FREQUENTLY ASKED QUESTIONS – Rhinoplasty

What is Rhinoplasty?

Rhinoplasty is a surgical procedure that reshapes and alters the nose by reducing or increasing size, changing shape of tip or bridge, narrowing span of nostrils, or changing angle between nose and upper lip. 

What is “reconstructive” rhinoplasty?

“Reconstructive Rhinoplasty” is a more accurate rhinoplasty which usually employs the open technique to allow excellent exposure of the nasal anatomy.  This approach requires the skill of a skilled and experienced plastic surgeon, and is very ideal when there is a significant amount of work to be done on the nasal tip which is specially true among Asians. Once the implant has been carefully placed on the bridge and/or tip, the nasal anatomy are put back one be one like a puzzle to ensure that the implant blends well to the contour of the nose.  More often than not, this kind of rhinoplasty uses cartilage and/or gore-tex implants.  

What is an open technique? 

The open technique requires a very small incision along the thinnest part of the skin (columella) between the nostrils. The incision which is only 3-4mm long normally heals without any visible scar.  

What is “classical” rhinoplasty?

“Classical rhinoplasty” employs the closed technique if only small modifications are being made to the nasal tip. This approach usually uses a silicone implant.  

What is a Closed technique?

The Closed technique is performed through incisions inside the nose which advantage is the invisible scar from the outside.  However the downside of this technique is the lack of exposure of nasal tip.  

Which is better between classical and Reconstructive Rhinoplasty?

Since Reconstructive Rhinoplasty is a more accurate rhinoplasty using an open technique that provides an excellent exposure of the nasal tip, Dr. Lansangan prefers this kind of approach.  

What nasal implants does Dr. Lansangan usually use?

Due to safety considerations which provide a natural look and permanent results, Dr. Lansangan favors the use of gore-tex and cartilage implants.  

What are the advantages of GORE-TEX implant?

GORE-TEX implant is a subcutaneous augmentation material (SAM which has the following advantages:
·                     safe, worry-free and rejection-free
·                     provides a natural look as its soft consistency allow it to blend well with the natural contours of the nose
·                     soft consistency likewise prevent implant rejection
·                     absence of eventual nasal contraction since it allows rapid and natural tissue ingrowth
·                     durable, biocompatible and biologically inert
·                     more economical and less invasive than rib cartilage implant (either autologous harvest or irradiated donor cartilage)  
For more details about it, please go to our dedicated section about GORE-TEX Implant. 

What are the advantages of CARTILAGE implant?

The most apparent advantage of cartilage implant is that it came from humans, which can either be from our very own cartilage or from a donor.  Like gore-tex, the use of cartilage implants results to a safe, natural-look, rejection-free and contraction-free rhinoplasty.  Cartilage implants can be harvested from our nose (septal), ears or ribs. Another option is the use of irradiated donor cartilage.  

Can an ear or nasal cartilage be used to augment a flat nasal bridge?

NO. Cartilage harvested from nose and ears can only be used to augment the nasal tip since they are not long and big enough to accommodate the bridge (dorsum).  Cartilage used for the augmentation of nasal dorsum is the one harvested from our rib which is otherwise called as “autologous rib cartilage harvest”. This is the gold standard in surgical rhinoplasty. However, aside from being very expensive, some patients do not want to have another cut on their ribs, much more undergo a simultaneous surgery on that area. 

What is “Material Rejection”? Why does it happen in some cases of nasal augmentation?

“Material rejection” is a the undesired expulsion of the implant  from the operated nose which happens due to infection,__________ and daily trauma due to friction created by a hard implant like silicone. The nose with articulations in the lower and upper lateral cartilages is a dynamic structure which conforms to the force exerted by an external pressure up to certain point. With this nature, inserting a hard implant on the nose is like “placing a nail” on it which may eventually lead to material rejection.  For more details, please visit our section about side effects of silicone implant 

What is “Nasal Contraction” and why does it happen after a couple of years since the time of operation?

“Nasal contraction” is the overtime encapsulation of the tissues around the hard implant (i.e. silicone) which results to the tightening of the nasal area. If remained uncorrected, this will lead to deformation of nasal appearance and further complications.  For more details, please visit our section about side effects of silicone implant 

Do “Material Rejection” and “Nasal Contraction” happen with gore-tex and/or cartilage implants?

NO. Gore-tex and cartilage implants ensure safe, rejection-free, contraction-free rhinoplasty. Nil case of rejection with gore-tex implant only happen to immuno-compromised patients (diabetics, HIV infected, etc.) 

Is Reconstructive Rhinoplasty an out-patient procedure?

Yes, it is an out-patient procedure. 

How long does the procedure take?

The procedure takes about 2-3 hours depending on the extent of nasal correction the patient wishes to have. 

How does it feel like undergoing the procedure? Is there pain?                                               

Typically, general anesthesia is used for Reconstructive Rhinoplasty. With this, the patient will experience NO pain while the procedure is being done. The Anesthesiologist will discuss this prior to the procedure, and will take into consideration the patient’s medical history, the procedure, and other relevant wishes.     

What is recovery like?

Dr. Lansangan suggests to take a week off from work.  Generally there is little pain and mild discomfort due to stuffy nose. A minimal bleeding from the incision site is common which often resolves in 3 days. The patient will have some swelling and bruising around the eyes that usually begins to disappear within few days. By the time the sutures and nasal splint are removed on the 6th day, much of the bruising has gone, and should completely subside in 2 weeks. The patient will be prescribed with pain relievers, antihistamines and antibiotics which he has to strictly follow to avoid complications.  For a more details, please click to instructions before and after surgery: rhinoplasty.  

How soon can patient go back to work?

Some people with deskbound jobs go back to work after 3-5 days.  On the 6th day, upon removal of the nasal splint and the sutures, some begin to work as usual. However, for some whose jobs require demanding activity (i.e. athletes, field engineers, etc.), it may take about 2-3 weeks to return to work.  

When can significant improvement be seen?

You will notice a significant improvement immediately. In fact, result can already be visualized even when the splint is still on. You will certainly appreciate the result better a week after the splint is removed. However, the final result will be evident on the 6th month when all the swelling has resolved and skin contraction is complete.  

Can I have other aesthetic surgery simultaneous with rhinoplasty?

Yes. The most common surgical procedures that are done in conjunction with rhinoplasty are chin augmentation, fat transfer (cheek augmentation), eyebag removal and eyelid creation. Below is a photo of a patient who underwent rhinoplasty simultaneous with eye-widening and eyelid creation.  

Who are the candidates for this procedure?

Individuals who are self-conscious and bothered about the look of their nose and wish to either correct or dramatically improve it can undergo the procedure provided they have realistic expectations, are generally healthy and not immuno-compromised (diabetics, HIV infected, and the likes). Patients are advised to disclose to the surgeon his general health, any kind of chronic illness and medications. Of particular concerns are: diabetes, hypertension, heart disease, liver and kidney disease, bleeding and wound healing problems, and cancer.  

What if the patient has a health problem? Can he not undergo the cosmetic procedure?

In case of a health problem and the patient is over 50 years old, Dr. Lansangan will refer the patient to a private physician. A clearance from the private physician indicating the health problem, the treatment details and the health ability of the patient to tolerate the general anesthesia and the procedure safely will determine if he can undergo the cosmetic operation.  

In some cases of general anesthesia intolerance due to health concerns, the procedure is done under local anesthesia, with or without sedation, depending on the recommendation and clearance issued by the patient’s private physician.

How do I choose a Rhinoplasty Surgeon?

There are many good rhinoplasty surgeons available, so choosing the best one for you is a challenge. Your surgeon should listen well to your requests and not tell you what you need. He or she should educate you enough to help you understand what you are going through, but not overload you with information. He or she should only promise realistic results. He or she should work toward creating a natural and improved look for your nose, and not necessarily a “PERFECT” nose as suggested by magazine advertisements or celebrities.