so you've decided you want a rhinoplasty what's your next step in this video I'm going to dive into the homework you need to do in choosing a rhinoplasty surgeon take you through the consultation process and tell you how to get ready for your big day I'm Dr Andre panosian board certified plastic surgeon and this is inside plastic surgery [Music] before we get started make sure you hit that subscribe button so you don't miss out on all original content that will educate you on all aspects of plastic surgery I've designed this channel as an important resource for anyone looking to educate themselves on all topics make sure you're always well informed in the previous video we talked about what a rhinoplasty or a nose job is what are the different types and what are the different techniques involved to give you an idea of how this signature plastic surgery procedure is done I will leave the link to this video in the description below before we launch into the nitty-gritty I want to stress that as commonplaces rhinoplasty may seem on the internet on TV or even on social media it's important to understand that this is one of the most difficult procedures in plastic surgery where surgeon experience is more important than almost any other variable I've said before that the nose is a central feature of your face it gives you character it affects your self-esteem and is crucial for proper breathing it's easy to think that if the surgeon advertises him or yourself as a plastic surgeon then they're somehow able to deliver a beautiful rhinoplastic result and you get to see so many of them on social media and from searching online where it seems that there are only great results out there when it comes to this procedure but I hope to dissuade you from that Myth today so what is it that makes rhinoplasty so difficult when you consider that the nose is front and center on your face there's going to be very little room for error the nose is composed of a delicate balance of soft cartilage muscle bone mucus lining and skin all of these tissues have to be taken into account when doing a proper rhinoplasty and to know where the limits are for any given patient let's talk about overall nasal Aesthetics when someone has a big nose what does that really mean when you break it down does it mean that the tip sticks out far from the face does it mean that there's a large hump on top is the tip really wide does it mean big nostrils does it mean a hanging tip well all of these features can also be present in a relatively small nose so let's ask the question again what does it mean to have a big nose to answer this question it's important to understand that we are really interpreting crudely what our eyes see but if you drill into the details further you will see that a nose will look the way it does because of favorable or unfavorable proportions and of course symmetry does the top or dorsum of the nose match the projection of the tip is the tip itself too wide for the base of the nose is the very top of the nose between the eyes called the radex very very deep in relationship to the tip projection is the dorsum too wide in comparison to the base of the nose the analysis can go on and on the reason we break it down this way in terms of proportions is because this concept plays a key role in getting an outstanding result in rhinoplasty if we focus on how the tip looks in isolation or how big a hump is the results can look disproportionate and odd there are also certain features we like to see in a pleasing nasal appearance things like elegant dorsal nasal lines beautiful Contours and shadows along the lateral walls of the nose An Elegant or well rotated tip are all what makes the nose truly look beautiful what this all translates to is that if someone thinks their nose sticks out too far for example they may not understand that this is more related to the shape and orientation of the tip cartilage structures combined with possibly a large dorsal hump it has less to do with the physical distance of the tip from the face similarly if someone thinks their nose is skinny but they have a large dorsal hump they need to understand that simply removing the dorsal hump will make the dorsum look wider without some other Maneuvers I hope these examples illustrate how complex the relationships are between the various structures of the nose of course we can't ignore the presence of breathing problems a very important part of the preoperative examination involves looking inside the no is there a deviated septum or a thickened turbinate that results in some limitation of air flow does because the mid portion of the nose collapse when breathing heavily all of these issues need to be documented before surgery and the plan will have to include correcting these abnormalities simultaneously now you're ready to find yourself a rhinoplasty surgeon what do you look for nowadays it's easy to get caught up in how famous a plastic surgeon is on Instagram Tik Tok or if they played one on TV as much as social media and the internet have empowered potential patients to get more information on different procedures and plastic surgeons it's still kind of the Wild West there are no regulations on marketing or claims that are being made by anyone online photos can be altered surgical experience is often exaggerated and influencers are frequently paid to produce followers and likes it has truly become a case of buyer beware and unfortunately many people have suffered the consequences so no matter how famous someone is on Tik Tok or how many followers and likes they get make sure you do the following number one make sure sure the surgeon is certified by the American Board of plastic surgery or that they are board certified by one of the recognized fields in the board of Medical Specialties this is the only recognized Medical Professional board why well the board certification process ensures that the person doing your surgery has passed a certain set of tests training programs credentialing and are in good standing in his or her field now being board-certified alone isn't going to be enough there are many board certified surgeons with questionable ethics and marketing tactics and without the proper experience you need number two do a quick search with the surgeon State Medical Board to see if there have been any disciplinary actions or violations to suggest that perhaps patient safety or negligence issues have come up searching the medical board will also reveal any medical malpractice judgments and arbitrations that the surgeon may have had against him or her number three visit your surgeon's website and social media accounts to view available before and after results make sure that their Vision along with what you had in mind for your own nose yes this is a real thing different plastic surgeons will have a different style to their rhinoplastic results some may favor a pinched look to the nose or one that is very lifted others may have very subtle results that may not be all that noticeable number four check out your surgeon's reviews online to see if there are any glaring shortcomings you may not have considered take these with a grain of salt though as some patients may use them to air Grievances and have them not be related any particular work that was done and on the flip side other reviews may be manipulated to show the plastic surgeon more favorably unfortunately this is our new reality number five see if someone you know has had a rhinoplasty done by the plastic surgeon you're considering to see what they have to say many patients these days will travel for the Cosmetic procedures so you may not have anyone locally in this regard but it can give you invaluable insight into issues such as confusing pre or post-operative instructions a feeling that you're just another customer or a sense of basic abandonment now all of these measures may not indicate that you have necessarily picked the right run of plasty surgeon it only ensures that you have screened potential surgeons on some basic level think of it as a standardized test or set of prerequisites now it's time to narrow it down and go for a consultation this can be done in person or virtually it's always best to get a consultation in person if you can but you can still get a decent exam virtually through an experienced surgeon the only thing that cannot be checked during a virtual consultation is what the nose looks like inside is there an obstruction or source of breathing difficulty or any anatomic variations luckily most of these issues are correctable at the time of surgery and can be predicted ahead of time by an experienced rhinoplastic surgeon and with a very good history when you consult your surgeon there are several things you're going to want to pay attention to number one professionalism this is one of those things that people sometimes think they understand or or don't like to talk about but I think is incredibly important to take note of sometimes this goes hand inhand with customer service is here or she well addressed is the office clean and organized is the staff welcoming are you made to wait long to see the surgeon is the surgeon punctual is the surgeon well spoken and well informed is there the appropriate privacy you need while waiting or when you're in the exam room all of these things do add up to give you the sense that the person who will do your surgery is serious and passionate about his or her profession and the job they're willing to do on your nose number two does your surgeon listen to your complaints about your nose or does he or she launch straight into what he's going to do medicine is a unique profession that involves relationship building the doctor patient relationship is one of the most sacred relationships among any human interaction although a caring Doctor Who listens is not always a prerequisite to getting a great result is definitely important in determining if he or she cares enough about doing a good job for you and to look out for your safety number three it's important to talk about what you can expect as a result rhinoplasty is a life changing procedure whether you think so or not it has the power to change your self identity either in a good way or bad it's important for the surgeon to explain what is possible based on the exam performed for example people with thick nasal skin may not get a perfectly refined Tip since thick skin limits how much detail can be revealed excessive reduction of nasal bones may lead to other deformities and difficulty breathing if you have your heart set on a particular style of nose it's important for the rhinoplasty surgeon to discuss whether this is achievable for you as well as why or why not setting expectations ahead of time is the number one reason why people are unhappy after rhinoplasty even with what others may think is a fantastic result number four rhinoplasty is surgery any surgery should be taken seriously since it comes with some risk does your surgeon review what those risks might be what is the contingency plan if something goes wrong different doctors may have different policies I'll tell you what I do in my practice every patient I operate on gets my personal cell phone number why because complications can happen rarely thankfully and questions may arise that can impact your results or overall health I think that being able to connect with your surgeon 24/7 is important for not only providing peace of mind but to head off any potential problems during the postoperative period I can tell you that the worst feeling for surgeon is to get a call from the emergency room regarding a complication that your patient has had after surgery I can tell you that in nearly 20 years of having this policy I've never had a complication developed from not being available to my patients number five what is your surgeon's revision policy in the world of plastic surgery when you're dealing with the human body and living tissues with differences in physiology genetics Anatomy there can be instances when the results don't turn out quite like what you or surgeon expected in this situation what are your options is it another procedure is it an injection are you going to be nickel and dimed are you going to need more follow-up visits how does your surgeon handle these situations I know that most respectable rhinoplasty surgeons will stand by their patients in good times and bad that means avoiding excessive costs and inconveniences whenever possible in the end no matter how much you take into account any or all of the factors mentioned so far you will have to ultimately trust the surge you select now I realize how difficult and unscientific that sounds but the field of medicine is all about trust trust for understanding your desires and wishes trust for your safety trust to handle anything that arises during your recovery trust that your surgeon has your back just like you are family rhinoplasty can take anywhere from 2 hours to 8 hours depending on the type of rhinoplasty being performed and the requirement for any non-customary Maneuvers such as Rip cartilage or ear cartilage grafting for example a typ iCal primary rhinoplasty takes about 2 to 3 hours while a complex CFT rhinoplasty that requires rip cartilage grafting will take up to 8 hours in some cases nothing in surgery is without risk in rhinoplasty risks include the typical bleeding infection or anesthesia complications that virtually any surgery big or small will have in addition when it comes to the nose there can be small differences in symmetry from one side to the next Contour irregularities during the healing process bad scarring which can be genetic in nature and rarely with new breathing difficulties thankfully the incidence of these complications is quite low with a well executed rhinoplasty usually you will get a call from the surgery center sometimes the night before to go over where you need to be and at what time in the morning they will also review any diet and activity restrictions at that time usually before any type of general anesthetic based surgery we ask that patients avoid eating or drinking drinking anything after midnight to ensure a safe anesthetic experience in addition patients are usually asked to avoid using any type of aspirin or nonsteroidal anti-inflammatory medications such as ibuprofen Motrin or Advil at least two weeks before and up to 2 weeks after surgery these medications are known to increase the risk of bleeding going along with this there are many herbal supplements that can also contribute to bleeding during surgery in general it's just safer to avoid using any herbal supplements at least 2 weeks before before and up to 2 weeks after surgery in order to avoid a potential problem that's pretty much it for the prep at one point rhinoplasty was associated with quite a bit of dressings specifically an external cast or splint would be combined with internal nasal packing which was often a source of anxiety for patients especially when it came to removing them thankfully this has changed nowadays it is rare to use any nasal packing and in my practice I have begun to phase out the need for an external nasal splint as well this definitely improves overall anxiety and stress as well as discomfort sometimes when the dressings are necessary they will be removed at the first postoperative visit one week after surgery no matter what surgery is being performed there will always be some restrictions on activities afterwards specifically for rhinoplasty most patients will need to avoid any strenuous physical activities heavy lifting contact sports or blowing the nose for a period of 6 weeks in addition eyeglasses or sunglasses are to be avoided for the same time period to avoid shifting any structures underneath patients are also asked to try and sleep on their backs as much as possible during this time this is to avoid any external compression on the nose recovery after rhinoplasty is relatively quick when it comes to light duty occupations such as those involving desk work work in front of a computer is allowed even on the first post-operative day some people like to return to work one week after surgery if there is an external splint or dressing in order to avoid attention if there is bruising that typically lasts 2 weeks and can be easily covered up with makeup swelling is a normal process of any surgery Peak swelling usually happens approximately 3 days after surgery and will disappear in a top- down manner starting with the top of the nose and progressing down to the tip the tip often retains swelling for up to 1 year after surgery and in some cases longer which is why it is important to be patient with the process in this age of immediate gratification this can be very difficult for some people but with patience to results will last a lifetime just another quick note on swelling sometimes it is easy to get caught up in instant reveals of rhinoplastic results either intraoperatively or at the onee post-operative followup at this point the nose has not had a chance to go through its process of swelling and healing I often caution my patients that if the nose looks too perfect after the initial dressings are removed then chances of it remaining so diminish with time I have performed a large number of revisions of patients who have had rhinoplasties by different surgeons over the years only to hear the complaint that the nose looked amazing in the beginning and later it just fell apart some patients even blame themselves for their bad long-term outcomes the reason for these poor long-term results is that the fundamentals of rhinoplasty may not have been followed well since the goal was to get the initial results looking great well that about wraps up the second part of what you need to know about getting a rhinoplasty join me in the next video when I will discuss what you can do after rhinoplasty to make sure you get an outstanding result and one you will love for the rest of your life if you're new to the channel come join us I would love to see you here hit the like button and subscribe to get the most complete and well organized experience in all things plastic surgery and if you need to come see me go to Dr panosian