Welcome to Plastic Surgery Talk with Dr. Stephen Mulholland brought to you by SpaMedica. Hello and welcome. Dr Stephen Mulholland here in Toronto, Canada. Welcome to Plastic Surgery Talk and our latest podcast. Today’s podcast is on rhinoplasty. One of the most common procedures, always in the top three, rhinoplasty, that we do in plastic surgery for decades. The question is, what is the best time to do a nose job? So if you’re considering a nose job, what’s the best age? Well, I did training in both ENT and plastic surgery, so I do a lot of noses in my practice, both for function, like breathing and sinus issues, but mainly breathing and then appearance, the cosmetic aspect of a nose job.
So if its function that you’re looking to improve, you’re looking to improve your airway, you may in fact be doing nose surgery a little younger, perhaps in your mid teens, if you got a persistent deviation of your septum. A septoplasty might be needed so that you can breathe properly. Let’s say it’s a cosmetic rhinoplasty, the appearance of the nose, not the function, what is the best time? There’s really two large bulges in demographics when patients present to me for a nose job. The first is the younger patient. The younger patient has always had a nose that doesn’t fit their face. Their perception is that there’s a nasal facial imbalance, the nose is far too big for the craniofacial anatomy, the skeletal anatomy, and that’s the most common, the large knows that you want to make smaller, a bridge bump, a bulbous tip.
Occasionally and rarely, the nose can be too small for the craniofacial skeleton and nasal appearance and that’s more common in ethnicities like the Far East Asian noses where there is an insufficient dorsum or bridge or as a result of hereditary conditions and autoimmune diseases. So let’s say it’s a typical reduction rhinoplasty. The common youth bulge will be somewhere between 17 and 18 and early 20s. Why do we wait generally till 16 or 17 years old? Because the nose is still forming, is still growing, the cartilages and the bones and you don’t want to do a nose job only to have the bones grow after the nose job and you have some overgrowth or compromise of an otherwise good result.
When you’re young, you don’t always have access to the same kind of of capital, of money that you might have and after tax dollars when you’re older. So often the younger patient is going to finance a nose job through finance entities like IFinance Canada or Medicard. Then there’s the older group. The older group of reduction rhinoplasty typically happens between say 50 and 65 and why is there that second bulge of presentation? In general, because as faces age, they undergo a deflation like air out of the balloon, the cheeks shrink and as the face is shrinking, the nose which is static, which may have been marginally balanced in your middle years, starts to look like it’s growing, the nose looks like it’s growing, is getting larger. When in reality most of it is because your face is shrinking.
There are some ongoing thickening of the nasal tip and of sebaceous tissue, but generally the second wave of rhinoplasties between let’s say, late 40s and 65 is because the nose looks disproportionately large to a face that has shrunken from age and so two groups that present for rhinoplasty for two different reasons, but the same goal, a beautiful nasal facial balance and proportion.
So when undergoing a rhinoplasty, it’s always a combination of realistic expectations on the part of the patient, an understanding of what their nose face balances like now and through the use of computer imaging and high tech 3D software, I can often show, and a good well trained surgeon can show, pretty much the range of improvements that a patient can expect in the outcomes. So expectation management is easy to deal with. I walk patients through computer imaging to show what kind of nose you likely will have based upon the description on what you want after our discussion. So it’s kind of a try before you buy. It doesn’t mean it’s the best time to do a nose job.
Yes, expectations of outcome is important, but you need to be in a good psychological perspective and frame of mind. If you had a recent life upheaval such as a relationship breakup, a bereavement or a loss of a loved one, a sudden change in life, living conditions or job, there’s often a lot of stressors in your life that means you should probably put off your elective cosmetic surgery until those stressors are removed in your life. You can’t be depressed. You need to have the optimal state of mind, so untreated depression, recent loss of a loved one and bereavement, recent change in a serious relational situation, having a nose job is not going to find you a significant other or get back a significant.
So in summary, what’s the best time? It’s really when you have the emotional stability up a good point in your life, when you are psychologically prepared for the stress of recovery and when you’ve had a consultation where you’ve been able to visualize through computer imaging the kind of outcomes you can expect, your expectations have been managed. A nose job cannot save a marriage. A nose job cannot get you off antidepressants. A nose job cannot change your life. A great rhinoplasty can beautify the nasofacial balance, and then you and a healthy mental perspective can change your life.
Is there a best time of the year, a season in particular in which a nose job or rhinoplasty she’d be performed? It really comes down to patient’s ability to plan for recovery. So if you’re a teacher or a professor or a student, you really only have some options like school breaks. That means summertimes, Christmas breaks or spring breaks. If you are a professional or a stay at home mom or parent, you have a little more flexibility and then you’re going to try and manage it around what’s comfortable. Generally, the winter and fall months are a little more comfortable because it’s not so hot and sweaty when you’re in your nasal cast in that first week. But you’re going to adjust the best time in your life and your job around the recovery requirements, which at least a week of recovery following a nose job and then you fit that envelope into your busy life.
What should a rhinoplasty patient expect in terms of recovery? Well, in general, it’s a reduction rhinoplasty with some breathing work called the septoplasty or the removal of turbinates, you’re going to have your nose packed. You’re going to have packing in your nose when you wake up from your surgery. You’re going to have a cast on externally. You’re going to have swelling. You’re going to have probably a raccoon eyes. You’re going to look puffy. You’re going to look like you’ve been assaulted. You had been, in essence, you’ve had your nose broken, and so you need to plan for this. Generally, you’re going to come back, depending on your surgeon on the third day or the fourth day to get the packing out or whatever air splint has been used following your septal breathing work.
Then you’re going to come back on day six or seven, and any little sutures on the inside or outside that are removable are going to be removed and the cast will be taken off. At that time, you’re likely be shown some incisional care instructions and how to massage perhaps or mobilize some of the swelling off your nose. Some surgeons have you don’t touch your nose at all. You’re going to be given instructions. No sleeping on your nose for six weeks, so a lot of back sleeping and side sleeping, but no front sleeping. Be Very cautious blowing your nose heavily because you can start some bleeding from the nose or even dislodge the bones and be very cautious in areas where there’s high contact like a supermarket or a crowded job or an elevator or sporting events where you might get elbowed and caused some nose displacement.
So generally you need about one week off. If you can afford two weeks off from your work, even better. When you go back to work, you’ll be able to tell your coworkers or people you don’t want to know that you had hit your nose on a door. You slipped and hit your nose on an Uber car door. You got a softball in the nose during a sporting event or you had a door open on your nose, make up an excuse to account for the swelling. By the time you go back after a week, the raccoon eyes, the discoloration will largely be disappeared or it’ll be turning yellow or light greenish. You can camouflage it with some camouflage makeup or some tinted toner or bronzer. So usually one week, preferably two back in the workforce. The result of your nose starts to show on the bridge by three to six weeks, on the tip by 12 to 24 weeks, but the final result for rhinoplasty is never really apparent for about one year.
What’s the difference between a injectable nose job or five-minute nose job and a surgical rhinoplasty? In the surgical rhinoplasty, surgery is used to manipulate change in size or contour, the cartilages on the tip of the nose and/or the bones of the bridge of the nose and actually change their shape, size or proportion relative to the facial skeleton. With a five minute nose job or injection, the cartilages and the bones of the nose or not really altered. We lay down and inject soft tissue filler is usually the hyaluronic acid sugar gels like Juvederm and Restylane, on top of the nose to hide bumps, indentations, concavities, crookedness or irregularity. So it’s an overlay injection technique were no surgical manipulation is performed.
Advantages of the injection nose job, takes five minutes, essentially no recovery. Advantage of the surgical nose job, directly adjust the cartilaginous and bony abnormalities or irregularities that have created the imbalance between your nose and your face. It’s a permanent solution for a longterm integration of nose and face. Like all plastic surgery and facial plastic procedures, a rhinoplasty can be a tricky operation. In fact, a rhinoplasty, much like a facelift is known to be one of the trickier procedures, so therefore pick the best nose surgeon for you. How do you know you got the best nose plastic surgeon?
Well, one with experience. One that has training, the training could be in basic plastic surgery or basic ENT, both with a facial focus. In my case, I did both plastic surgery and head neck, oncology, ENT, facial cosmetic training and oncologic work, and so I had a double training that’s allowed me to really focus on things like face lifts and nose jobs with the anatomy and the skills and the training over the last 25 years to really bring that to something complex like the nose. So you want experience, you want training and basically someone with a great reputation. A guy who does good noses is going to have lots of patients talking about those good noses who are going to tell friends, who are going to go on social channels, share those experiences.
You’re going to get to know in any big city who the good nasal surgeons are, and generally in a big city of two, three, four million people, you’re going to have five to 10 good nose surgeons that may have ENT or plastic surgery background training or double boarded, double trained physicians. So you’re going to seek out a doctor with a good reputation, with a lot of experience, with the ability to meet with you and give you a consultation using computer imaging to give you a sense of what your nose is going to be before you even have the surgery done. These are some of the factors that are going to go into deciding the right surgeon. You’re going to go online and look at social media. You’re going to look at rating review sites. You might check out with the local medical board or college about their status, make sure they’re certified, make sure that there’s been no lawsuits. Basically do a lot of due diligence so that you find the best nasal surgeon for your complex and important integration of nose, face and shape.
So thank you again for joining me. Dr Stephen Mulholland here at Plastic Surgery Talk. Our podcast today was a new twist on rhinoplasty. When is the best time to do a rhinoplasty and what other factors you need to consider in that complex decision? If you found this to be informative and interesting and entertaining, please share it with everyone on your social media channels and join us again for our next podcast here at Plastic Surgery Talk.