Rhinoplasty (Nose Job / Nasal Surgery)
Rhinoplasty refers to surgery to change or correct the shape of the nose, both internally and externally. Internal changes often include a septoplasty (straightening of a deviated septum) or widening the internal nasal valves, to improve the ability to breathe through one’s nose. Often, insurance coverage will offset a significant portion of the cost of the surgery when patients have difficulty breathing through the nose, a deviated septum, a septal perforation, or history of a prior broken nose. Because of his volume of rhinoplasty and the frequent need for functional surgery, Dr. Mehta is in-network with a wide range of insurance plans.
Dr. Umang Mehta is an expert at both primary (first-time) and revision rhinoplasty. He specializes in both endonasal rhinoplasty (closed approach) as well as open rhinoplasty and has extensive experience with both surgical techniques. He is also an expert in septal perforation repair and uses the latest in technological advances, such as an absorbable PDS plate, to perform this surgery. During his training, he learned from numerous talented rhinoplasty surgeons all over the United States and Canada. He was one of a handful of surgeons nationwide to publish a chapter (Nasal Analysis) in Master Techniques in Rhinoplasty and Nasal Reconstruction. Additionally, Dr. Mehta has lectured numerous times to residents, medical students, and premedical students on the topic of rhinoplasty, at USC Medical Center, Saint Louis University Hospital, and Stanford University. At USC, he was also given the privilege of teaching the technique to several future head and neck surgeons in the operating room. He has also published his research on nasal obstruction and nasal surgery in well-respected peer-reviewed medical journals, while also having been invited to present his papers at national facial plastic surgery and otolaryngology meetings.
Most surgeons would agree that rhinoplasty is the most challenging plastic surgical procedure, given the careful consideration of both aesthetics and function. This surgery should be performed by specialists with extensive training and a profound understanding of both the nasal airway as well as the anatomy of the nose.
For certain patients, nonsurgical rhinoplasty, also called liquid rhinoplasty, is an excellent option. This procedure involves the injection of fillers such as Restylane, Perlane, Juvederm Ultra, Juvederm Ultra Plus, Radiesse, or Artefill in the nose. The procedure takes just a few minutes to perform in the office and can be an alternative to surgical rhinoplasty for patients with small irregularities or indentations. Also, injection of filler above and below a hump can help camouflage it. The effects can be temporary or permanent, depending on the choice of filler. Dr. Mehta is adept and experienced at nonsurgical rhinoplasty and can advise you if this is an option for your nose.
Your visit for a rhinoplasty consultation with Dr. Mehta typically lasts around an hour. He will begin with an extensive discussion of what exactly bothers you about your nose. This communication of the desires, aesthetic and expectations of the patient is truly the most critical component of the entire rhinoplasty process.
Dr. Mehta will obtain a careful history, including medical conditions which may affect your ability to undergo and recover from surgery. Any history of adverse reactions to anesthesia or medications commonly given before, during, and after surgery is also determined. Any history of difficulty breathing, breaking your nose or prior nasal surgery is particularly relevant.
This discussion is followed by a thorough examination of both the inside and outside of the nose. Dr. Mehta will carefully palpate the outside of the nose, to feel the thickness of the skin and assess the underlying nasal bones and cartilages. The inside of the nose is painlessly examined with a nasal speculum. The nasal septum, the wall which divides the nose into a right and left half, is inspected as well, to determine the degree of deviation and status of the cartilage.
Following the physical examination, Dr. Mehta will photograph your nose from seven different angles. The images are displayed on his computer, enabling both Dr. Mehta and you to inspect your nose in detail.
Dr. Mehta then utilizes software to “morph” your nose, to give you an idea of the appearance of your nose after surgery. This computer imaging is a very important process, as it gives you the ability to communicate your aesthetic desires to Dr. Mehta and better understand the surgical goals. During this discussion, Dr. Mehta will begin to formulate his plan and explain to you all of the steps of the operation. These “morphed” images of your nose are stored and used during your surgery as a guide or template. While not a guarantee of results, this imaging process is invaluable in making sure that you and Dr. Mehta are on the same page going into surgery.
After this initial consultation, most patients return for a preoperative visit two or three weeks before surgery. At this time, Dr. Mehta will again review your images with you in detail, allowing you to communicate any new thoughts or questions since your first visit.
Dr. Mehta will also go over your list of medications and supplements, as it is usually necessary at this time to discontinue any products that can increase the risk of bleeding during or after the surgery. These include, but are not limited to, aspirin, ibuprofen, heparin, warfarin (Coumadin), Plavix, vitamin E, fish oil and numerous other supplements. The decision to stop any of these prescription or over-the-counter products is made in conjunction with your primary physician. Medical clearance and other tests may need to be obtained, depending on your age.
Dr. Mehta will give you your prescriptions or call in your pain medication and possibly antibiotics at this visit as well. This allows you to pick up these important medications prior to your surgery, so that postoperatively, you and your caretakers can rest and concentrate on your recovery. Dr. Mehta will advise you to pick up Arnica Montana and Bromelain, two homeopathic products which reduce bruising after surgery. These are taken as directed, beginning immediately after surgery. You will be given detailed preoperative and postoperative instruction pamphlets, to read prior to your surgery. It is important to minimize salt intake and avoid alcohol for three days leading up to your surgery.
Lastly, you will have the opportunity to spend time with Jill, our office coordinator, to answer any logistical questions related to your surgery. Your final surgical fees are settled at this visit as well.
On the day of surgery, you will arrive at the surgical center with a friend or family member who will drive you home and care for you after your surgery. It is imperative to come in on an empty stomach, not eating or drinking anything for at least 8 hours prior to your surgery. This includes water and chewing gum. You should wear loose and comfortable clothing, including a shirt which buttons in the front to avoid having to pull anything over your head after surgery.
The operating room nurse will meet with you first to go over your instructions in detail. You will then meet your anesthesiologist, who will have carefully reviewed your medical and surgical history. You will have the opportunity to ask the anesthesiologist any questions you may have at this time. Finally, Dr. Mehta will meet you and your friends/family to answer any last minute questions as well.
Dr. Mehta generally works with the top notch anesthesiologists from Associated Anesthesiologists Medical Group (AAMG) in Palo Alto. These anesthesiologists are all board-certified MDs who practice at a number of area hospitals including Stanford University Hospital. Because of the numerous cases Dr. Mehta has done with AAMG, there is a mutual familiarity and comfort level and patients are truly in the best of hands.
After surgery, you will wake up in the recovery room, where your vital signs are carefully monitored by the anesthesiologist and recovery room nurse. You will have a rigid splint on the outside of your nose with tape underlying it. Dr. Mehta will, on occasion, place a small piece of Telfa packing in either side of your nose. This material is non-stick and extremely soft, similar to the white portion of a Band-Aid. This is left in place for as little as 30-45 minutes or possibly overnight, depending on the surgery performed.
After approximately two hours in the recovery room, you will be discharged home, in the care of a responsible adult for the first night. Your caretaker will be instructed to assist you with icing your nose and the area around your eyes for the first 48-72 hours after surgery. You will sleep with your head elevated at 30-45 degrees. At this time, you will begin taking your prescribed medications as well as the Arnica Montana and bromelain. Eating fruits such as pineapple and papaya are encouraged as well, as they are thought to help minimize bruising.
You will return to the office the following morning to be seen by Dr. Mehta. He will remove your packing, if needed, and go over your instructions in detail. Over the next 4-5 days, most patients develop bruising around the eyes and cheeks, while pain and discomfort are usually mild to moderate. Often patients will feel fine to work from home as early as 2-3 days after the procedure. You are encouraged to undertake light activity, like walking, as early as the day after surgery.
Your diet should be soft, mild in flavor and with minimal salt for the first 10-14 days after surgery. To minimize the risk of bleeding and reduce swelling of your nose, you should avoid any vigorous activity or heavy lifting for this same period of time.
Your next visit will be 6-7 days after surgery, at which time your splint is removed. In open rhinoplasty cases, the few, tiny sutures placed on the columella (between the nostrils) are removed at this time. Your nose will be somewhat swollen when the splint is removed, though the majority of the swelling disappears over the subsequent few days. On average, patients return to work or school around 8-12 days after surgery though this certainly varies depending on one’s degree of bruising/swelling and comfort level.
The next visit will be at five to six weeks after surgery, at which time, Dr. Mehta will consider injecting your nose with steroids if there is a need. You will then be seen at 3 months, at which time the first set of “after” photographs are often taken. Your subsequent visits will be about every 3 months until the 12-18 month mark, by which time the miniscule bit of residual swelling will typically have resolved.
Rhinoplasty is a delicate surgical procedure which, when performed by an expert surgeon, yields excellent results for the vast majority of patients. The surgery is well tolerated by most people with a brief recovery period afterwards. The surgery can have a profound effect on both your ability to breathe as well as the shape of your nose.
If you have any additional questions or would like to schedule a consultation, please contact our office.