Rhinoplasty Q & A with Dr. Hartman Fine Arts Skin & Laser Aesthetic Plastic Surgery

Elena: Good morning, Dr. Hartman.

Dr. Hartman: Hey. Hi, Elena.

Elena: Hey. Today, I just want to talk about a little bit about rhinoplasty, the process, and expectations for that.

Dr. Hartman: Great. Great topic. Okay. Perfect.

Elena: Our first question is what is a rhinoplasty?

Dr. Hartman: It's very important to know what a rhinoplasty is capable of and what it's not expected to do. Rhinoplasty is a surgical procedure. It's a nose job, as other people call it. Most of the rhinoplasties that we do are called open. We make a little incision and lift the envelope of the nose, and then do work. It's designed to address specific problems. There may be a bump on the nose. It could be some problem with the tip here. What it's not designed to do is make a "perfect nose". Generally, if you look at the spectrum of problems that a nose might have, it's going to address several of those problems; one, two, three of those problems. It doesn't, in any way, by any rhinoplasty surgeon, guarantee that you're going to have a "perfect nose".

Even though we have this term plastic surgeon, plastic is actually a Greek term meaning to change. It's not like it's the nose is a lump of clay that we can perfectly sculpt a nose. It doesn't work that way because it's a living part of a body that has to go through its own healing. It has its limitations about what's already there. We can, very successfully, address specific problems and make improvements on those specific problems.

That's what rhinoplasty is. It's a great procedure as long as you're very clear that it does specific improvement, but it's not designed to make a perfect nose.

Elena: Right. What is achievable then during a rhinoplasty and after?

Dr. Hartman: Yeah. Typical things that people talk about or want to improve is they have a hump on their nose. They want to have that reduced. That's a fairly straightforward process. Now there could be limitations on how much you can do with that in a single procedure. Many times, people have sort of a boxy or bulbous nose that they want some improvement in the cartilages of the nose. That's very achievable. You can have what's called a hanging columella, where this part hangs too low. Again, it's a specific issue that can be addressed.

To think that you're going to take my nose, for instance, and make the perfect movie star nose out of it. That's probably not achievable. Again, like Michael Jackson, you want to know that you don't try to push it too far. There are limitations of what can be achievable.

Elena: Okay. Great, so you said what is not achievable also.

Dr. Hartman: Yeah, so the nose has, it's there for function. It's there to help us breathe, and so there are support structures in the nose that you have to continue to respect. We can't, sometimes, take things farther than the anatomical structural limitations of the nose allows us to do.

Elena: Okay. Great. What is the process of healing after your rhinoplasty?

Dr. Hartman: Like anything, any type of surgery a person's going to have, there is a period of inflammation. The acute, the immediate phase of inflammation, peaks at around day three or four. There could be swelling of the nose, certainly. There can even be swelling under the eyes — one or both of the eyes. You can have swelling of the upper lip. You can have swelling up in the forehead. That period peaks at around the third day and then gradually improves throughout the first, second, and third week. That's going to be about 70% to 90% of the inflammation that occurs after rhinoplasty. There's always going to be some inflammation after rhinoplasty. Inflammation is part of the healing process when our body recruits the appropriate cells and biomessengers to cause new blood supply to come in and the cells necessary to clean up debris from the surgery and to begin to weave in new, elegant sheets of support and fascia tissue in the nose. That's a very important part of any kind of surgery is the healing process, the inflammation process. That inflammation is, generally, 70 to mostly 90% gone after about three weeks. By that time, the nose is very much looking like what it's going to. That last 10% takes up to a year to resolve. There will be some thicker parts of the nose that take up to about a year to improve.

There's usually some tiny, little stitches somewhere if it's an open rhinoplasty. Those come out in about a week. They're very, very small. Sometimes, we can laser [inaudible]. That's very discreet placement of those incisions, and they're almost never noticeable. About 2% of the time are they noticeable, and only about 1% of the time after rhinoplasty is it significant enough that it bothers the patient. That's a possibility, too, that there be a scar usually right in there and there, the heart of the columella. It's also sort of an irregular scar. I like to call it gull-wing incisions sometimes, or a step-off incision, so that it very much doesn't catch notice.

Elena: Okay. Great. What should we expect after having a rhinoplasty then?

Dr. Hartman: The initial issue of discomfort generally mostly resolves after about two days, a day or two. There is some pain if you will, or discomfort that is going to be there for the first day or so. Now, we don't do narcotics in any of our practice anymore. It's become a scourge in the American culture is narcotics. Studies actually show that if a person has surgery, their pain course after the surgery is worsened by using narcotics. You can do much better by just doing nothing, maybe a cold bag of peas on there or some Tylenol or Motrin, but it's better not to use narcotics. We don't in our practice. Generally, the worst of the discomfort is there for the first day or so. Then there could be some other discomfort that's sort of mild and very manageable, not really noticeable except if you sort of push on it. It could be there for days to weeks to maybe even a month or so.

The other thing that's kind of noticeable in rhinoplasty, especially open rhinoplasty, where it's lifted up and worked on that way, you can also do work from inside the nose in some cases. That's called a closed rhinoplasty, but is that the tip of the nose often will be somewhat numb for weeks to months afterward. Those sensory nerves have to reintegrate, and so that's very common. Elena: Okay. Great. Thank you so much, Dr. Hartman, for all that information.

Dr. Hartman: You bet. In our practice, we're always here before, during, and after any kind of procedure. We're available for texting conversations. We want to keep you in the loop. That's always part of it anyway, even though we're trying to address common things right now is that we're here for you afterward to make sure that your course after rhinoplasty is as smooth as it could possibly be.

Elena: Okay. Great.

Dr. Hartman: Yeah. Great.

Elena: Thank you so much.

Dr. Hartman: Thanks, Elena.

Elena: Bye.

Dr. Hartman: Bye.