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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, but the biggest risk is obtaining an end result that is acceptable to the surgeon and patient. Too often the portrayal of cosmetic surgery in popular culture simplifies the “nose job” or “tummy tuck” procedure. 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 an unsatisfactory result 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

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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, provided by a Board certified Anaesthesiologist, 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 to two weeks after surgery. At one week after surgery most patients 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. Patients with thick heavy skin can take up to 2 years to fully heal in.

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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 occasionally have a rolled piece 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 will 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 in the first 24 hours afer surgery to control swelling. Patients will normally find that they have very little energy during the first 5 days post, similar to having a bad cold.

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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 carries with it an inherent level of risk.

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. About 1/3 of patients who get a nose infection will have unforeseen changes in the appearance of the nose because of the infection damaging the nasal cartilage.

Severe nosebleeds are the most common early complication and occur in about 2% 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 10% or so. Some 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. On occasion a more significant revision may need to be undertaken.

Revision nasal surgery

Revisions are undertaken only after a full year or more of healing has occurred. This is because it takes a year for the majority of the swelling to settle, in order that the end result can be seen accurately. With revision surgery it is important to realize that the risk of yet another revision is the same, that is, 10% or so. As well, noses can only be operated on a few times before the surgery gets technically difficult. Once a patient has had three or more nasal procedures the question arises as to what can, practically speaking, be achieved by operating yet again. Patients will sometimes say that they would just like their old nose back on their face. This cannot be done. All you can do is take the result the patient is left with, and alter it again in the hope of improvements.

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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