Cosmetic Surgery

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Nose Reshaping

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Nasal Plastic Surgery

Probably the greatest impact on how a person looks is the size and shape of their nose. Some people are unhappy with the nose they were born with, others are disturbed by the way aging has changed their nose. Many people have suffered an injury to the nose that has not only distorted it, but may have caused difficulty breathing through it. Because the nose is the most defining characteristic of the face, it is a common target of cosmetic facial surgery. Whether it is removing a small hump, tightening up a broad tip, or drastically reducing a large nose, nasal plastic surgery, or “rhinoplasty” is designed to reshape the nose for a more pleasing and harmonious appearance on the face. Rhinoplasty, or a “nose job” is one of the most popular cosmetic facial surgeries.

David Hendrick, MD has been performing rhinoplasty and nose sculpting in Kansas for many years and has patients come from Kansas City, Wichita, Hutchinson and other communities around Kansas. Dr. Hendrick is a board certified plastic surgeon and a member of the American Board of Plastic Surgery. He is highly qualified to help you achieve your goals with procedures like rhinoplasty.

Rhinoplasty is widely considered to be the most difficult procedure in all of plastic surgery, for it is truly “surgery of millimeters”- very small changes can create dramatic differences in the nose, either for better or for worst. This is not surgery for beginners or the occasional nose surgeon. If you are planning to have plastic surgery on your nose, you want a specialist. Dr. Hendrick is such a specialist. Not only is Dr. Hendrick a board certified facial plastic surgeon, he is also a board certified ear, nose, and throat surgeon. Furthermore, Dr. Hendrick is “fellowship-trained” in plastic surgery of the nose, which is the highest level of surgical training this country has to offer. He trained in his fellowship under three internationally acclaimed nasal plastic surgeons - Dr. Eugene Tardy, Jr., Dr. Dean Toriumi, and Dr. Gary Burget. He has written and lectured on the subject of rhinoplasty and has an extensive background in cosmetic and reconstructive plastic surgery of the nose.

Although certain aesthetic “norms” for the nose have been described and well understood by many facial plastic surgeons, the most important feature of the nose is how well it harmonizes with the rest of the face. This is where the artistic sense of your surgeon comes into play. The ultimate goal of a rhinoplasty is to de-emphasize the unfavorable characteristics of your nose, create a more pleasing shape and size to your nose, and to draw attention away from your nose to your eyes, where people should be looking at you to begin with. All of the incisions for rhinoplasty are hidden inside the nose, or are carefully hidden beneath the nose so as to go unseen or noticed. Some rhinoplasties involve only soft tissue and cartilage work. Other rhinoplasties require cutting the bones of the nose. After a detailed consultation and exam, Dr. Hendrick can tell you which rhinoplasty technique will best achieve your goals.

FAQ

Are there any visible incisions?
No. All of the incisions are inside the nose. Occasionally a small incision is necessary on the skin between the nostrils (so-called “open” rhinoplasty), but this incision is out of sight and heals virtually invisibly. In cases where the nostril opening needs to be reduced, a small incision is sometimes hidden in the crease beneath the nostril. This is also well disguised and not noticed.

Do you have to “break” my nasal bones?
Rhinoplasty doesn’t always require that changes be made to your nasal bones. In cases where the nasal bones need to be realigned or narrowed, the bones are cut with fine surgical chisels applied from inside the nose. So “breaking” the bones is really not necessary.

Do I have to have packing inside my nose?
Although many surgeons believe in packing the nose for several days after rhinoplasty, Dr. Hendrick finds that this is rarely necessary. Instead, Dr. Hendrick usually places small sponges in the nose overnight and removes these the next day.

Will I have a cast on my nose?
After reshaping the nose, Dr. Hendrick will usually apply a lightweight aluminum “splint” to the outside of the nose for the first week. This stabilizes the nose and reminds the patient not to bump the nose while it starts healing.

Will there be swelling or bruising?
Depends. When only soft tissue work is done there may be no bruising and only mild swelling after surgery. When bone cuts are made the amount of bruising and swelling can be more noticeable. This swelling typically disappears within a week and bruising clears after one to two weeks.

Is there much pain?
Not typically. The first night most people feel a sense of “pressure” where the nose is. If bone cuts are made these areas can be tender to touch for several days, but don’t usually hurt at rest. Most patients only take pain medications for a few days and don’t believe that pain was a significant part of there recovery.

How soon will I be able to see my “final result”?
There will usually be some change that will be immediately apparent. However, many of the changes that your nose will take on require that the wound healing process run its course first. As well, even miniscule amounts of swelling in the tissues can distort and hide the eventual final result. The goal is a good long-term result, not something that looks great right off the OR table only to contract and look bad months later. You can expect most of your final result to be apparent at six months. However, after rhinoplasty your nose continues to change in small ways for several years.

Will insurance pay for my nasal surgery?
If your surgery is strictly cosmetic, no. If there is a well-documented functional problem, such as severe nasal obstruction or chronic sinus disease, insurance MAY pay for some portion of the procedure. There have been abuses of nasal surgery and insurance coverage by others in the past and most insurance plans are very vigilant about reviewing these cases. If we believe that insurance coverage is reasonable, we will submit your photos and history to your insurance for “pre-determination.” Ultimately you are responsible for any portions of the bill that insurance fails to pay for. Most nasal surgery is strictly cosmetic or involves only a modest amount of non-cosmetic work that insurance may or may not cover. You should be prepared to cover the entire expense as a “cosmetic” procedure.

I’m not sure what I want my nose to look like - can you do computer imaging to show me some possibilities?
At Heartland Cosmetic Surgery we do not do computer imaging. It would be wonderful if surgery were as easy as manipulating a drawing tablet on a computer. This is not the case. What can be drawn on a computer is not necessarily what can be accomplished surgically. Instead of computer imaging, we rely on a very detailed examination of our patients, precise pre-op photography, and an involved discussion with out patients about the goals of surgery. We provide realistic feedback about what is or is not accomplishable with the surgery. In this manner realistic expectations are most successfully met.

Post-op Instructions

Please read and become familiar with these instructions BEFORE and AFTER surgery. By following these instructions carefully, you will assist in obtaining the best possible result from your surgery. You should begin observing these instructions on the day of surgery.

1. Do not blow your nose for at least 2 weeks following surgery. Wipe or dab gently with Kleenex if necessary. You may also use saltwater spray (“Ocean Spray”) in your nose as frequently as you like to help dissolve thick, congested mucus. A gentle “sniffing back” toward your throat is permissible to help clear secretions.

2. Keep a dressing underneath your nose and change as necessary until drainage stops. Drainage will be a blood-tinged color and will last from 1 to 3 days after surgery. You may require frequent dressing changes the first 24 hours after surgery.

3. If nasal dressings are inside your nose after surgery (nasal “packs”), these are to simply minimize bleeding immediately after surgery. I will remove these in the office the morning after surgery. Since your nose will be obstructed, your first night of sleep after surgery may be fitful. Sleeping with your head propped up on pillows will help you to breathe better through your mouth for this first night.

4. If plastic splints are inside your nose to help keep your septum straight, these will tend to increase your mucus production and congestion. This is normal. I will remove these splints in the office after about a week. Use of saltwater spray will minimize your congestion. These splints are not uncomfortable and cannot be seen by outside observers while they are in place.

5. If a cast is on the outside of your nose to help hold the external parts of your nose in place, this will need to be kept DRY and IN PLACE for A WEEK. Showering, facial cleansing and hair washing must be done very carefully to keep the cast dry and in place. Avoid pullover shirts and sweaters. The cast primarily serves as a reminder to you not to bump or disturb your nose in any way as it begins to heal. If the cast should loosen and begin to fall off, please gently tape it back over your nose. I will remove the cast in the office after a week.

6. Sutures used inside your nose are all dissolvable and will disappear over a few weeks’ time. If your type of surgery requires any sutures on the outside of your nose, the sutures are usually nonabsorbable and will be removed in the office after 5 or 6 days. These outside sutures are finer than a human hair and break easily, so be very ginger with these areas.

7. If your type of surgery does require the use of external sutures, please apply antibiotic ointment (any type) to the suture line 2 to 3 times a day to prevent crusting and to minimize scar formation. If any crusts do form, do not remove them! Picking crusts will increase scar formation.

8. You will be provided prescriptions for pain control and antibiotics. Take these as directed. Pain after nasal surgery is modest, easily controlled with pain medications and for most patients lasts only a few days after surgery. Antibiotics are strictly precautionary. If you experience nausea or any other side effects from your medications, call my office for a prescription change.

9. Avoid extreme physical exertion (including most athletic activities and intercourse) during the critical phases of healing. Depending on the amount of surgery, this period will range from 2 to 6 weeks. If any bony cuts or rearrangements were performed as part of your surgery, this healing will require a full 6 weeks. Activities that are notorious for accidentally dislocating the newly aligned bones include swimming, skiing, sex and playing with children and grandchildren.

10. Avoid manipulation of your upper lip to keep your nose at rest for 10 to 14 days. Therefore, avoid chewy foods, brush your teeth gently with a soft toothbrush, minimize smiling, grinning and excessive facial movements and limit telephone conversations and social activities during this period.

11. Absolutely avoid sun exposure or sun lamps for 6 weeks after surgery. Beyond 6 weeks the nasal skin (including any incision lines) should be protected from the sun and UV radiation using a good sunscreen (or makeup with sunscreen) for a year. Failure to observe these precautions can turn the skin (and any external incision lines) unnaturally pink or red.

12. If any structural work was required of your upper nasal bones or cartilage, do not wear eyeglasses, sunglasses or goggles on the bridge of your nose for at least 4 weeks. If eyeglasses must be worn, support them from your forehead with a strip of adhesive tape.

13. Occasionally, surgery on the front part of the nose or septum will result in numbness or tingling to the upper lip or teeth. This is temporary and usually resolves completely in a few weeks.

14. Don’t be concerned if the nose, eyes or upper lip show some swelling or discoloration. This varies from patient to patient and usually clears in 2 to 3 weeks. To cover discoloration, you may use a cover-up makeup such as “ERASE” by Max Factor, “COVER AWAY” by Adrien Arpel or “ON YOUR MARK” by Kenneth.

15. Depending on the amount of surgery your nose required, the nose may be a little “puffy” for a time following surgery. This will resolve with time. In fact, it takes at least a year for all swelling to subside. “Healing” of your nose continues in small, subtle ways for the rest of your life. Observing a low-salt diet and limiting strenuous activities will help minimize this puffiness should it occur.

16. Follow-up appointments are scheduled depending on the type and amount of surgery performed on your nose. I typically see patients the first day after surgery if nasal packing must be removed, 5 to 6 days after surgery if sutures must be removed and 7 to 10 days after surgery if nasal splints or a cast must be removed. Thereafter, I will see you as frequently as necessary to ensure good healing and an optimal surgical result.

17. If the use of ear cartilage was required for your surgery, you will have a dressing sutured to your ear and a suture line just inside the bowl of your ear. Avoid sleeping on the affected ear, keep the suture line covered in antibiotic ointment and keep the ear and its dressing DRY. I will remove the dressing and sutures 5 to 6 days after surgery.

If you should have any questions or concerns during your recovery, do not hesitate to call my office at 785-309-0900 or 1-866-760-0900.

“ Throughout the operation and numerous follow-ups Dr. Hendrick was thorough, professional, and communicated very well. Additionally, my best regards to the entire OR and nursing staff. I was taken very good care of. Thank you.”

--T.L., Rhinoplasty

Post Op Instructions

Gallery Before and Afters