Rhinoplasty, or cosmetic nose surgery, is a procedure to improve the appearance and proportion of the nose that will enhance facial harmony.
The shape of your nose is usually the result of heredity. Occasionally, the shape is altered after an injury or previous surgeries.
While Caucasian type noses may require reshaping or reduction of bone and cartilage, Oriental type noses may frequently require an addition of deficient nasal dorsum and trimming of cartilages.
There are basically two types of rhinoplasty: one that will require reduction such as the correction of humps or wide nasal bones at the bridge (sometimes called reduction rhinoplasty) ; the other, that will require adding to the lack in the height of the bridge of the nose (also called augmentation rhinoplasty).
Augmentation rhinoplasty is usually done under local anesthesia with sedation, as an office out-patient surgery. Patients can go home immediately after the operation, or after half an hour of rest. Reduction rhinoplasty however, which may include refracturing of the nasal bones, is more frequently done under general anesthesia.
Augmentation rhinoplasty with tip and alar correction will take between 1 ½ to 2 hours. Reduction rhinoplasty together with nasal tip and alar correction will take between 2- 2 ½ hours.
Rhinoplasty can change the nose size, the profile, the symmetry in relation to the other facial features. Large or bulbous nasal tip or wide nostrils can likewise be changed. The aim is to improve your self confidence.
A consultation with your surgeon is the first step an individual should take if considering rhinoplasty.
Select a surgeon who is highly qualified and one whom you can trust.
How do you select a plastic surgeon? You choose a surgeon who:
Rhinoplasty should be considered by an individual because it is her own desire, not to fulfill someone else’s or the person’s desire to be like someone else’s image. To want to look like a picture in a magazine may not be a realistic approach to having rhinoplasty.
During consultation, you can discuss candidly your expectations about looking and feeling better after surgery, while keeping in mind that the desired result is improvement, not perfection. Likewise, the surgeon can explain what services he can provide to meet your expectations.
During consultation, the patient will be asked about his medical history, drug allergies and previous medical treatments, use of alcohol, herbal supplements, and smoking. He/she is also evaluated with regard to his/her medical status to see if he/she qualifies to undergo surgery safely. In few instances where patients have prior history of cardiac, hypertension, pulmonary, endocrine conditions, clearance from an internist/ cardiologist may be sought as may be deemed necessary.
A splint will be placed over the nose. The splint is placed for protection and as a pressure dressing to reduce post-operative swelling. A nasal pack is placed in each nostril to absorb the liquid and blood from the wound inside the nose. The splint and sutures are removed 5-7 days after the operation.
You will experience maximum swelling during the first 3 days but it will gradually subside. Elevating the head during sleep will hasten the decrease of swelling by gravity. However, you will experience swelling off and on. Sometimes, it will worsen in the morning during the first 6-12 months after your operation.
Tolerance to pain is an individual matter. Some experience it as an ache, while others experience greater discomfort. Most augmentation rhinoplasty patients have minimal discomfort after the operation. Those who undergo nasal bone refracturing may experience a greater amount of discomfort.
You will be prescribed antibiotics as well as the appropriate pain medications which will help minimize the discomfort.
You may return to work between 7-10 days. Strenuous activities like gym, swimming, jogging can be resumed after 4-6 weeks.
In the tropics where the UV light, specifically between 9am-3pm, enhances the swelling of post-operative facial wounds, prolonged and direct exposure to the sun during the first 3-4 weeks should be avoided.
Swelling is down to a minimum by about 2 to 3 months after the operation. It is only then that you will begin to see the final result. You can basically appreciate much of the result in 2-3 months, although it may take up to one year for your new contour to be completely appreciated.
You will be given a set of instructions on how to take care of yourself after your operation. Following these instructions is key to the success of your surgery. You will be asked to refrain from activities that can potentially injure the operated nose, like exercise, games, and some social activities. And of course, you are to avoid subjecting your healing nose to excessive force, abrasion, or motion during the time of healing.
As people age, the effects of gravity, exposure to the sun, and the stresses of daily life can be seen in their faces. Deep creases form between the nose and mouth; the jawline grows slack and jowly; folds and fat deposits appear around the neck.
A facelift (technically known as rhytidectomy) can’t stop this aging process. What it can do is “set back the clock,” improving the most visible signs of aging by removing excess fat, tightening underlying muscles, and redraping the skin of your face and neck. A facelift can be done alone, or in conjunction with other procedures such as a forehead lift, eyelid surgery, or nose reshaping.
If you’re considering a facelift, this brochure will give you a basic understanding of the procedure when it can help, how it’s performed, and what results you can expect. It can’t answer all of your questions, since a lot depends on the individual patient and the surgeon. Please ask your surgeon about anything you don’t understand.
The best candidate for a facelift is a man or woman whose face and neck have begun to sag, but whose skin still has some elasticity and whose bone structure is strong and well-defined. Most patients are in their forties to sixties, but facelifts can be done successfully on people in their seventies or eighties as well.
A facelift can make you look younger and fresher, and it may enhance your self-confidence in the process. But it can’t give you a totally different look, nor can it restore the health and vitality of your youth. Before you decide to have surgery, think carefully about your expectations and discuss them with your surgeon.
When a facelift is performed by a qualified plastic surgeon, complications are infrequent and usually minor. Still, individuals vary greatly in their anatomy, their physical reactions, and their healing abilities, and the outcome is never completely predictable.
Complications that can occur include hematoma (a collection of blood under the skin that must be removed by the surgeon), injury to the nerves that control facial muscles (usually temporary), infection, and reactions to the anesthesia. Poor healing of the skin is most likely to affect smokers.
You can reduce your risks by closely following your surgeon’s advice both before and after surgery.
Facelifts are very individualized procedures. In your initial consultation the surgeon will evaluate your face, including the skin and underlying bone, and discuss your goals for the surgery.
Your surgeon should check for medical conditions that could cause problems during or after surgery, such as uncontrolled high blood pressure, blood clotting problems, or the tendency to form excessive scars. Be sure to tell your surgeon if you smoke or are taking any drugs or medications, especially aspirin or other drugs that affect clotting.
If you decide to have a facelift, your surgeon will explain the techniques and anesthesia he or she will use, the type of facility where the surgery will be performed, and the risks and costs involved. Don’t hesitate to ask your doctor any questions you may have, especially those regarding your expectations and concerns about the results.
Your surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. Carefully following these instructions will help your surgery go more smoothly. If you smoke, it’s especially important to stop at least a week or two before and after surgery; smoking inhibits blood flow to the skin, and can interfere with the healing of your incision areas.
If your hair is very short, you might want to let it grow out before surgery, so that it’s long enough to hide the scars while they heal.
Whether your facelift is being done on an outpatient or inpatient basis, you should arrange for someone to drive you home after your surgery, and to help you out for a day or two if needed.
A facelift may be performed in a surgeon’s office-based facility, an outpatient surgery center, or a hospital. We suggest to hospitalize patients for 2-3 days when general anesthesia or sedation like twilight sleep is used. Occasionally, it is done on an outpatient basis. Certain conditions such as diabetes or high blood pressure should be monitored after surgery, and may also require a short inpatient stay.
Most facelifts are performed under local anesthesia, combined with a sedative to make you drowsy. You’ll be awake but relaxed, and your face will be insensitive to pain. (However, you may feel some tugging or occasional discomfort.)
Some surgeons prefer a general anesthesia. In that case, you’ll sleep through the operation.
A facelift usually takes several hours-or somewhat longer if you’re having more than one procedure done. For extensive procedures, some surgeons may schedule two separate sessions.
Every surgeon approaches the procedure in his or her own way. Some complete one side of the face at a time, and others move back and forth between the sides. The exact placement of incisions and the sequence of events depends on your facial structure and your surgeon’s technique.
Incisions usually begin above the hairline at the temples, extend in a natural line in front of the ear (or just inside the cartilage at the front of the ear), and continue behind the earlobe to the lower scalp. If the neck needs work, a small incision may also be made under the chin.
In general, the surgeon separates the skin from the fat and muscle below. Fat may be trimmed or suctioned from around the neck and chin to improve the contour. The surgeon then tightens the underlying muscle and membrane, pulls the skin back, and removes the excess. Stitches secure the layers of tissue and close the incisions; metal clips may be used on the scalp.
Following surgery, a small, thin tube may be temporarily placed under the skin behind your ear to drain any blood that might collect there. The surgeon may also wrap your head loosely in bandages to minimize bruising and swelling.
There isn’t usually significant discomfort after surgery; if there is, it can be lessened with the pain medication prescribed by your surgeon. (Severe or persistent pain or a sudden swelling of your face should be reported to your surgeon immediately.) Some numbness of the skin is quite normal; it will disappear in a few weeks or months.
Your doctor may tell you to keep your head elevated and as still as possible for a couple of days after surgery, to keep the swelling down.
If you’ve had a drainage tube inserted, it will be removed one or two days after surgery. Bandages, when used, are usually removed after one to five days. Don’t be surprised at the pale, bruised, and puffy face you see. Just keep in mind that in a few weeks you’ll be looking normal.
Most of your stitches will be removed after about five to seven days. Your scalp may take longer to heal, and the stitches or metal clips in your hairline could be left in a few days longer.
The chances are excellent that you’ll be happy with your facelift-especially if you realize that the results may not be immediately apparent. Even after the swelling and bruises are gone, the hair around your temples may be thin and your skin may feel dry and rough for several months. Men may find they have to shave in new places-behind the neck and ears-where areas of beard- growing skin have been repositioned.
You’ll have some scars from your facelift, but they're usually hidden by your hair or in the natural creases of your face and ears. In any case, they’ll fade within time and should be scarcely visible.
Having a facelift doesn’t stop the clock. Your face will continue to age with time, and you may want to repeat the procedure one or more times-perhaps five or ten years down the line. But in another sense, the effects of even one facelift are lasting; years later, you’ll continue to look better than if you'd never had a facelift at all.
The tumescent technique is a relatively new liposuction method that can reduce post operative bruising, swelling and pain. Because blood loss is minimized during tumescent liposuction, use of the technique reduces the chance that a blood transfusion will be needed.
In the tumescent technique, areas of excess fat are injected with a large amount of anesthetic liquid before liposuction is per-formed. The liquid causes the compartments of fat to become swollen and firm or “tumesced.” The expanded fat compartments allow the liposuction cannula to travel smoothly beneath the skin as the fat is removed.
Any person who is a candidate for traditional liposuction is also a good candidate for the tumescent technique. Although the technique can be used on any area of the body, it is commonly used on areas that require enhanced precision, such as the face, neck, arms, calves and ankles.
Individuals who have large areas of excess fat may also be good candidates for tumescent liposuction.
Although the anesthesia requirements are lessened and blood loss is minimized with tumescent liposuction, patients undergoing the procedure still face the same risks and cosmetic complications associated with traditional liposuction surgery.
There are also risks specifically associated with the tumescent technique. These rare complications include pulmonary edema (the collection of fluid in the lungs), which may occur if too much fluid is administered; and lidocaine toxicity, which occurs if the solution’s lidocaine content is too high.
You can reduce your risks by choosing a board-certified plastic surgeon who has adequate experience with the technique.
For many patients, general anesthesia is the best option. For others, the anesthetic contained in the solution combined with sedation may provide sufficient comfort during the procedure. Or, if your doctor feels it’s appropriate, the tumescent solution itself may serve as the sole means of anesthesia.
In tumescent liposuction, the warmed tumescent liquid -- a dilute solution containing lidocaine, epinephrine and intravenous fluid -- is injected into the area to be treated. As the liquid enters the fat, it becomes swollen, firm and blanched. Liposuction is then performed on the tumesced areas.
The long-acting effects of the anesthetic solution help to provide pain relief after the procedure and decrease the need for additional pain medication.
For the first day or two after surgery, most patients experience swelling in the treated areas, as well as some fluid drainage from the incision sites.
Light activity is usually resumed within the first few days after tumescent liposuction; normal activity can be resumed within a few weeks.
Patients are usually able to see a noticeable difference almost immediately after surgery. However, more improvement can be seen after three weeks, when most of the swelling has subsided. After about three months, any persistent mild swelling will disappear and the final contour will be visible.
Patients are usually very pleased with the results of the procedure. By eating a healthy diet and getting regular exercise, you can help to maintain your slimmer figure or leaner physique.
Blepharoplasty, or aesthetic eyelid surgery, is a procedure to correct drooping upper eyelids and puffy bags below the eyes. It can eliminate conditions that give an individual a tired appearance, such as wrinkled folds of skin on upper eyelids, bags under the eyes and sagging eyebrows. This involve removing excess skin, fat, and muscle.
Upper or lower eyelids will take between 1-1 ½ hours. Upper and lower eyelids when done together will take between 2-3 hours.
Blepharoplasty is done usually under local anesthesia with sedation, as an office out-patient surgery. Patients can go home immediately after surgery, or after half hour of rest.
A consultation with us is the first step an individual should take if considering blepharoplasty. Here you can discuss candidly your expectations about looking and feeling better after surgery, while keeping in mind that the desired result is improvement, not perfection. Likewise, we can explain what services we can provide to meet your expectations.
During consultation, the patient is also evaluated of his/her medical status to qualify to undergo surgery safely. In few instances where patients have prior history of cardiac, hypertension, pulmonary, endocrine conditions, clearance from an internist/ cardiologist may be sought as may deemed necessary.
Tolerance to pain is an individual matter. Some experience it as an ache, while others experience greater discomfort. Most eyelid surgery patients have minimal discomfort post-operatively.
You will be prescribed the appropriate pain medications which will help minimize the discomfort. Frequently, mild analgesics, like acetaminophen/paracetamol (Tylenol), is sufficient to relieve the discomfort.
Swelling is expected after surgery and comes to maximum about the 2nd or 3rd day after surgery.
There will be temporary discomfort, tightness of the eyelids, swelling and bruising. There can be excessive tearing and sensitivity to light for the first few weeks. As the wound begins to dry up, you may experience temporary dryness or itchiness of the eyelids especially around the incision sites.
You will be instructed on steps that can minimize the degree of swelling, like ice compresses, head elevation, use of an eye ointment or eye drops, etc.
Reading and focusing is usually difficult during the first 2-3 days. You may return to work between 7-10 days. If you wear contact lenses, you may have to wait for 2 weeks or more before you would use them.
Strenuous activities like gym, swimming, jogging can be resumed after 4-6 weeks.
This pertains particularly in the tropics where the UV light, specifically between 9am-3pm, enhances the swelling of post-operative facial wounds. Prolonged and direct exposure to the sun during the first 3-4 weeks should be avoided.
Swelling is down to a minimum at about 2 to 3 months after surgery. It is only then that you will begin to see the final result.