Introduction:
Rhinoplasty or nasal reshaping is a very common procedure performed on men and women to reshape the nose. It is usually performed for cosmetic reasons but can also be performed for functional reasons. In other words, if there is a mechanical obstruction in the nose that blocks the nasal airway, this obstruction can often be fixed with surgery. Because the nose is located in the center of the face, it is something that we notice right away when looking at someone. While there is not a single type of nasal shape that is considered ideal for everyone, there are certain characteristics that make a nose either attractive or unattractive. Some of the more common “problems” that people would like to change are a bump on the dorsum (top) of the nose, a wide base, a wide or bulbous tip, a long nose, and very wide nostrils. Obviously most people will only complain of some of these “problems”.

Who is a candidate for rhinoplasty?
Rhinoplasty is performed on men and women of almost all ages. It is a common procedure for teenagers, those in their 20’s to 40’s, as well as for those in their 50’s or 60’s who are unhappy with the way their nose has changes as they aged. As long as there are realistic expectations, most people who are unhappy with the appearance of their nose and can specify what really bothers them, are candidates.

Is there anyone who should not have a rhinoplasty?
As long as the person is in good health and does not smoke for at least 2 weeks before the surgery, there are no major contraindications to the procedure. It is very important, though, to understand the goals of the procedure, and have realistic expectations.

How long does the surgery take?
The surgery can take anywhere from 30 minutes to 3 hours depending on the technique used and the complexity of the case. Average time is 2 ½ hours.

When will I see the final results?
The nose can swell considerably after surgery. It takes approximately 1 month for 80% of the swelling to go down. It may take 6 months to 1 year for all the swelling to be gone and to see the final result.

Is the nose packed?
Dr Wigoda does not use packing but rather a splint inside and outside the nose.

How much bruising, swelling, and pain is there?
If the nasal bones are broken, there will be a fair amount of swelling and bruising around the nose and eyes. The bruising will take 1 to 2 weeks to disappear. The majority of the swelling will be gone in 1 month. There is some discomfort for the first 3 to 5 days that is alleviated with pain pills.

What are the different techniques used?
The technique is generally divided into a “closed” or an “open” technique. The closed technique was by far the more common way to do it up until the last few years, when the open technique has gained more popularity. In the closed technique, incisions are made inside the nose and the bone and cartilages are partially removed and/or reshaped. In the open technique, the same internal incisions are made but a small incision is also made on the skin of the bottom of the nose (columella). This allows the skin to be lifted off the nose and allows the surgeon to see the cartilage and bone much better. Many surgeons feel that they can be more precise doing the procedure this way. The incision on the columella heals very well and leaves a very small scar that is difficult to see. Dr Wigoda uses the open technique in the majority of cases.

Where are the incisions made?
They are made on the inside of the nostrils and, if using the open technique, on the columella (the skin separating the two nostrils).

Will my nose have to be broken?
In the majority of cases, patients have a wide nasal base. By fracturing the nasal bones, the width of the nose can be reduced. While the bones do not have to be broken, reducing the width of the nose will often make the nose more attractive.

How long is the incision? Will it be noticeable?
The incisions on the inside of the nose are not visible. The incision on the outside leaves a very fine scar that is difficult to see once it has healed. It measures only about 4 to 5 millimeters.

What are the potential risks with this type of surgery?
Risks include a worsened appearance, scar deformity, asymmetry, worsened breathing, hole (defect) in the septum, and prolonged bleeding. These are all relatively rare.

What type of anesthesia is used?
The surgery is usually done under general anesthesia

Will I have to change any bandages?
Dr Wigoda will remove the bandages after 7 days.

Will there be stitches that have to come out?
If the rhinoplasty is done with the open technique, the sutures come out at 7 days. Sutures placed in the inside of the nose are absorbable and will fall out after a few weeks.

When do I come back to see the surgeon?
You will see the Dr Wigoda after 7 days to remove the dressing, and then periodically to make sure you are progressing as you should.

How long do the results last?
The results essentially last a lifetime. As you age, however, the nose will change in shape to some degree.

After the stitches are out and I have totally recovered, do I ever need to come back?
Dr Wigoda will ideally want to see you after 6 months, 1 year, and 2 years to check your progress.

What happens before I have the surgery?
You will first have a consultation with Dr. Wigoda to discuss your particular case. Once you have decided to proceed with the surgery and have scheduled a date, you will return for a second visit at which time Dr. Wigoda will review the surgery with you, photos will be taken, consent forms will be signed, and further instructions and prescriptions will be provided. Full payment is made prior to surgery (or financing is arranged). You will have lab tests drawn and an electrocardiogram done by your primary care physician (or we will recommend where to do this) one to two weeks prior to the surgery. A medical clearance may be needed.

What happens on the day of surgery?
You will arrive at the office surgery center. You will not have eaten or drank anything since midnight the night before. You will be checked in and your vital signs will be taken. You will put on a gown. An intravenous line will be started. Dr Wigoda will mark your nose with a marker. You may be given a sedative in your I.V. to help you relax before you are taken back to the operating room.

What happens after surgery?
Bandages will be placed on your nose. You will recover for 1 to 2 hours in the recovery room. You will then be driven home by a friend or family member. Your activities will be limited for the first few days. It is advisable that you not drive for at least 3 to 5 days after surgery. You will be seen 7 days after surgery for removal of the splints and sutures. As the pain and swelling decreases you will be able to resume normal activities. Dr Wigoda will allow you to resume strenuous exercise after 4 to 6 weeks.

When can I resume sexual relations?
You may want to wait at least two weeks until you are well on your way toward healing. Early sexual activity may prolong your soreness and discomfort.

When will I see the final results?
It will take 3 to 4 weeks for most of the swelling to resolve and probably 6 to 12 months for all if it to resolve. After this you should have a reasonably good idea of what the final look will be.

What is different about the way Dr. Wigoda does the surgery?
Dr. Wigoda was fortunate to train with many pioneers of rhinoplasty procedures in Dallas. He has combined the best aspects of each technique to create his own rhinoplasty procedure. The technique he uses causes minimal pain and has natural results.

Please take a moment to contact Dr. Wigoda with any question you may have