Rhinoplasty Los Angeles, CA
Considering Rhinoplasty or Nose Surgery? Looking to Put Your Best Face Forward?
Dr. Kenneth Hughes, MD in Los Angeles has developed a real passion for producing natural rhinoplasty results. Dr. Hughes performs about 100 nose reshaping procedures (rhinoplasties) each year. He performs both open rhinoplasty (with an external scar on the underside of the nose) and closed rhinoplasty (no external scars).
Though the closed rhinoplasty is a more difficult procedure and most surgeons perform open rhinoplasties, Dr. Hughes performs most of his rhinoplasties with the closed approach. This has several benefits for the patient : 1) the patient has no visible scars 2) the structure of the tip is better preserved 3) the patient heals more quickly with less swelling and 4) there is better remaining blood supply to the nose.
This scarless approach to rhinoplasty is utilized by Dr. Hughes to produce results that are always natural . In addition, Dr. Hughes’s rhinoplasty patients are looking good far sooner than in open approaches, often in two or three weeks. However, please be aware that conventional wisdom in rhinoplasty is that results take one year to be fully recognized.
Dr. Hughes does not produce pinched tips or collapsed noses or noses with visible tip grafts. In addition, Dr. Hughes has special fellowship training at Harvard University that allows him to not only produce the cosmetic result you desire, but also prevent postoperative breathing problems. Being adept at correcting both cosmetic and functional components of septoplasty and rhinoplasty, Dr. Hughes has the expertise that few possess.
Dr. Hughes has expertise in both primary (first time) rhinoplasty or revision rhinoplasty (secondary, tertiary) and can improve your nose after previous surgery or trauma. Even if you were not satisfied with your first surgery by another surgeon, do not despair. Dr. Hughes has a solution for you. About 25% of Dr. Hughes’s rhinoplasties each year are revisions of rhinoplasties done elsewhere.
Much discussion these days is given to ethnic rhinoplasty. Dr. Hughes operates on people of all ethnicities, Caucasian, Hispanic, African American, Middle Eastern, and Asian among others. Although each ethnicity may have features that are more prevalent, the individual and the goals of that individual and not the ethnic group are what really matters.
Each patient is assessed as an individual, and plans are made for an operation that is tailored to achieve the goals of that patient.
Whether you need your tip reduced or rotated upward, your hump reduced, your bridge elevated, or your whole nose made smaller, Dr. Hughes can tailor the rhinoplasty to your individual needs and tastes. With minimal downtime with this scarless approach, your time for rhinoplasty in Los Angeles or Beverly Hills at Hughes Plastic Surgery is now.
Or Browse Dr. Hughes’s Chapters on Photography and Preoperative Workup:
PREPARING FOR SURGERY
- STOP SMOKING: Smoking reduces circulation to the skin and impedes healing. It is best to avoid smoking, second hand smoke and cigarette replacements, such as nicotine patches or gum, in the perioperati ve period. While you should ideally stop smoking for 2 weeks before and after your surgical procedure, YOU MUST NOT SMOKE FOR A MINIMUM OF 24 HOURS BEFORE AND 24 HOURS AFTER SURGERY.
- TAKE MULTIVITAMINS: Start taking multivitamins twice daily to improve your general health once you have scheduled your surgery.
- TAKE VITAMIN C: Start taking 500 mg of Vitamin C twice dai ly to promote healing.
- START TAKING AN IRON SUPPLEMENT: A good iron supplement, such as Feosol Spansules, is required starting one week before surgery and four weeks following surgery. Bowel movements may appear darker than usual as a result. Feosol is available without prescription.
- DO NOT TAKE ASPIRIN OR IBUPROFEN: Stop taking medications containing aspirin or ibuprofen. Review the list of drugs containing aspirin and ibuprofen carefully. Such drugs can cause bleeding problems during and after surgery. Instead, use medications containing acetaminophen (such as Tylenol).
- LIMIT VITAMIN E: Limit your intake of Vitamin E to less than 400 mg per day.
- FILL YOUR PRESCRIPTIONS: You will be given prescri ptions for medications. Please have them filled BEFORE the day of surgery and bring them with you.
- CONFIRM SURGERY TIME: We wi ll call you to confinn the time of your surgery. If you are not going to be at home or at your office, please call us to confirm at (310) 275-4170.
- PRESCRIPTIONS: Make sure that you have filled the prescriptions you were given and set the medications out to bring with you tomorrow. Make sure to have the number for your pharmacy ready so that if Dr. Hughes and associates need to call in any special medications for you on your day of surgery they wi ll have that infonnation readily available.
- CLEANSING: The night before surgery, shower and wash the surgical areas with an antibacterial soap such as Dial, Safeguard, pHisoHex, or Phase II I.
- EATING AND DRINKING: Do not eat or drink anything after 12:00 midnight except for a small amount of water to rinse your mouth while brushing your teeth.
- SPECIAL INFORMATION: Do not eat or drink anything! Ifyou take a daily medication, you may take it with a sip of water in the early morning.
- ORAL HYGIENE: You may brush your teeth but do not swallow the water.
- CLEANS ING: Shower and wash the surg ical areas again with an antibacterial soap such as Dial, Safeguard, pHisoHex, or Phase Ill.
- MAKE-UP: Please do not wear moisturizers, creams, lotions, or makeup.
- CLOTHING: Wear only comfortable, loose-fining clothing that does not go over your head. NO TIGHT PANTS. Remove hairpins, wigs, and jewelry. Please do not bring valuables with you.
- CHECK IN/PREPARATION: Surgery Time:
- You should plan to arrive 45 minutes earlier than your scheduled surgery time. Patients less than 18 years old must be accompanied by a parent or legal guardian. When you arrive at our office on the day of your surgery, give the receptionist the phone number of the pharmacy you would like us to call for any spec ial medications Dr. Hughes and associates might prescribe.
- CARETAKER: Someone must spend the first night after surgery with you.
RHINOPLASTY POST-OP INSTRUCTIONS
- The first week you will need to rest frequently. You need to walk around the house every 2 hours as tolerated. Avoid stairs if possible.
- For the first week post-op, sleep on your back with your head elevated. This will keep tension off your nose. Do not sleep face down or on your side.
- Avoid picking anything up greater than 1-2 lbs the first two weeks. The doctor will advise you when you can start lifting anything heavier.
- Do not exercise until the doctor says you may do so.
- Do not bend over try keeping your head back as it may cause bleeding.
- You may not drive the first week or while you are taking pain medication. After that it will depend on your ability to handle a car without causing any discomfort. You should wear your seatbelt at all times.
- Do not engage in sexual activity at least 2-3 weeks after your surgery.
- No smoking. This will interfere with your healing.
- Eat light the first 24 hours, clear liquids advancing to a regular diet as tolerated.
- If you have persistent nausea stick to a bland diet until it subsides.
- The pain medicine may cause constipation. Drink plenty of fluids. You may take any over the counter laxatives or stool softeners as needed.
- You will have tape and/or a splint for 1 week.
- It is normal to have numbness over the surgical sites for several weeks or months.
- Do not use a heating pad or ice around the surgical sites. It could cause a burn.
- You may shower the first week avoiding your face, as it may cause the splint to fall off. The splint will be removed at first post-op visit.
- It is normal to see small amounts of dried bloody drainage on the nose. You may put Vaseline on edge of nostril with a Q-tip. Do not poke or touch inside the nose. Do not pick at scabs or crusts.
- You will have a gauze under your nose that you may change as necessary.
- Take your antibiotic until it is completed. Antibiotic should be taken with food at each dose.
- If the pain medication is a narcotic it should be taken as prescribed. Do not take any Tylenol while on pain medication. The medication we prescribe may already have Tylenol in it.
- Do not drink alcohol or drive a car while taking pain medication.
- The pain medication may cause nausea and should be taken with food at each dose.
- You may resume your regular medication after your surgery except for Vitamin E, Fish oil and Aspirin (wait at least 5 days post-op).
- If you take aspirin or coumadin check with the doctor to see when you may resume them.
CALL THE OFFICE IF YOU HAVE:
- A temperature greater than 101.5 degrees.
- Excessive bleeding from the incision.
- A sudden increase in drainage, pain, or swelling around the incision site or the surrounding area.
- If you have persistent vomiting.
Analyzing the Deformity in Rhinoplasty
Rhinoplasty is considered by most plastic surgeons to be one of the most difficult operations to perform along with full breast lift (mastopexy) and face and neck lift. There is a wide variation in an individual patient’s nasal anatomy and cosmetic concerns. Dr. Hughes will discuss in great detail what is realistic for a certain patient and what is not. The most important consideration is that a patient must be able to breathe well after rhinoplasty. Otherwise, the surgery is a failure. Dr. Hughes frequently performs secondary rhinoplasties for breathing and for cosmetic concerns.
Who is a good operative candidate?
In general, a good candidate is one who will get significant benefit from the surgery, and one who has realistic expectations about what to expect as a final result. All patients should realize that final results will take at least a year to be realized.
As your plastic surgeon, Dr. Hughes will have to assess these items during your consultation.
First, what is the nasal deformity of the patient?
The patient must be able to articulate what things that he or she does not like about the nose. Certain things are easy to point out, such as a large hump on profile view. Other things are more difficult to ascertain or articulate. Dr. Hughes will work with you to determine exactly what you would like fixed. Dr. Hughes does not perform the same operation for every nose. He performs the rhinoplasty that you want.
Dr. Hughes will evaluate your goals and determine if they are realistic. Neither Dr. Hughes nor any other plastic surgeon can make someone’s nose like that of a famous actress. Healing factors alone and skin thickness and texture make that impossible. Finally, Dr. Hughes understands facial proportions and aesthetics, and he will help to achieve balance and harmony with nose and face alike.
Nasal Anatomy in Rhinoplasty
The Dorsum of the Nose
The dorsum is the area of the nose from the forehead to the tip. Patients can have complaints of both increased nasal width or decreased. Patients may also complain that the dorsum has a hump or bump on it. Similarly, patients may have a scooped out dorsum or a collapsed nasal vault. Finally, the superior most aspect of the dorsum may be too high or too low. All of the these items can be addressed with a rhinoplasty with Dr. Hughes.
The Nasal Tip
The tip is one of the most frequently disliked parts of a patient’s nose. For many the tip may be too big or bulbous or possibly too wide. This large tip can frequently be corrected with cartilage removal and suture techniques.
Some patients may complain of a tip that is too small or pinched. Sometimes these patients have breathing difficulties that must be corrected at the time of the surgery. Occasionally, the patient may require cartilage grafts to fix either the breathing problem, give more support, help with asymmetry, or improve tip projection. Sometimes, in nasal revision surgery, tip grafts may need to be removed among other maneuvers.
The tip may also be droopy or too low. Frequently, these patients will want the tip lifted to create a more refined look.
The Nasal Base
This is the area of the nostrils. Many, many patients have a great deal of nostril asymmetry that may be frequently unmasked when a tip is elevated or rotated upward. Very little can be done to improve the asymmetry of the nostrils. Dr. Hughes will point out if you have a great deal of nostril asymmetry.
The nostril size can be reduced to improve symmetry. Large nostrils or noses that appear too wide at the base can be reduced as well. Dr. Hughes frequently performs these procedures for Latin American and African American patients, although this procedure can be performed in any ethnicity.
Operative Details in Rhinoplasty
Dr. Hughes will perform a thorough internal and external exam. Nasal photographs are taken for preoperative analysis.
The Operation (Closed Rhinoplasty – Scarless Rhinoplasty)
The patient will arrive about 30 minutes prior to the surgical start time. Dr. Hughes will meet with you again to determine if there are any additional changes you would like to make to the operative plan. Also, Dr. Hughes will confirm with you the items of the nose that will be addressed as well as those items you would like to be unaltered.
The rhinoplasty operation will be performed under general anesthesia. The operation will last one hour or so. Extremely challenging secondary or tertiary rhinoplasties may last 1.5 hours or so.
Dr. Hughes will inject local anesthetic with epinephrine to help with pain control and minimize bleeding. Dr. Hughes will used his closed approach to rhinoplasty so that the patient will have no scars that are visible. He will make incisions along the rim inside and at the junction of the upper and lower lateral cartilages. Dr. Hughes will trim the lower lateral cartilages called a cephalic trim. This will reduce the apparent size of the nasal tip and will help the tip rotate upward. Thus, this technique can raise a droopy tip.
Sometimes, Dr. Hughes will trim a little bit of the cartilage at the lower portion of the septum to help reduce apparent droopiness or columellar hang.
At this point, Dr. Hughes will reduce the cartilaginous portion of your hump if you have one. Next, he will reduce the bony portion of your hump. Next, Dr. Hughes will infracture your nose to both narrow the width of your nose and close the open roof caused by removal of the bony dorsal hump. If your dorsum does not require any surgery, these steps will not be performed. In addition, you will likely not have any bruising if no osteotomies are performed and very little if they are.
Next, Dr. Hughes will proceed to refining your nasal tip.
Operative Details in Rhinoplasty and Follow-up
The Nasal Tip
The nasal tip can be altered by dozens of maneuvers. Only the most common maneuvers will be discussed here.
Sometimes, a columellar strut can be placed to elevate the tip. Usually, the graft is taken from the septum at the time of the rhinoplasty. Sometimes, the cartilage taken from the dorsal hump removal can be used as a strut or as cartilage graft needed elsewhere.
Tip sutures or stitches are used in their various forms to mold the tip to be more narrow or create lift or improve asymmetry. These stitches are placed into the cartilaginous structure itself. These are very powerful stitches in altering a nasal tip in rhinoplasty. Interdomal and intradomal sutures reduce nasal width and produce tip definition by creating the ideal cartilaginous framework for the tip.
Cartilage grafts can be harvested from septum, ear, or rib in general. They are used for a multitude of purposes. Cartilage grafts can be crushed to improve symmetry in crooked nose cases. Rib cartilage can be used to recreate a dorsum in traumatic deformities. Cartilage grafts can be used for tip projection or definition.
Sometimes grafts can be used to hide tip asymmetry. When possible, excised alar cartilage can be used as grafts to provide subtle tip refinement and accentuate changes produced by suturing. When this cartilage does not suffice or more is needed, cartilage can be harvested from the septum or the ear.
The internal incisions are closed with light sutures. No nasal packing or internal splints are placed, so breathing is not compromised. A small white nasal splint will be placed. This concludes the surgery.
Dr. Hughes will see you in one week to remove the splint. Patients frequently notice improvement in appearance immediately with marked improvement at three weeks. Many of Dr. Hughes’s postoperative photos in the rhinoplasty photo gallery are taken at the three week follow-up appointment. However, full improvement may take one year.