NOSE JOBS BEFORE AND AFTER | RECOVERY TIME | RISKS | PITFALLS
NosePlasty Clinic Surgeons are very aware of the Pitfalls and Risks of Rhinoplasty Surgery.
“We had got to a point where cosmetic surgery had become so normalized it was like buying shoes. We focused on the cosmetic part of the phrase, not the surgery bit- we need to bring back the idea that this is a medical operation with risks.”
Quote from Mr. Fazel Fatah, President of the British Association of Aesthetic Plastic Surgeons.
Some Rhinoplasty/Nose Job Risks and Pitfalls in all Nose Cosmetic Surgery by all Clinics and by all Surgeons.
- A general plastic surgeon not trained in Ear, Nose and Throat will do a manual and visual evaluation and analysis of the external or visible anatomy of the nose. General plastic surgeons are not trained to examine the internal structures and pathology of the nose and sinuses. General plastic surgeons do many types of plastic surgery, such as liposuctions, face lifts, breast implants and reductions, blepharoplasties (eye lid surgery), and rhinoplasties, but unless they have had ear, nose and throat speciality training then they are not trained in internal, post-nasal or para-nasal pathology, thereby precluding general plastic surgeons from diagnosing and treating internal nasal passage problems (such as sinusitis, allergy, polyps, valve stenosis, mucosal problems, tumours, turbinates etc.) and importantly, nasal obstruction and its causes. Training for this requires ENT experience and special instrumentation. However a fairly large percentage of people (some authorities put the figure at over 35%) who consult a doctor for nasal cosmetic surgery state that they have been diagnosed as having sinusitis or a post-nasal drip. Statistically almost a third or more do have some internal nasal deviations requiring attention. Formal training in inner nasal surgery, is essential for approximately 35% of cases seen in nasal cosmetic consultations- (see Dr. Rollin K. Daniel's statistics who clearly states in his book 'Rhinoplasty-Atlas of Surgical Techniques'... "I am absolutely convinced that at least 35% of cosmetic patients who deny nasal obstruction do indeed have a significant pre-operative anatomical deformity that, if uncorrected, will result in post-operative obstruction."). The general plastic surgeon who is not trained in inner nasal surgery may need to seek the assistance or joint participation of surgeons trained in internal nasal surgery to assist in internal nasal surgery procedures such as spreader grafts, septal perforation repair, nasal valve opening and the obtaining of grafting cartilage from the internal passages of the nose. The assistance of an additional surgeon can substantially increase the cost of the nose job.
* NosePlasty Clinic surgeons are not general plastic surgeons. They are fully
trained Ear, Nose and Throat surgeons specialising and dedicated only to
cosmetic surgery of the nose.
- General anaesthesia is the most common anaesthetic method used for nasal cosmetic rhinoplasty. You will be booked to enter the hospital the day or night before the surgery with instructions not to intake food or drinks for 12 hours, because you will be given general anaesthesia. General anaesthesia usually demands the use of an endo-tracheal tube to be inserted into the wind pipe (larynx) and throat and gauze packing to prevent blood aspiration. It also requires a lowering of the blood pressure in order to reduce bleeding. Because of the length of the surgery (which can take up to five hours in some cases), the risks of deep vein thrombosis and other complications is increased. You will not be able to walk immediately after the surgery because general anaesthesia has a general, muscular and neural effect and there is generally a long post anaesthetic recovery. You probably will experience throat discomfort or even some throat pain after the surgery because of the mandatory tube insertion, local anaesthetic spray into the larynx and throat packing. You could also develop some voice change due to the irritation from the laryngeal intubation. Nausea and sometimes vomiting are also common.
* Conscious Sedation is used by NosePlasty Clinic and this in most cases avoids
all the above mentioned problems and complications which are associated
with general anaesthesia.
- General anaesthesia, for safety reasons, usually demands hospital in patient admission into a general hospital or clinic. Most hospitals and clinics cater for all types of patients- general surgery, orthopaedics, medical diseases, gynaecology, all types of plastic surgery—from skin grafts to tummy tucks, liposuction etc.) General hospitals and clinics generally are of concern because of super bug infections such as Methicillin Resistant Staphylococcus (MSR) and Clostridium. An infection in a nose job can have serious cosmetic repercussions.
* NosePlasty Clinic is dedicated ONLY to rhinoplasty surgery in private
nose cosmetic surgery clinics and thereby avoids the potential problems of
general hospitals. NosePlasty Clinic rhinoplasty clients are never operated upon if
they have any infection. In some instances, if there is any doubt, a nasal swab is
obtained pre-surgery in order to establish whether the patient is a carrier of a
streptococcal or super bug nasal infection. (Undiagnosed chronic sinusitis is an
example of a bacterial carrier.)
- Pre-operative photographic imaging of the nose is important, as you will only be able to have a view of the operated nose after the splint has been removed. If you have not been shown before surgery, the morphologically designed nasal shape result by pre-operative image morphing, it can be quite stressful and upsetting to be faced with a nose in the mirror that is quite different to what you had expected it to be. Be aware that pre-operative, computer image manipulation does not predict the surgical result and no reliance should be placed on them. The computer generated images are simulations only and actual results may differ. However they do make you aware of possibilities, probabilities and force you to take a realistic approach to the anticipated changes to your face. Some nose surgeons as a matter of principle, do not use pre and post surgery photographs or imaging but at NosePlasty we always do photography and computer images of your nose and face.
Nose Job Risks Before - After - Recovery which may occur in any rhinoplasty by any surgeon in any clinic !
(This is not a complete list. Ask questions and get answers
from your surgeon!)
- Nose bleeds or ruptures of small blood nasal vessles may occur post operatively. Visible vessles under the skin may appear in thin skins and these can be corrected with laser or sclero-therapy by a dermatologist.
- An infection can occur. This is extremely rare at NosePlasty Clinic as it is situated in a secluded environment where sick or infected patients are not allowed entry. We even insist that anyone, staff or patient, is not allowed into the surgery or consulting rooms if they have a head cold or any upper respiratory infection. We ask that if a client has an appointment and develops a cough or head cold, he/she should please reschedule their appointment.
- The normal risks of any anaesthesia that accompany any surgical procedure can occur. The risks are minimized by the Conscious Sedation technique. The anaesthetic risks can vary from mild to severe and may be pulmonary problems, vascular problems such as thrombosis, allergies to drugs and medications. Cardiac and pulmonary complications can occur in longer procedures and may be associated with the formation of blood clots in the venous system. Because during surgery NosePlasty Clinic uses Conscious Sedation which does not require paralysing drugs (as in General Anaesthesia), muscle tone is retained and muscle movements are active and take place during the surgery. This dramatically minimises the probability of vascular problems. NosePlasty Clinic has never encountered such problems even though there is always a statistical risk of medical problems associated with any medical or surgical procedure.
- Excess scar tissue formation or deviations due to scar tissue formation can develop. This is the major unpredictable possibility, which can affect the anticipated result, but as a general rule severe scar tissue formation in the mid face area (the nose area) is rare. In some cases scar tissue can be treated with steroid injections. Severe scar tissue formation-'keloid' rarely can occur
- If bone or cartilage is grafted or altered, minor irregularities may develop (due to movement or scar tissue formation) and occasionally can be felt or seen.
- Unpredictable nose asymmetry can occur. This may be the result of pressure from a pillow during sleep or injury or scar tissue formation or facial muscles asymmetry or sometimes the result of other causes which cannot be determined.
- Change in skin sensation (numbness) around the nose and seldom around the mouth may occur. This usually disappears with time. Temporary loss of smell may occur. Recovery usually takes place within a few weeks.
- Extrusion, displacement, absorption, infection or rejection of grafted material can occur. This cannot be predicted and may require revision procedures.
- Excess scar tissue (keloid) can occur. Again this is rare in the mid face and the possibility cannot be predicted unless you have had previous keloid formation in your face or body.
- Unpredictable results are possible. The aesthetic outcome of rhinoplasty cannot always be foreseen. Bones may dislodge, and cartilage and soft tissue may change in shape over time. In addition, results may not be as you had hoped, and asymmetry is possible. Scar tissue formation is unpredictable and neither the surgeon nor the patient has any control over the healing process, which the surgery is dependent upon for many nose shaping changes. The healing process and draping of the skin over the nasal bones and cartilages cannot be foreseen and secondary procedures may occasionally be required to refine the results or to achieve the intended result. Be aware that costs are involved in these secondary procedures.
- Possibility of revision surgery requirement. In some situations, it may not be possible to achieve optimal results with a single surgical procedure. A minor, secondary procedure may be necessary to reach the intended aesthetic result. Surgery is not an exact science, and surgical results and outcomes in primary or secondary operations are not predictable. No Clinic or surgeon in the world can or will guarantee the results of primary or secondary rhinoplasty surgery and NosePlasty Clinic, Mr. John-Calinikos and or any other surgeon in the world likewise cannot and will not guarantee results.
- Nose shaping surgery is not a choice based on medical reasons. It is an elective procedure and it is the client’s choice as to whether he/she is prepared to take risks associated with the surgery, anaesthesia and sedation. All the risks, complications and costs can be avoided by not having nose shaping, rhinoplasty, noseplasty or nose job cosmetic surgery. See FAQ
- Post conscious sedation recovery is within half and hour and post surgery after NosePlasty (swelling and bruising) recovery is usually rapid and occurs within a few days to a few weeks. Total and complete aesthetic healing needs time and usually takes place over the period of 12-14 months.
Data update regarding General Anaesthesia.
Medscape Medical News dated February 9, 2012. Laura Newman, MA
Combination Surgeries, General Aneasthesia Drive Adverse Effects (AE).
"Six years worth of data from Alabama (USA) revealed 52 AE, including 49
complications or hospital transfers and 3 deaths. General anaesthesia was implicated in 89% of reported incidents; 42% were cosmetic surgeries."
Plastic surgeons were linked to nearly 45% of all reported complications in Florida and 42.3% in Alabama, write the researchers.
Article published in February 2012 issue of Dermatologic Surgery.
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