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Q&A Nose

How do I know if my appearance can be improved by surgery?  
On your first office visit, this question will be discussed and your pictures will be taken, either with a digital camera, a regular camera, or both.  Drawings and sketches done on your profile pictures will clearly show what changes may be made to improve your appearance. You will be given copies of all the pictures taken and all the drawings done.

The color prints from film require one or two weeks and are five by seven inches in size. You will be offered copies of each one or they can be mailed to you.

The drawings on your own pictures show what is possible.  The prints of the drawings can be done on the first visit and are eight by ten inches in size and are black and white. We prefer black and white prints even though they can be printed in color for many good reasons.

You will have the opportunity to see twenty books, each containing approximately 200 before and after 5x7" photos of changes in appearance of the nose. This can give you an idea of what can be done on a routine basis.

Anyone who wants to know what improvements can be made in their appearance may take this opportunity to have their pictures taken to see what can be done.

Actually, just about anything that can be drawn can be done. And we can make the nose just about anything we want it to be in shape with few limitations (which, if they exist, will be explained in detail). 

So anyone can do the drawings. If the person wishing to have a certain look or appearance wants, they can do the drawings themselves, or have someone else do it. For many years different artists have done the drawings for us, usually with pen and pencil long before there were personal computers. And we can show some of those drawings and allow copies to be taken.  And still, today we will use the pen or pencil on copies of the digital drawings to further improve them 

Many copies and photocopies of the photographs and drawings may be taken home for further study.  When you have selected the drawing that is the most attractive for your face and personality, the doctor will know how you want to look.

Is the surgery painful? 
Nasal surgery itself is not painful.  There is usually very little discomfort following the operation, although the nose may be somewhat tender to touch. Rarely is medicine for pain required. Over 90% of patients say the surgery was a pleasant experience.

Are there visible scars from the operation?
 No. All incisions are made inside the nose where they cannot be seen, although there are some very rare exceptions

For these rare exceptions this will be explained to you. There should be no scars. 

There is such a thing as the open technique, which leaves a little scar in the skin on the little column of tissue that is between the nostrils. This can result in a visible scar. We do not do this.  

Is there any danger in nasal surgery? 
There is not much danger involved.  It is probably more dangerous to drive to the office to have it done (because of the risks involved in driving a car) than to have the surgery. Some infection or nosebleed may occur in a very small percentage of cases. The incidence of noticeable or serious infection or bleeding is less than one in a thousand.

 Local anesthesia is preferred over general anesthesia because it is so much safer.

At what age may surgery be done? 
The surgery can be done at any age.  A badly injured or deformed nose with obstructed breathing may be repaired in children.  Also, many elderly persons benefit tremendously in their appearance and breathing comfort because of nasal surgery.

At what age is it best to have nasal surgery to correct an  enlarged nose or a nose with a "bump" on it? 
The nose is usually still growing until age twelve or thirteen for girls and fourteen or fifteen for boys.  It is usually best to wait until about this age. Sometimes the younger person will have a much better result if the procedure is done early before the nose grows and becomes very large. 

Does the nose grow longer and larger with age?  
As we grow older, our noses tend to droop along with the skin of the eyelids, cheeks and neck. Normal elongation of the nose accentuates any hump-like appearance and makes the person look older and the nose larger.  Many breathing problems that result from aging may be corrected, and a more youthful appearance can be restored via nasal surgery.

How is nasal surgery performed? 
The patient is given sleeping medicines and medicines to prevent any discomfort.  Enough medicine may be given to allow the patient to sleep through the procedure if desired.  Shaping and remodeling of the nose is carefully and gently done, working inside the nostrils.  The nose is made numb with local anesthetic.  The patient is assured there will be no significant discomfort. 

All patients complete a questionnaire about their experience with the operation and the anesthesia, and anyone visiting us is welcome to see all of the thousands of questionnaires and the answers have been tabulated and summarized for quick perusal.

Where is this surgery performed?  
The surgery may be performed either in our outpatient surgery center or in the hospital, especially if insurance is expected to cover part of the cost. Many patients prefer to have surgery performed as an outpatient because of greater privacy and the financial savings gained from not having to pay for a hospital bill.

Can cosmetic surgery of the nose be performed at the same time as surgery to correct a breathing problem? 
Yes, this is frequently done very successfully. Occasionally the problems must be handled separately. 

Can the breathing through the nose be made worse by having cosmetic surgery performed? This is certainly possible, though it is very rare and unexpected, especially when surgery is performed by a nose specialist who also does surgery to correct breathing problems.

What caused the "bump" on my nose, or how did my nose become crooked? Sometimes there is a clear history of injury.  Many crooked or bumped noses, however, result from minor injuries in early childhood or infancy which neither the person nor the parents remember.  Some large noses and breathing problems are partly hereditary.

Will medical insurance pay for the surgery? If there is a legitimate breathing problem or if there is a history of an injury causing a deformity and/or a breathing problem, insurance will usually pay part of the cost.  The office staff can help you determine how much your insurance will cover.

How much will nasal surgery cost? We follow the California Medical Association's Relative Value Scale guidelines. These guidelines can be explained by the office staff.  The fee may be more or less, depending on what needs to be done.  The exact cost will be determined for you when you are seen in the office.

What does it cost to be seen and have my photographs taken? The initial office consultation as of 1998 is eighty US dollars and includes follow-up visits as needed several weeks later for discussion of the pictures and for planning of the change in appearance.  There is no additional charge for photographs.

Is the nose more fragile after surgery? The nose should be touched only very gently for three weeks following surgery.  Contact sports such as football and basketball, in which the nose may easily be injured, are prohibited for two months.

Are there any restrictions on my activity following surgery? During the first week, the less active a person is, the less swelling they will have.  Swimming is allowed after one month. Written instructions are given to each patient for post-surgery care. Occasionally, a cast is required, but usually there is no bandage and the person is breathing comfortably through the nose with no stuffing or packing necessary. 

Is packing required after surgery? Not very often. More than 90% of our patients require no packing in the nose, and are breathing through the nose when they are ready to go home.-- Usually the nose becomes quite congested after the first night, and frequently is so obstructed with congestion in the first week that little or no air at times can get through. Then it is like recovering from a cold.

Is the breathing obstructed after surgery?  Yes usually. There is some congestion or swelling inside the nose in most cases, and it feels like having a common cold in the first week or so. Some persons who had very blocked breathing before surgery, breath better than ever from the moment the surgery is done.

What can be done for the stuffy nose in the first week after surgery? The patient is encouraged to sniff back or to inhale through the nose to keep the airway as clear as possible. Blowing is prohibited because it will cause more swelling or even a nosebleed. It is alright to take over the counter decongestants, such as Sudafed or Actifed, but nose sprays or drops must not be used.

On your after surgery instructions there is an explanation of sniffing warm salt water and this can be very soothing and a great help.

If the patient is unable to breathe well on the second or third day after surgery, a visit to the surgeon can correct the problem by opening the airway to make the patient much more comfortable.

Will I be "black and blue" after surgery? Most  patients have no "black and blue" and very little swelling. Usually if there is slight discoloration or swelling, it  can be covered with make-up the day the tape is removed from the nose in the office, five or more days after surgery. Some persons bruise easily no matter what is done, and may become discolored and swollen in appearance. Our usual patient who has no significant discoloration finds that the very little swelling present has mostly subsided in one or two weeks following surgery.

How long does it take to be presentable in appearance after nasal surgery? Usually only one week after surgery, with the help of a little skin tone make-up, strangers you meet will not be able to tell any surgery was done. For those patients who bruise easily, two  or three weeks may be required. Close friends and relatives may detect a change in appearance, depending on how great a change is made, especially in the first month after surgery. Those persons who want only to be seen when they look their best, and  persons who are especially sensitive to the opinions of others, may want to take several weeks to adjust to their new look themselves before they make any appearances.

When does the nose appear normal after surgery? Very often the nose appears shorter and more turned up in the first two or three weeks due to swelling. Most of the swelling subsides by the end of three weeks. The remainder gradually disappears over a period of months. When the change in appearance in the nose has been a small one, the nose usually looks near normal when the cast is removed. The greater the change, the more the swelling and the longer time  required for the swelling to subside.

How long does it take for the swelling and discoloration to disappear? There is usually very little swelling or discoloration. Ordinarily the small amount of swelling present has mostly subsided in one or two weeks.  Any slight discoloration present may usually be masked by make-up when the tape from the nose is removed four to five days after surgery. Some individuals bruise very easily and no matter what is done, they may become discolored and swollen in appearance. These cases are generally back to normal in three or four weeks.

Will my nose look too turned up or will it fit my face? On your first visit, your pictures will be taken, and you will be asked to return to discuss the photographs. You should plan to spend an hour or more with my assistant and myself on that visit. Computer drawings may take the place of photographs. In the discussion of your pictures you will be asked what changes you feel would most benefit your appearance. My assistant and I will make some suggestions and indicate to you what can be done. As the plans are made, a final goal is selected from the profile drawings we have made and on which there is mutual agreement. You may take copies of the drawings  home for further study.

The result of surgery is generally very much like the planned goal and is often better than expected. Frequently, however, the nose looks temporarily too turned up in the first few weeks until the swelling subsides.

How can I be sure I will be happy with my nose?  Though  happiness cannot be guaranteed, most people are happy with an improvement in appearance. It is our goal to create a change in appearance that almost everyone will agree is an improvement. I believe the most important person to please is the patient. Every reasonable effort will be made to accomplish this. In about one out of four patients, some additional surgery may be done to achieve the most desirable result.

When may I return to work?  Some persons who are self-employed, such as the owner or manager of a business, return to work the next day. If the work involves stooping or straining or appearing in society, at least a week's leave should be taken. Some of my office assistants have returned to work in the office with the bandage still on the nose one or two days after surgery. For those who have sick leave accumulated and want to be away from work during the healing period, up to three or more weeks off work is recommended.

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 William Roy Morgan, M.D., F.A.C.S  Last modified: January 22, 2015