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DONALD J. CAPUANO, M.D.
Plastic Surgeon

You are interested in information about the surgical procedure for treatment of a nasal problem. This problem may involve breathing (internal) problems, reconstructive or cosmetic (external) problems, or a combination of internal and external complaints. The procedures are generally called septalplasty (the internal portion) and nasalplasty or rhinoplasty (external surgery).

Some surgeons refer to external nasal surgery as rhinoplasty. The meaning is the same. The derivation of the words differ. Rhino takes its origin from Greek and nasal from the Latin language.

Nasal surgery is highly individualized surgery. It is complex in that what someone desires may not be able to be accomplished. This may be because the risks of attempting to correct a problem may be too great, the anatomy of the nasal structures prevents full or adequate correction to the individual's satisfaction. For example, the skin of the nose may be too thick; the bones may be too flat or wide; the proportions of the face may not be 'ideal' and so forth. Some individuals seek perfection. They see pictures of models in magazines and desire the same or similar noses. They should realize that the one 'shot' on the cover or on the page took probably hundreds of poses to accomplish. Add to this a 'makeup job' - and perhaps a little 'brush up' on the negative. Certainly the original nose was not perfect !! If you have looked as we have at the noses of the 'stars', before and after make up, you would see the limitations of 'nose jobs'. Even the 'stars' do not have perfect noses. In fact their noses are far from perfect !! - How can that be with all the glorious plastic and cosmetic surgeons in Hollywood ??? !!! Such expectations and desires for the perfect nose or the nose that you want to see in the mirror are perhaps the major potential problems associated with nasal surgery. In spite of this, most patients are improved and happy with the results of surgery. Nationwide, one in five to one in ten individuals undergo a second nasal surgery. In rare instances three or more surgeries are done. The surgeries depend on the degree of difficulty and the expectations of the individual, the characteristics of the nose, such as thickness of tissues, healing, repeated injuries, and so forth.

You should be aware of other risks and complications of nasal surgery. Bleeding, infection, septal perforation, (an internal window not visible externally), risks of anesthesia, and as mentioned, residual problems that may require further surgery are risks.

Certain conditions are anticipated and expected after surgery. There will be some degree of swelling, black and blue, numbness at the tip of the nose, crusting and minor bleeding are not uncommon. Numbness at the tip usually goes away in a few weeks but may persist for months. Permanent tip numbness is rare. You may notice numbness in the roof of your mouth. This has been temporary, and is usually associated with significant septal work. We have not seen a case where this has been permanent or a major problem.

Sometimes the nose will 'run' after surgery. This may persist for weeks or months. This may be associated with allergies, and may be bothersome for a time. Rarely does it need treatment.

If internal work is done on the nose and a 'window', 'hole' or 'perforation' should occur, you would probably not know about it unless told. Such conditions have not needed treatment, and are not frequent.

There have been cases reported where patients experience decreased sense of smell and/or taste following surgery. These problems have not been seen in Dr. Capuano's experience, but can occur.

Severe bleeding, infection, being worse than after surgery, major unequalness and/or visible scars are very uncommon.

Life-threatening problems have not occurred. Conditions such as severe allergic reactions to medications, anesthesia problems including death, paralysis, vegetation, must be mentioned for the sake of completeness but we have no direct knowledge of same.

Since they have not occurred, and because of the safety record of anesthesia at Park Ridge Ambulatory Surgery Center, we have no reason to believe they will.

If one reads about plastic surgery of the nose, hundreds of things have happened during and after nasal surgery. Because they are rare or one time occurrences, they will not be discussed unless you have particular concerns. Thus You must be aware that although the possibility of severe problems are low, nasal surgery like any surgery, can be unpredictable.

Please be aware that it is important for us to know if you use illegal drugs, i.e. marijuana, cocaine, etc. Drug use, especially cocaine use has increased in today's society. We know of at least eight deaths caused by cocaine use prior to nasal surgery when patients did not admit use (nationwide - none that we know of in this area). You must inform the Doctor if you use drugs, as this may increase the risks of surgery significantly.

The risks and complications particular to your nose will be discussed with you during your office visits and examination. We ask that you discuss any concerns openly. If you have any questions regarding a particular risk(s), please ask the Doctor. In some instances the office staff may be able to give you information about your particular concerns as they have worked with Dr. Capuano for many years and has knowledge of his methods and so forth.

Incisions for nasal surgery are usually all on the inside of the nose. There are some exceptions for example, in cases where the nose is to be made smaller at the base. Dr. Capuano would discuss external incisions with you.

If in the doctor's judgment during the operation that an incision needs to be made to do the operation and the incision was not discussed before surgery, you should understand the reasons for it. This is rare.

Occasionally during surgery conditions may occur which may require less than total correction and which might limit surgery. Again the Doctor must use best judgment and such circumstances are rare.

If your surgery is done as "walk-in" or Ambulatory Surgery, the procedure is performed in the morning, and you should be able to return home sometime in the afternoon. You will be sent information from the Center about what time to arrive for your surgery. You will need someone to drive you home and stay with you for at least twenty-four hours following surgery.

If you are being admitted to the hospital for your surgery, you will most likely be admitted the morning of your surgery, and in most cases be able to go home the following day.

We ask that you make two more pre-operative appointments to speak with the Doctor, so that any questions may be discussed, and instructions given to you. This is our office routine for nasal surgery.

We ask that you refrain from taking any products containing aspirin for at least two weeks prior to your surgery. Do not eat apples, as they contain an aspirin-like substance. If you are taking aspirin on the advice of a physician, please let us know. Aspirin "thins" the blood, which may cause more bleeding during surgery.

You must not eat or drink anything from midnight the night before your surgery.

The evening prior to your surgery, and the morning of your surgery, please clean the inside of your nose gently with Q-tips. You may shower the night before and/or the morning of your surgery.

Oral hygiene is important. We remind you to brush your teeth and use a mouth rinse the evening before and the morning of surgery.

Do not wear contact lenses the day of surgery or immediately following surgery. You may resume wearing contact lenses by using them for short periods of time at first. Gradually increase the time over a number of days.

Please remove ALL eyeliner and make sure your face is clean and free of makeup, creams, lotions and powders before your surgical procedure.

In most cases following internal nasal surgery, your nose will be packed with a gauze packing. This should be left in place. If the gauze starts to come out, use a Q-tip to gently push it back into place. If this is not effective, snip off the excess gauze with a clean pair of scissors.

Chances are that you will have a splint on your nose, which should be kept clean, dry and on. You may also have a gauze pad under your nose for drainage. This can be replaced as needed. No showers are allowed until you are seen in the office.

You will be given medications for swelling, discomfort and to prevent infection. Please take these medicines as directed, and finish all prescriptions unless advised otherwise. If you have a problem with any medication, please call the office.

Regarding work: we do not advise working while your splint and/or packing are in place. The estimated time away from work depends to a large extent upon the nature of your job. Under usual circumstances, you may return to work anywhere from two to three weeks following your surgery. If you work in a dusty environment, or are required to do heavy lifting, you may have to stay out of work even longer. Please discuss your job with the Doctor so you may obtain a better estimate of time away from work.

CAUTION: If you are a body builder, weight-lifter, exercise seriously, or if your job requires heavy lifting, you must be aware that after surgery you CANNOT lift heavy objects, strain or do significant facial grimacing for at least three months, and sometimes more after surgery. The length of the restriction depends upon the complexity and extensiveness of your surgery. THIS IS VERY IMPORTANT. If this pertains to you, you must notify the Doctor BEFORE YOUR SURGERY and discuss your particular situation.

Following surgery, do not hit or bump your nose. Do not sleep on your nose. Make every effort not to do so. Avoid strenuous activities, and do not bend over or lift heavy objects. You will be advised regarding activity when you are seen in the office. If you feel you are going to sneeze while the dressing is on, try to sneeze through your mouth. If you do sneeze through your nose, check the packing (if used) to make sure it has not moved.

At the time of your first office visit following surgery, packing, if used, will be removed. The dressing will also be removed. You should now be able to shower, and it is advised that you do so, allowing the steam to help clean the inside of the nose. You may gently wipe the lower inside of your nose with Q-tips. Do not blow your nose until advised otherwise. It is important not to hit, bump or sleep on your nose, as it is still in the healing stages.

Do not put anything (except Q-tips in the lower inner nostril area) in your nose. Doing so could change the eventual result of surgery.

Swimming and vigorous exercise should be avoided for approximately one month. Cigarette smoking and contact with harsh chemicals should be avoided for as long as possible.

Following surgery, you may feel or notice small irregularities in the nose. In many instances, after swelling decreases these irregularities will change markedly. These irregularities are not unusual, and are usually associated with the fracture of the nasal bones. In many cases bones do not uniformly fracture, resulting in irregularities which may be noticed. Usually these are felt and not seen. Please be aware that if the height of the nose is decreased, this widens the nose, either in actuality or visually.

No person has a face that is symmetric. This includes the nose. You may notice from pictures taken at different angles that there are slight to significant differences. Many people have one profile they prefer over the other, i.e. left side or right side. Since the entire face itself is not symmetric the relationship of a nose to a the sides of the face is not the same. You may note unequalness before and after surgery, and will probably have unequalness of the nose following surgery. This is usually not noted except upon close inspection or analysis, and we mention this so you will be aware if this happens in your particular case.

Photographs will be taken before, possibly during and after your surgery. If photographs have not been taken, please let us know. These are for your office chart only, and you will not be identified except for our records.

If you are a Blue Cross / Blue Shield subscriber, you will have to fulfill the following criteria issued from Blue Shield in order for your insurance to cover an external procedure: 1. At the time of your injury, (if post-traumatic) your current insurance policy had to be in force. If the patient is a minor, then the policy of a parent would apply. There can be no lapse in coverage. 2. An X-ray showing a nasal fracture is required. Please be advised that a nasal fracture is only seen in approximately 80 percent of nasal fracture cases. Even very severe fractures may not be detected by X-ray. As a Plastic Surgeon, I am aware of this, and feel that this requirement from the insurance company is unjust. In some cases a review of your history by the insurance company may result in payment. This is not the usual case. Insurance has almost always paid for internal nasal surgery for problems with breathing.

Since policies within an insurance company may vary, you should check to your satisfaction the above requirements especially if your contract should happen to be changed.

Also of importance is the cost of further surgery if needed. Since secondary nasal surgery is not unusual (as mentioned above), additional costs for further hospital or surgical therapy could be incurred. In some instances this could be covered by insurance and other times not. If you have particular concerns about any of the above, Please discuss it with Dr. Capuano and / or the office staff before surgery.

More information re nasal surgery

RHINOPLASTY IN THE MALE

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