Rhinoplasty: Q&A

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Overwhelmed After my Nose Job Consults

ok ive had 2 rhinoplasty consults: 2 questions 1. md#1 says he must intubate me md#2 says he will not intubate me (iv sedation) so is it best to be intubated or not for rhinoplasty? 2. md#1 says he will not break my nose md#2 says he must break my nose how can they have such different techniques? md#1 says my nose is narrow enough not to need to be broken but md#2 says it is absolutly nessescary. both physiscans are experienced board certified thanks

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29 Doctor Answers | Asked by tiffypoo62 in Hickory, NC

Doctor Answers (29)
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I prefer general anesthetic for nearly all Rhinoplasty Surgeries performed in my practice.

I read your concerns. Since your nose is part of your airway, I prefer general anesthesia with oro-tracheal intubation to protect your airway from post-nasal bleeding encountered during Rhinoplasty Surgery. Many reputable surgeons use IV sedation, but general anesthetic remains my choice for nearly all Rhinoplasty procedures performed in my practice. Nasal bone osteotomies are required if your nose needs to be narrowed, or if your bridge needs to be lowered. If you're a borderline... more

Eric M. Joseph, MD

197 reviews

West Orange Facial Plastic Surgeon

www.ericmjoseph.com

Confusion after Rhinoplasty Consultations

Selecting a surgeon will be the most difficult decision you will make. At this stage, I recommend that you see multiple results in patients that had noses like yours - that should be the most important parameter. Don't worry about things like the surgeon's preference for delivery of anesthesia.

Richard W. Fleming, MD

9 reviews

Beverly Hills Facial Plastic Surgeon

www.bevhills.com

Help on deciphering opinions about your planned Rhinoplasty

Rhinoplasty is a very delicate and personal procedure. Every patient is different as is every surgeon. Finding the right surgeon for you can be a difficult task, since all surgeons have their own sense of aesthetics in addition to yours. Because of this a rhinoplasty can be approached from many different angles, giving very different results. It is best to make sure your surgeon knows as precisely as possible, what you are looking for and explains to you how he is... more

Overwhelmed after nose job consults

It is best to have general anesthesia for a rhinoplasty. It is the safest way to undergo an anesthetic so that the blood does not pool in the back of the throat, down into the trachea. Patients do not need to be intubated for general anesthesia, but they will need an LMA, which protects the airway from blood. As far as osteotomies or breaking the nose, these are performed only after the hump has been removed. A very small hump removal will not require breaking of the... more

Pick the surgeon that you feel comforable with - honest about his work

The consultation with a surgeon gives you a chance to get some detailed information about the procedure we are interested in. The amount of that information can be overwhelming at the time. In many situations we seek a second consultation to compare surgeons’ answers. You have to remember that even though they are both board certified plastic surgeons, their approach can be very different. It does not mean one is better than the other. The most important for the patients is to... more

If you're confused about your nose surgery after 2 consults, get another opinion.

Not only should a surgeon give you an opinion, there should be a rationale that makes sense to the patient. If it doesn't make sense maybe another opinion would help. I use video imaging to educate the patient and sometimes myself. If you're confused about infracturing, you can do a nose operation on the computer with and without infracturing to see how it looks.

Overwhelmed After my Nose Job Consults

Different surgeons have different philosophies, different techniques, and even a different aesthetic eye. We are lucky to live in a time when technology can help in these situations. I often use computer imaging (that is, morphing photographs) to show patients what my goal for surgery would be for them. In this way, we can come up with a common goal, and I can tell patients what is realistic and what is not. A picture is worth a thousand words.

Method Not As Important As Outcome

There is more than one way to get a result with rhinoplasty. I would not be as concerned with how the procedure is to be done as ensuring that you and your surgeon are on the same page as to the desired outcome. If the surgeon can image what things might look like that would be helpful.

D.J. Verret, MD

3 reviews

Dallas Facial Plastic Surgeon

innovationsfps.com

Rhinoplasty consultations

Surgeons tend to do what they are most comfortable with, and that can vary, but many times, that's all chaff. The wheat is the results, but you won't know it until you get the surgery! The problem is that people think cosmetic surgery is a consumer good, and you can essentially shop around like any other consumer good. That may be true, but you can't so easily return the product once you bought it! There is a lot of nuance in this field, and it took us years to get good... more

Rhinoplasty consults

In general, I believe most anesthesiologists and plastic surgeons prefer general anesthesia with rhinoplasty in order to protect your airway. Please don't feel overwhelmed - rhinoplasty is an art. Every surgeon like every sculptor may have a different plan to get you the look you want. There is no necessary right or wrong answer. The most important thing is for you and your surgeon to have a good understanding of what you personally would like your nose to look... more

Rhinoplasty anesthesia and nose fracturing

The type of anesthesia a surgeon likes to use depends a lot on their personal preferences/experience and on what maneuvers need to be done. Minor refinements can be done under local anesthesia (numbing injection) if the patient wants. I prefer using general anesthesia for most of my rhinoplasty cases. Most are extensive enough that I like to have the airway protected. The question of whether osteotomies need to be done is better answered after seeing your nose. They are typically done if... more

Whether or not to make osteotomies ("break nose") during Rhinoplasty

These are good questions you raise. As far as the anesthesia: a skilled anesthesiologist or crna working with an experienced surgeon can do a fine job using IV sedation, however some anesthesiologists are nervous about "sharing an unprotected airway" with the surgeon, and would prefer to have a closed circuit (breathing tube or intubation). Your IV sedation doctor should have the ability to intubate you if necessary, and the office must be accredited . A... more

Roy A. David, MD

11 reviews

San Diego Facial Plastic Surgeon

General and break it!

I typically use general anesthesia for most of my procedures. I think that general anestheis with a tube is a safer option than an unsecure airway with a sedated patient (and fluid dripping into the throat). Be careful of surgeons that want to do a sedation in their office! It is best to be in an accredited facilty. Most rhinoplasty surgeries involve fracturing the bone, esepcaily if there is a hump or any type of narrowing the nose. It is a rare caes that... more

Nose Job options

I can understand your quandary. The anesthesia may not be a problem. Either Conscious Sedation (you awake with IV Sedation) or General Anesthesia (intubated and the anesthesiologist controlling your breathing) work well for this. I personally use General, but this is just my and most of my patient’s preference. The one thing you need to ask is if the surgeon who uses IV Sedation could use General anesthesia if you preferred. If not, this means that he/she is not operating in a... more

Overwhelmed by nose job consults

It can be easy to become overwhelmed after several rhinoplasty consults, and resolving differences of opinion is often no possible. Focusing on the technical details, anesthesia type, pattern of fractures, open or closed, can distract you from the bottom line. The important question is how do you wish your nose to look, and which surgeon give you the confidence that he will get you there. Look over the before and afters on the practice website, and go over computer images of how proposed... more

Consensus for my nose job?

You will likely never get two consults that are exactly the same. Every surgeon and anesthesiologist will do things a little differently. Choose who you trust and then trust him por her to do what they are commfortable with and what they think is best for you.

Rhinoplasty anesthesia, and bone fracturing (osteotomies)

Don't worry too much about anesthesia. I have patients under general anesthesia for rhinoplasty, but there are a lot of good surgeons who don't. The question about osteotomies is a bit bigger and more important. This will definitely have a visible affect on the shape of your upper nose. If you have a hump that is being lowered, you almost certainly will need infracturing of the bones. It is impossible to give you good direction without at least pictures (an exam... more

Anesthesia and rhinoplasty

Every surgeon does things a bit differently. Some prefer general others prefer seddation. As for nasal bone infracturing, that really depends upon the goals of surgery.

Steven Wallach, MD

12 reviews

Manhattan Plastic Surgeon

Overwhelmed After my Nose Job Consults

I believe that for the patient safety general anesthesia with endotracheal intubation allows excellent control of the airway and therefor it is my technique of choice . If you only need tip rhinoplasty then no fracturing of the nasal bones is necessary. Any lowering of the nasal dorsum (hump removal) will require osteotomies(breaking) of the nasal bones and infracturing.

Rhinoplasty

If you go to 10 plastic surgeons you will likely hear 10 different ideas on how to approach your nose. If you are removing a bump then osteotomies are usually necessary. I would make sure to see some before and after photos and see if what you think looks good and what your doctor thinks looks good is on the same page. This is probably the most important thing, because in the end all you want is good result done in a safe manner. I personally have 2 different anesthesiologists I work with... more

Overwhelmed After my Nose Job Consults

You will have to decide which surgeon does a better job and you can trust. Once, you have made that choice, then you will have to allow him/her to make the decisions about the technical aspects of the surgery. The best way to choose a surgeon, is to look at as many before and after photos to get a good idea of what to expect.

Get second opinion can help with feeling overwhelmed

OK, don't be overwhelmed as this is how medicine is praticed. It's an art, not cook book so different Rhinoplasty Surgeons will definitely do things differently and sometimes drastically so. IMHO of performing Rhinoplasty for over 20 years, general anesthesia using an ET Tube is the safest way to protect your airway during a Rhinoplasty and as such, is the only way I perform or recommend Rhinoplasty. As far as whether or not your bones should be broken, I can't... more

Nosejob basics

1- Anesthesia is a choice for physicians. Some will perform it under local anesthesia, some under general and others in a twilight. My concerns are with the ones in the middle. Local anesthesia is safe because the patient can protect his lungs from any blood seeping into the back of his throat. General anesthesia protect the lungs by putting a tube in that stops any secretions from dripping. The twilight anesthesia is the most worrisome for aspiration. 3- Breaking the bones depends not... more

Overwhelmed After my Nose Job Consults

Read Dr. Stephen Prendiville's answer a few times. He is right on track. Alternatively seek 2 more opinions and discuss your previous opinions with thses new evaluations.

Differing Opinions After Rhinoplasty Consults

I realize that these diverging opinions are confusing. Unfortunately, there is no way to give a third opinion without pictures, but I can speak to several of the issues. Intubation: this is a Surgeon preference and one that I share for Rhinoplasty. Do you have not to be intubated? No. However, my preference is to secure the airway with intubation due to the possibility of bleeding and associated concerns about obstruction. Breaking the Nose (Osteotomies):... more

Overwhelmed After my Nose Job Consults

Intubation during enaesthesia for rhinoplasty makes the procedure safer and more comfortable for the patient, regardless whether the nasal bones have to be re-positioned or not. It sounds like you would benefit from a third opinion.

So many options

As you are quickly learning almost all plastic surgery procedures have multiple variations to get the same or similar results. If you feel that both surgeons understood your wishes for improvement then I would go with the one you felt most comfortable with. I personally use general anesthesia during my rhinoplasties but it's possible to do iv sedation in some cases. Breaking the bone is common to narrow the nasal width but if you are close to an optimal width I could see how both... more

Mahlon Kerr, MD

16 reviews

Austin Plastic Surgeon

Rhinoplasty confusion

Excellent question and concerns! I see this all the time in my practice. Rhinoplasty truly involves a leap of faith on the part of the patient as the surgeon is recommending changing the shape of an organ right in the center of your face! Imaging can show only so much and the result is dependent on the thickness of the overlying skin, the underlying bony structure, etc. It is impossible to comment on your specific case in the absence of photographs and a comprehensive consultation,... more

Differing Professional Opinions about my Nose

I wouldn't stress too much about the anesthesia unless you yourself have a definite preference. Rhinoplasty can be expertly performed under either sedation or general anesthesia. Surgeons themselves typically have a preference. For example, I have grown to prefer general anesthesia as it allows me to work more efficiently and I know the patient is unaware of the procedure. However, patients with concerns or fears of general anesthesia can have their procedure with a simple I.V. sedation... more