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FAQ


Is facial cosmetic & reconstructive surgery safe?

By and large the procedures involved in facial reconstructive surgery are safe. However, as with any type of surgical procedure there are certain inherent risks, especially where a general anesthesia is involved. But the bigger risk is aesthetic-related. Too often the portrayal of cosmetic surgery in popular culture simplifies the “nose job” or “tummy tuck” procedure and if a patient’s expectations aren’t realistic or if the practitioner is not fully qualified or experienced enough, the patient runs the risk of having a botched procedure that may not be reversible. A qualified specialist is best equipped to inform you of the specific risks inherent to the type of surgery you’re seeking.

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How do I know if I’m a candidate for surgery?

To undergo any manner of cosmetic surgery is an extremely important and highly personal decision. In some cases, it may be to correct or reconstruct a disfigurement or impairment that has occurred naturally (i.e. from birth) or is the result of trauma or injury. In other cases, surgery may be medically necessary to halt a deteriorating quality of life resulting from the impairment. Still others choose surgery because they believe it will bring them greater confidence and enhance self-esteem. The key is to ensure that your own expectations of how you will benefit from results are reasonable and achievable. Other considerations such as costs, risks, options recovery time, etc. should be discussed with a qualified surgeon in the early stages before making your decision. Finally, a little research on your own about your procedure will make subsequent discussions with your doctor all the more valuable in helping make your decision.

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How do I find the right surgeon?

Start by seeking out a physician who is board-certified by a reputable institute such as the American Board of Facial Plastic and Reconstructive Surgery or the Royal College of Physicians and Surgeons of Canada. This signifies that he/she has completed up to 15 years of rigorous training and examinations at accredited institutions, in addition to having professional practice experience. Board-certified doctors are in a position to give you the most complete information about risks and options regarding your surgery. Other questions one might consider include:

How many years has he/she been in practice?
What is his/her area of expertise?
Does he/she keep up to date with the latest developments?
Are before/after photos available?
If patient testimonials are available are they favourable?
Does the physician have hospital privileges?
What are the cost estimates – for the consultation as well as the surgery?

You may have to interview several physicians before you find the right one, and, ultimately, it could come down to chemistry – how you feel about a doctor’s manner and level of engagement might just be the X-factor that helps you make a decision. A useful and thorough discussion of considerations to take into account when choosing a plastic surgeon can be found at http://www.plasticsurgery.org/patients_consumers

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Rhinoplasty or Nose Surgery


How long does nose surgery take?

Simple rhinoplasties involving bump removal and re-narrowing take about seventy-five minutes. The simplest open nose procedure can be completed in under two hours while a revision rhinoplasty or a cleft-lip nose procedure will take two and a half hours. Rarely will any nose procedure take longer than three hours to complete.

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Does rhinoplasty require general anaesthesia?

Dr. Kibblewhite prefers to use complete (general) anaesthesia as it provides more comfort to the patient and is in some ways safer than sedation.

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Does rhinoplasty require an overnight hospital stay?

Rarely. Rhinoplasty is almost always carried out as a daycare procedure.

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What are the healing times for nose surgery?

In the short term, most patients will be breathing adequately through the nose one week after surgery. At that time surgery will be adequately healed for patients to return to regular activities. Full healing times for rhinoplasty results to achieve their final appearance can range from nine to 18 months with most patients achieving it at 12 months. Much of the healing time, especially in the late stages, involves the nose skin refinements around the tip of the nose.

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What can I expect during the 24 hours following rhinoplasty surgery?

Immediately after the operation your nose will have a metal splint or brace on it, and may have a rolled pieces of material in each nostril, which are removed after 24 hours. There is always bleeding from the front of the nose in the first 24 hours and the nose is always difficult to breathe through – impossible if there are rolls in the nose. Any pain or discomfort at this time is treated in the recovery area. Once this settles down you will be released and use oral medication to control any pain you may experience. After the first 24 hours, most patients are relatively pain-free although there may be some bruising/swelling and difficulty breathing through the nose until the swelling subsides. It is very important to use ice or cold packs as frequently as possible on the nose to control swelling.

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What can I expect one week after rhinoplasty surgery?

The external splint is removed one week after surgery. When the splint is removed, there can be mild acne-like changes under it. All open rhinoplasty and some closed rhinoplasty procedures as well can result in mild numbness of a small area of skin just above the nasal tip. This is temporary. Also, the nose always looks slightly swollen early on. Most patients usually return to normal activities within a week or so.

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What are the risks of complications developing in the early stages?

Regardless of the purpose, every surgical procedure, especially those involving general anaesthesia, carries with it an inherent level of risks.

There is less than a 1 in 50,000 chance of significant complications due to anaesthesia and a 1% chance of developing a significant nose infection. If an infection does occur patients are placed on antibiotics and their time to full healing is usually delayed.

Severe nosebleeds are the most common early complication and occur in about 3% of patients, usually within 5 to 12 days after the surgery. When this happens, the nose needs to be repacked and, occasionally, the patient is admitted to hospital to manage the bleeding.

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Are there any other risks of complications developing after rhinoplasty?

Patients who had a nasal obstruction before their rhinoplasty have a 10% chance of feeling that they cannot breathe through their nose properly afterwards. For patients without nasal obstruction the chances are less.

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What is likelihood that revision surgery will be required?

Any time the shape of the nose is changed, there is a possibility that the changes do not work out the way the surgeon or patient intended resulting in the need to redo the nose surgery. All rhinoplasty surgeons incur revisions and should be able to cite a revision rate – usually between 5 and 10%. Most of these revisions are relatively minor – the smoothing of small bumps or filling in of small dents – and are usually performed only once the initial rhinoplasty has fully healed; a minimum of 12 months or so. Occasionally, more significant revision may need to be undertaken.

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Blepharoplasty


How long does eyelid surgery take?

Eyelid surgery takes about 75 minutes to perform. If the upper and lower lids are done in the one procedure it will take two and a half hours.

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Does blepharoplasty require general anaesthesia?

Blepharoplasties are usually done under local anaesthesia, with sedation via an intravenous tube. Upper lid blepharoplasties can be done using local freezing only.

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Does blepharoplasty require an overnight hospital stay?

No.

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What can I expect immediately after the blepharoplasty surgery?

Immediately after the operation the eyelids will be covered with a cool compress, and special eye ointment will be used to dress the incisions.

There is a small amount of bleeding from the edges of the incisions in the first few hours along with bruising, as eyelids tend to bruise easily. Typically patients wear large sunglasses to hide their eyes.

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Is eyelid surgery painful?

There is little pain with eyelid surgery – any pain that does occur is usually well controlled with oral pain medication. In lower lid eyelid surgery there is a pulling feeling from the outer corner of the eye resulting from the skin-tightening stitch.

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What should I expect in the early stages of blepharoplasty recovery?

There is a mild amount of swelling, and occasionally some skin numbness near the incisions. In addition, there are mild irregularities of the skin that settle in a few weeks.

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How long does the post-surgery healing take?

There is some swelling of the soft tissues after eyelid surgery and bruising takes seven to ten days to resolve – in some instances it could take up to three weeks. The eyelids will look acceptable after two weeks, but will take approximately 6 months to completely settle and reach their final look.

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Are there any complications with eyelid surgery?

There is a slight chance of blood pooling under the skin, which is easily resolved by draining. There is a much lesser chance of infection at the surgical site, which can be treated with oral antibiotics.

There is also the possibility that the eyelids will not close completely during the first few days, particularly at night when sleeping, causing a gritty, uncomfortable feeling in the eyes. This is usually treated with eye drops or ointment until the problem resolves. A much rarer problem involves the eyelashes turning inward or outward, which would require revision surgery to correct. The lower eyelid in particular requires support so the surgery on the lower lid is kept conservative for this reason.

Having said this, as in all cosmetic operations, the main complications in eyelid surgery are of an aesthetic nature. It is extremely difficult if not impossible to safely remove all excess skin and fat during blepharoplasty. If a surgeon tries to be too aggressive, the results can leave the patient with an unusual hollow-eyed appearance. Further, if the eyelid skin is pulled too tight, distortion in the contour of the lid can result.

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Otoplasty or Ear Surgery


How long does ear surgery take?

Otoplasty takes about 75 minutes to perform.

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Does otoplasty require anaesthesia?

Otoplasties are often done under general anaesthesia in children. In adults, otoplasties can be done in an outpatient setting with local freezing only.

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Does otoplasty require overnight hospital stay?

No.

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How long does it take to heal?

There is some swelling of the soft tissues covering the ear cartilage, although this settles relatively quickly. On removal of the dressing after one week, the ears may look slightly swollen and a little flattened. They quickly change to their final, new position on the head within [##] days/weeks.

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What is involved after otoplasty surgery?

Immediately after the operation an extensive dressing looking somewhat like a turban is placed over the ears. This dressing will stay in place for 5 - 7 days. After removal of the dressing the patient must wear a headband day and night for the first week, and at night only for the following four weeks.

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Is there bleeding or bruising?

There is a small amount of bleeding from the edges of the incisions in the first few hours. There is little visible bruising.

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Is the ear surgery painful?

There is little pain with ear pinning surgery. It is usually well controlled with oral medication.

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What can I expect in the early stages after otoplasty surgery?

There is a mild amount of swelling, and occasionally some skin numbness near the incisions. There are mild irregularities of the skin that settle in a few weeks.

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Are there any complications with ear surgery procedures?

In the early stages standard complications are a collection of blood developing under the skin, which can be drained. There is a very small chance of getting an infection of the surgical site, which can be treated with oral antibiotics.

The most common problems in suture technique otoplasty is from the sutures or stitches. They can pull out too early (usually if the ear gets pulled accidentally) and thus the ear returns to where it was before the surgery. The stitches can come through the skin and need to be removed.

As in all operations done for aesthetic purposes, the main problems are aesthetic. With ear pinning, the main problem is putting both ears in the same position, and having them look natural.

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Estimated amount spent on nose reshaping procedures in Canada in 2003:

$500 million +

Average cost per nose reshaping procedure:

$5,000 to $10,000