is applied under general sterile preparation and protocols. A slight prick of a needle may be felt in the arm when the anaesthetist administers the initial sedation, but even that is pain free because the skin is anaesthetised by anaesthetic cream. All procedures in the aseptic, surgical theatre are performed with the usual aseptic, sterile protocols. The whole event is non-traumatic. Nose cosmetic surgery performed by surgeons trained in the noseplasty method is physiologically minor and do not require general anaesthesia. (In the rare event that a general anaesthetic is preferable this can be arranged with hospital admission, but we are convinced that in the vast majority of nose shaping cases general anaesthesia and in-hospital admissions are unnecessary). *Anaesthesia-from the Greek words an=without asthesis=sensation. Also see Blogs
- When the surgeon is finished you gently wake up from a deep sleep and 'voila’-the surgery has been completed and you didn’t even know it had happened! A one to three hour operation seems like 15 minutes to you! Twenty minutes to maybe half an hour after you wake up you walk with assistance to the recovery room and then after resting for another half to one hour you go home or residence with your NEW NOSE! There is no nausea, no bleeding and no pain or disorientation. (There may be a small blood staining of the nasal gauze.)
The Surgery Details
The definition of rhinoplasty is literally, shaping of the nose (from the Greek word "Rhino"=nose and "Plasty"=shape).
At NosePlasty Clinic we perform
- minimally invasive nose and chin augmentation surgery
- with the least possible injury to the nose
- the least stress to the patient as a whole.
- The surgery and any grafting that may be necessary is performed only with your signed, written permission.
Rhinoplasty surgery is performed either as an open or a closed procedure.
The best approach is discussed with you at your consultation. The best approach is determined with your consent by the surgeon, who explains the structural changes that need to be made to your nose in order to satisfy your and his aesthetic requirements.
- In a closed procedure, incisions are hidden within the nose.
- An open procedure requires an additional small incision across the narrow strip of tissue (the columella) that separates the nostrils. This incision is used in 'open' rhinoplasty techniques. This incision becomes virtually invisible with healing.
After the incisions have been made, the bone and cartilage support system of the nose is accessed. Next, minimal amounts of bone and cartilage are precisely removed, added to or re-arranged to provide a newly shaped structure. When the tip of the nose is too large, the surgeon can 'sculpt' the cartilage in this area to reduce it in size or augment it in the event of it needing tip support or augmentation. Sutures are placed to hold and refine cartilage shape.
- To refine the tip of the nose the surgeon might have to remove cartilage from your nose or add cartilage grafts to the tip. These grafts are called 'shield' and 'strut' or 'tip' grafts which are stitched into position. These grafts may be harvested from your own nasal septum or be obtained from a tissue bank (donor cartilage) or rarely, synthetic implants may be used (such as Silastic -a material similar to that used in breast implants).
- Grafting material may be required to build up or support your nose. There are a variety of synthetic materials available that can be used for grafting and grafting material can also be obtained from your own body. This is usually cartilage that is harvested from your own septal cartilage (the cartilage known as the septum that forms the separating wall between your nasal passages). Often cartilage can be obtained from your ear cartilage of from your rib cartilage. Donor cartilage is also used. This cartilage or other donor tissue is obtained from a tissue bank, (in the same manner as blood- (fluid tissue), is obtained from a blood bank.) The choice of all implants to be used is determined by your surgeon and used with your written, consent prior to the surgery.
- If there is a prominence of the nasal profile, this can be reduced by carefully removing small amounts of cartilage and/or bone from the bridge of the nose. Nasal bone repositioning may often be necessary following bony hump removal.
- In certain circumstances the surgeon may add cartilage, silastic or other synthetic substance or donor tissue to the profile in order to raise, enhance or smooth the nasal profile. The surgeon may also need to place grafts in the nose external or internal valve regions in order to facilitate your nasal breathing.
- If there is internal nasal blockage or obstruction this has to be dealt with by sculpting and re-positioning the dividing nasal partition (the septum) in order to alleviate and correct the obstruction. This can often prevent or stop snoring. In some instances internal nasal valve narrowing has to be kept open with the placement of 'spreader' grafts.
- In many cases grafting material is taken from this septum in order to fashion grafts that are positioned to support and define the nasal tip or used as 'spreader' grafts to correct nasal valve narrowing. (This is the field requiring internal nasal surgery expertise, which is acquired by surgeons who are trained in internal nasal specialization -Ear Nose and Throat).
- If the nasal bridge is collapsed, this may be raised by means of graft material, which may be synthetic, or donor cartilage/tissue.
- If the nasal bridge is too broad this can be corrected by loosening the nasal bones and repositioning them inwards. This results it bruising around the eyes which lasts about 2-4 weeks.
- The angle of the nose in relation to the upper lip can be altered for a more youthful look or to correct a distortion.
- The nose can be made to look longer or shorter by defining the angle between the brow and the 'starting' point of the nose and by adding a graft to the end of the septum of the nose.
- If ‘flaring’ nostrils are present this can be surgically corrected by excising small wedges of
tissue from the edge of the nasal opening (Nip & Slide procedure). This technique is often necessary in African noses, but it is not
limited only to African noses. It is often necessary to be performed in Asian or European noses.
- At the completion of the skeletal and cartilaginous restructuring the skin tissues are re-draped over the new frame and the incisions are closed.
- When it comes to stitches, slow dissolving sutures are used internally, and fast dissolving sutures close any external incisions. Grafts usually require fine, permanent sutures. Cartilage binding sutures may be used to redefine nasal tip shape.
- A plastic or aluminium splint is usually applied to the outside of the nose to help retain the new shape while the nose heals. It's also usual that you may have gauze packing or to support the nose internally for 24-48 hours. Occasionally (and dependent on your surgeon) nasal packing is sometimes not necessary. In complicated cases you may require internal splinting with sheets of thin silastic in order to keep nasal tissue, bone and cartilages in position. These sheets are removed at the discretion of your surgeon, usually after a few weeks. Your nasal passages are kept patent in spite of the sheets, so you are able to breathe through your nose.
NosePlasty Clinic surgeons are trained in achieving these above mentioned, complicated surgical procedures. They are in essence uncompromisingly advanced, precise, micro surgical techniques in nasal surgery, which is painless from start to finish usually with less bleeding than with a tooth extraction. All surgery is performed under usual aseptic and sterile protocols. See About Us and Conscious Sedation
For more details about the surgical procedure see also
- The small splint placed on your nose to protect it and to keep it stable is removed after about 5-7 days by the surgeon. If packing has been placed inside the nose during surgery, it is usually removed the morning following the surgery.
- Pain medication is not usually required, because noseplasty is painless but you may be uncomfortable and feel a bit swollen, puffy and 'bruised'. You will be advised to avoid blowing your nose for fourteen to thirty days after surgery, and we advise that you don’t pick up weights or strain for twenty to thirty days post surgery.
- Bruising. In the days immediately following surgery, you may experience bruising and minor swelling around the eye area. The bruising can last 2-3 weeks, and can be camouflaged with face creams. Cold compresses often reduce the bruising and discomfort. We sometimes recommend anti-inflammatory medications.
- Absorbable sutures to the skin, which we normally use with our technique, do not have to be removed.
- Noseplasty (Rhinoplasty) surgery at NosePlasty Clinic is same-day surgery. You will be fully conscious and functional after 15-20 minutes and you can resume non-physical work the next day if you so wish. You will be able to present yourself socially without wearing a splint 5 days after the surgery. It is crucial that you follow your surgeon's directions and especially instructions to keep your head elevated when you sleep for a couple of weeks after surgery.
- You will be given full written instructions and you are required to walk at least 5 kilometres a day every day post surgery and to drink at least 5 litres of water per day. Vigorous activities and sport will be prohibited for several weeks after the procedure. Air travel is prohibited for 10 days post surgery.
- Sun exposure, exertion, and any possible risk of injury must be avoided. If you wear glasses, special arrangements must be made to ensure that the glasses do not rest on the bridge of the nose. You will be advised as to the type of frame you can use. (There are also specially designed frames available. Ask for details at Reception) Follow-up care is vital in order to monitor healing. Obviously, anything unusual should be reported to your surgeon immediately.
- It is essential that you keep your follow-up appointments with your surgeon. The follow-up consultations are the day after the surgery usually for removal of nasal plugs, then usually 5-6 or 7 days later for removal of the nasal splint. Thereafter the next consultation is after 10-14 days depending on the surgical approach that was used. Your surgeon will inform you if further consultations are necessary from his point of view. If the surgery was revision surgery or complicated you may need to be seen for longer than a couple of weeks. Uncomplicated, primary rhinoplasty usually does not require more than 10 to 14 days post surgery monitoring. After 14 days it's a matter of allowing the nose to heal, swelling to subside and the tissues to settle.
Summary of Usual Nasal Procedures Performed at NosePlasty Clinic.
To determine the surgical approach to your rhinoplasty, your surgeon will carefully evaluate your overall facial appearance, skin thickness, facial proportion and structure, while taking your medical history, race and personal goals into account. Surgical alterations that may be analyzed and considered necessary include:
- Reducing, enlarging, narrowing, refining or shortening a nasal tip.
- Shortening or lengthening the nose.
- Turning a tip up or down.
- Refining the tip by elevation or narrowing or dropping it projection.
- Narrowing of the alar flare. The shape and size of the nostrils are assessed.
- 'Nip and Slip' to narrow African nasal tip flare-a NosePlasty Clinic speciality.
- Eliminating deviations, bumps, humps and irregularities of the bridge.
- Lowering a high bridge or raising a low bridge or correcting a 'saddle' nose.
- Straightening the nose and nasal septum by variuos techniques
- Raising the nasal bridge.
- Narrowing a wide nasal bridge or widening a narrow bridge.
- Changing the size, shape and position of nostrils.
- Reducing nasal nostril flare-this procedure can be done in isolation very effectively.
- Eliminating nasal breathing obstructions-functional correction-septum or nasal valves.
- Combination of all the above.
- Implants and grafting nasal bridge or nasal tip
- Implanting a Silastic chin to balance the naso-facial profile.
- Implantation of donor cartilage, fascia or synthetic grafts.
- There is an endless variety of other corrections that may be required as every nose is unique and different.
Costs at NosePlasty Clinic are not fixed. How much a nose job costs varies according to the anticipated simplicity or complexity of the operation and by the estimated time needed for the surgery. As a general range surgery costs for primary (no previous nose operation), simple nose plastic surgery starts at about US$4,500.-- to US$5,500.-- and is determined by the aesthetic charges agreed upon.* Open rhinoplasty and revision rhinoplasty is of necessity more expensive than closed rhinoplasty and the more complex the procedure is, the more time is required and the more expensive it is. The surgeon may, at his discretion, keep his surgical fees as low as possible for people he believes deserve exceptional consideration and may even waive his charges for medical colleagues.
* Prices and costs quoted are estimated for 2016 and vary according to escalation and currency exchange rates.
The estimated costs of 'noseplasty' is usually considerably lower than the equivalent surgery performed at first-world medical clinics or hospitals in USA, and Europe. See 'About Us' and Rhinoplasty from a Distance
(Nip & Slip-see ethnic rhinoplasty-can often be the cheapest and best option-quotes are given after examination)
- At the time of the initial consultation an all-inclusive fee for the surgery is quoted, which includes the surgeon's fee, assistant's fee, specialist anaesthetist's fee, surgical venue hiring fees, surgery sister and staff, in-surgery medication, disposables and grafting material (if required). Grafting material costs average approximately €uro 600-1000. Post operative surgical care and follow up is included in the surgeon's fee. Post surgery medication is not included in the quotation.
- There are no hidden costs.
- If the event that any revision or touch up surgery is required, advised or necessary, the fee for this should be discussed with your surgeon prior to the initial surgery.
- You have the possibility of being examined and having a consultation (by appointment only) with our surgeon (or advice by the NosePlasty Clinic's appointed Consultant Assistant) in the following locations -dependent on their availability and suitable, advance arrangements being made:
Athens - Mykonos- Naxos, Greece (The facilities and surgical cost in Greece today
St. Gallen, Switzerland
Johannesburg - Pretoria, South Africa
Contact Us for referral to NosePlasty Clinic rhinoplasty surgeons, (noseplasty trained) in Greece and Austria and for surgeons in the USA who are linked to NosePlasty Clinic. See Rhinoplasty from a Distance
* In London we can arrange for you to have your face photographed and your face, nose and chin shape professionally morphed and analysed for optimum, image enhancing shaping-(surgical or non surgical). This service must be arranged by appointment via Contact us at NosePlasty Clinic. The images can be e-mailed to your selected surgeon prior to your consultation.
* For all countries outside of the UK e-mail 'virtual' morphing and assessment, of your personal face photographs can be performed by the NosePlasty Clinic surgeon/s and the results can be e-mailed to you. Contact us at NosePlasty Clinic
The cost for the photographic imaging service is payable to the imaging consultant or to the imaging centre. (Price must be verified at the time of appointment booking)
The cost of imaging and photographic computer morphing with professional advice can be detailed by Contact us at NosePlasty Clinic
* There is a nominal cash consultation fee for the surgeon if you decide to be examined and consulted by him at the same time as your photo imaging is performed. Prior appointment arrangements must be made. In places other than the UK conventional, photographic imaging and morphing can be performed and included with the surgeon's consultation fee. The price for this consultation depends on the country location and whether photographic imaging is required/requested and will be quoted to you when arrangements and appointments are made. Contact us for further details.
Note: Noseplasty surgeons are no longer available for consultation in the UK due to Brexit.
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