”We have been talking a lot about rhinoplasty in the past few weeks and I wanted to sort of fill out our profile on Rhinoplasty in terms of recovery because a lot of people ask about it. I think this is a big area of concern, the three most common questions I get around Rhinoplasty are “How long does it take to heal? Does it hurt after Rhinoplasty? And, how reliable, or how sure are we that we can get the results that we show on our computer enhanced imaging?”

I show everybody before and after images by changing or modifying their picture on a computer before the surgery. The last one I’ll go on reverse order. I feel very confident I can get very close to the image that I show on the computer of course anyone can change anything on a computer and I could put your nose on your forehead but that’s not physically real or practically real and so I try to get very close to what I think is reasonable expectation. There are some patients that come in with expectations that we really can’t achieve and I’m very honest in telling them that we can’t achieve that based on their anatomy but as long as everybody’s got realistic expectations we can get very close to the images that I draw.

The next one is about pain and most people have very little pain, I prescribe pain medicine for everyone after Rhinoplasty but very rarely do people take any of the pain medicine. Usually Tylenol at the most is sufficient to take care of any discomfort. I think the big objection or issue people have is in the first day or two, the nose is quite stuffy with a very light nasal packing that we use, like a back of a band-aid, it’s called telfa, we don’t use yards of material anymore like the old days, but that packing in the nose makes it so you can’t breathe so you have to breathe through your mouth for a day, sometimes two. Otherwise, there’s a reasonably good comfort level with Rhinoplasty just like the other facial procedures that we do.

The last one which is probably the most important one, is are there things that you can do after Rhinoplasty in terms of predictability to enhance the outcome. One of the things that are really common is people come in with a really twisted or crooked nose and that is usually because of the nasal septum which is the partition between the two nostrils made of cartilage in the front and bone in the back and it’s the front cartilaginous portion that actually bent in many patients that cartilage has memory to it meaning if it comes in twisted or bend it will want to go back to being twisted or bend even after we straighten it and even after we use splints to keep it straight while its healing. So those things are factors, those physical forces of memory in the cartilage and the natural twisting forces that occur after rhinoplasty are things that we have to deal with.

There are things that I do surgically that can obviate the twisting factors or forces that are in there including things like scoring or over lay grasp with very thin segments of bone that keep the nose splinted for the long term using the nasal splints which you really don’t feel inside the nose but keep it very straight while its healing are important. Also, while its often dismissed as being irrelevant, I do think that massaging the nose especially if we see some of that memory and a twist occurring in the first year after surgery can have a very large impact on straightening the nose.

Now there haven’t been a lot of controlled studies with this, this is anecdotal, but this is what I’ve seen in many patients over 25 years of doing this, that is, if we do counterforce massaging gently a couple of time a day for about 5 minutes, we can dramatically impact some of that cartilaginous memory that wants to pull in its original twisted shape or form.

In many revision rhinoplasties, I’ll find the reason for the twist and that’s something I can totally correct but if you’re born with a twisted cartilaginous component to the nose, one that makes the nose bend right or left, the steps that I take in surgery relax some of those memory forces and then there are steps we do after surgery including some gentle massage and that usually involves gentle grasping the tip of the nose and going in the opposite direction of the twist with a gentle motion that overtime will help to relax the twisting forces.

So we addressed some of the main questions and one of them again is, what can I do after rhinoplasty to make sure my results are the best they can be? There’s really a list of them but one of them include gentle massage and twisting of the twisted nose if there is some force of twisting keeping it from being perfectly straight.

Again this is all set in the context of reasonable expectations for outcome, if we take a severely twisted nose, the chance of it being a 100% straight is probably not real high, not that we don’t shoot for that goal, but I think we have to have reasonable expectations about it, and there are things that the patient can do to improve those chances.

If you have any other questions or you have any specific questions about yourself, or your nose, or if you have had a rhinoplasty and you’re unhappy with it, please don’t hesitate to write me at DrMaas.com, you can send photos or videos of your nose and I’m happy to answer your questions and even do a video tele-consultation with you and go over those images on the computer with you.

As always it’s my pleasure, this is Corey S. Maas MDTM on Looking Your Best.”

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