Posted on October 31, 2009 in Blepharoplasty
Many patients seeking an upper eyelid lift, or blepharoplasty, are pleasantly surprised to hear that they can undergo the procedure in the office setting. An upper eyelid blepharoplasty is one of the most gratifying procedures for both patient and surgeon. The procedure can have quite dramatic, yet natural appearing, results that provide a significant improvement in terms of looking more rested and youthful. Plus, upper eyelid blepharoplasty can usually be done in the office using local anesthesia (injection of numbing medicine). If desired, a low dose of oral Valium can also be given to provide more relaxation during the procedure. Most cases are completed in under an hour. Another huge advantage of doing this in the office is that patients avoid the additional costs associated with facility and anesthesia fees. In addition, there are no concerns with reacting to general anesthesia. The ability to achieve this type and degree of cosmetic enhancement under local anesthesia in the office makes upper eyelid blepharoplasty one of the most popular procedures we perform.
Posted on October 27, 2009 in Rhinoplasty
In many rhinoplasty cases where I have performed osteotomies (breaking the bone) I may ask my patients to do what we term are nasal exercises. Basically these involve pressure strategically placed along the side of the nasal bone using the patients’ fingers. During the rhinoplasty procedure we break the bone and reshape the nose to the desired position. A cast is then placed to fixate the bones during the first week or so. Once the cast is removed, the bones typically stay in their new position until they fuse completely around 6-8 weeks out from surgery. In some cases, however, the bones may drift slightly right after the cast has been removed. Sometimes this will not be visible for 1-2 weeks more because the overlying soft tissue is swollen and conceals the displacement. If the bone is noted to have drifted once swelling has subsided (appearing asymmetric or crooked), nasal exercises are recommended to get it back into proper alignment. This is a critical window of opportunity since the bones are still mobile and malleable up to 8 weeks out from surgery. Specific instructions to begin doing exercises should be provided by your surgeon as sometimes more pressure should be applied on one side versus the other (do not initiate this process on your own!). Usually the exercises are done 15-30 times throughout the day. Patients continue doing the exercises for up to 6-8 weeks. After that time the nasal bones are no longer mobile due to fusion of the fracture line, but hopefully by then the bridge is shadowing in a more symmetric, refined fashion.
Posted on October 22, 2009 in Rhinoplasty, Septoplasty
One of the most common fears following rhinoplasty and/or septoplasty is the possibility that the surgeon is going to pack the nose. This means the surgeon places gauze or similar material inside the nasal passages to put internal pressure on the tissues. This is done to minimize chances of bleeding as well as to promote stable healing of the internal lining (called the mucosa). Unfortunately, nasal packing after rhinoplasty/septoplasty is extremely uncomfortable. Not only is packing painful, it also inhibits patients from breathing thru the nose during the early recovery period. Because these issues can be so anxiety provoking for some patients, I stopped packing noses on a regular basis nearly 6 years ago. Instead, I use an absorbable suture to stabilize the internal tissues that also helps minimize bleeding. Doing this also allows patients to have at least some degree of breathing thru their nose in the early recovery period. If I do place anything in the nose after surgery, it might be a small piece of absorbable gel-like material that dissolves with use of salt water spray in the nose. Either way, I avoid having to pack the nose in the traditional manner, leaving my patients with a much more comfortable recovery.
Posted on October 21, 2009 in Rhinoplasty
I often get asked, “What is my downtime going to be following rhinoplasty?” The answer can certainly vary among different patients. However, in general, the first week you will have tape and possibly a cast on the nose. I usually remove sutures around 5-6 days out from surgery along with the tape and cast. On that day, your new nose will be ‘revealed’ but don’t expect it to look like the finished product. It will be moderately swollen and look quite large. By 10-14 days out from surgery, there will be a significant decline in swelling and bruising to the point where you will look what is termed ’supermarket presentable’ in public. Meaning, you and I will still recognize a certain degree of swelling but most people in line at the supermarket will not think twice when they see you. The swelling continues to decrease incrementally week by week and month by month. People with thin skin will typically see quicker resolution of the swelling compared to those with thick skin. Overall, expect a gradual decline with periods of time (days to weeks) where the nose may look more swollen. This can be affected by excess salt in your diet, warmer weather and even increased activity levels. Ultimately it does take a year or longer for your nose to heal completely. In the meantime, I will recommend regular follow-up visits to ensure that we maximize any opportunity to optimize your recovery.