Archive for November, 2012

How long does swelling last after rhinoplasty?

November 13th, 2012 | Category: Uncategorized

There are two questions at the forefront of most people’s minds when considering rhinoplasty. When will I look good enough to go back to work, school, or social activities? And, when will I see the result I want?

The first answer is easy. Swelling and bruising should be gone in the vast majority of patients within one week after surgery. At one week, most everyone is comfortable going back to normal social and work activities. That being said, your nose will still feel a little strange at that time. It will probably be a little numb and stiff, and your smile may feel tight or awkward. No else will notice this but you will be aware of it. It’s extremely rare for anyone to notice what’s different about you unless you’re announcing your impending surgery to friends or to the whole workplace. Most of our patients tell us they here statements like “Hey, you look good”, or rarely “There’s something different but I can’t put my finger on it”. The reason is that there is not an immediate dramatic change. In most cases, the change is gradual enough that it is seen only when we focus on the nose.

On the second question, you should be seeing a real and meaningful positive change in your appearance even within a week or two after surgery. But, at this stage, you may only be about halfway to the imaged or desired result. We are talking here about detail or refinement. The skin has been lifted and changes made to cartilage and bone underneath, and it takes weeks and months for the skin to contract around the bone and cartilage. Until then, the skin can feel a little ‘loose’ or spongy. As the skin contracts, it ‘shrink wraps’ onto the change structure allowing more detail to show through.

Some factors can affect this timing. Thicker, more oily skin can often take longer to contract. If the nose was made smaller or narrower, it will take more time for the skin to contract to that level. On the flipside, if the tip was projected or the bridge raised and augmented, you will generally see more definition sooner after surgery. Revisions can sometimes be slower to heal although not always. If a large amount of scar was taken out during a revision and cartilage resupported, the skin will likely be able to drape better more quickly.

Of course, there is some individual variation here. Some patients look fantastic after 3 months and healing is essentially done. Others may have some fluctuating puffiness and continued improvement well over a year or longer after surgery. Your surgeon will be able to give you a sense of your expected course of healing during your pre-op visit. Things can also be done along the way to help swelling go down and have you looking and feeling great as quickly as possible.

Check out another one of our blogs on healing after rhinoplasty.

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African American Rhinoplasty: Is Building Your Bridge Worth it?

November 02nd, 2012 | Category: Uncategorized

For many of our African American patients there is some real confusion as to what rhinoplasty can accomplish. The problem is that after having seen a number of different surgeons for consultation they are repeatedly told that in order to accomplish any “real” change they need to have the bridge of their nose built up.
The problem is that for most of you, it is not the profile view that has ever bothered you- it’s how wide your nose looks on front view that made you feel like your nose does not quite fit.

Unfortunately, many surgeons are not comfortable in dealing with the excessive width of the tip and nostrils and will instead focus on building up the bridge to make it look narrower. Again, while this treats part of the problem it does not address the tip and as a result your nose can still feel excessively wide. Moreover, because the surgeon often uses your septal cartilage in order to build the bridge it makes revision of the tip much more difficult.

In our experience, traditional reduction rhinoplasty generally does not work very well for African American patients. The reasons for this have been addressed in previous blogs on the topic, but suffice it to say that in most African American patients there is a layer of fibrofatty tissue that underlies the skin that covers the tip and makes the tip excessively wide and undefined. In order to create more tip definition and make it look more refined, this fibrofatty tissue often has to be dealt with during surgery and at least partially removed so that the skin can then contract down to the cartilage.

When we then couple this with suture techniques to help refine the tip and do alar base surgery (nostril narrowing) that addresses both the flare of the nostril as well as the width of the nostril (sill width) you can really tailor the procedure to address your goals in a very natural way. By combining all of this we have found that our patients are able to address the excessive width of the their nose and end up with a nose that is natural and stable so that they no longer have to think about their nose any more.

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