what is a typical consultation like?
At the end of the day, the goals are to give you a safe, stable nose which you will be able to breath through for your lifetime and to make you happy with the cosmetic result.
I customize each surgical plan and aesthetic goals for every patient individually. My personal mission is to give you the nose you’ve always dreamed of, within the limits of what can safely be accomplished surgically.
How to choose a rhinoplasty surgeon?
Best overall advice I can give is to consider seeing a Facial Plastic Surgeon, ideally one who focuses solely or mostly on noses.
Too often, I see patients that have had surgery on their nose where their breathing problems either don’t improve or actually become worse after surgery.
All Facial Plastic Surgeons have an Otolaryngology (ENT) background. During this training, we gain extensive experience working inside the nose and correcting non-cosmetic breathing issues of all types.Compare this to a general Plastic Surgeon, whose nasal experience is limited since they spend much of the time doing breast, lipo, tummy tucks, etc.
Even a good looking result will be unsatisfactory without being able to properly breath through the nose. Look for a surgeon with extensive experience with nasal breathing to ensure a safe and aesthetically pleasing result.
can a certain look be achieved
My goal 100% of the time is to make the patient happy with their nose, so I try to customize the result based on their desires. During the cosmetic evaluation, I use photoshop morphing software to be able to show a reasonable simulation of the predicted outcome.
Patients often bring photos of other noses they like, which can be helpful for me to learn what type of aesthetic you find most attractive.I will, of course, explain what can / cannot be achieved as well as offer my suggestions based on years of analysis of facial beauty and harmony.
Rhinoplasty is a somewhat unpredictable process which I attempt to make as predictable as possible. While no one can guarantee a specific result, if a patient has specific concerns about their nose, I can focus on those primarily and usually we can find a shared vision that can be accomplished with surgery.
where is surgery performed?
All rhinoplasty surgeries are performed in Aventura Surgery Center, a fully accredited Ambulatory Surgery Center operated by HCA.
what type of anesthesia is used?
The procedures are done strictly under general anesthesia with full time, licensed MD Anesthesiologists. Patients often ask about conscious sedation or even local anesthesia. Many cosmetic surgeons use conscious sedation as a marketing point (often administered by a Nurse Anesthetist and not an MD Anesthesiologist by the way). It sounds better somehow.
What many patients don’t realize is that the medicines used in conscious sedation are exactly the same as the ones for general anesthesia, just in a slightly less quantity. This allows the patient to breathe on their own still versus needing to be intubated for general anesthesia. This might sound beneficial, but if something were to go wrong, a patient would then need to be intubated urgently for airway protection. Intubation during an emergency can be risky and dangerous. Having a patient already intubated is actually safer.
ENT’s are masters of the airway. We are the ones called to perform life saving manuvers during any type of airway emergency. Thus it is from much experience that I truly believe a secure airway with general anesthesia (and MD Anesthesiologists) is the absolute safest way to perform this procedure. I am also present to make sure my patients are as safe as possible should any type of airway issue arise.
what is the day of surgery like?
Patients will go home the same day and should ideally have someone around the first night to assist them if needed.
I almost always perform open rhinoplasty, so you will have sutures on the underside of the nose on the columella and a cast on the bridge.
I do NOT pack the nose, but instead use soft plastic splints with holes in them to allow for as much nasal breathing as possible during the early recovery stages.
How long does the surgery take?
Surgery time can vary dramatically anywhere from 3-8 hours. On average for a primary case, it’s probably about 4-5 hours. Ultimately, this question is more akin to asking how long it takes to paint a painting than asking how long to bake a cake. This process is not cookie cutter (to continue the baking analogy).
I do whatever needs to be done, however long it takes me to make it look as good as it can look (within the safety limits of anesthesia of course).
OPEN or CLOSED RHINOPLASTY?
I often see surgeons advertise “no scar rhinoplasty” or some other similar marketing phrase. Essentially, these surgeons are referring to closed rhinoplasty. I only perform open rhinoplasty (well 99% of classes).
Why is this and what is the difference?
Well, open rhinoplasty does involve making a small scar in the middle portion of skin between the nostrils, called the columella. The scar is made in an “inverted V” shape so as to create a non-linear scar that is much more difficult to see once it heals.
The advantages of open rhinoplasty are tremendous. Primarily this small incision means that I can now directly view and manipulate under visualization all of the delicate structures of the nose.
This dramatically increases the ability to improve symmetry and create a very precise design. In a game where every half millimeter counts, to me this is an absolute must have.
The disadvantage is actually really minimal. The scar itself heals incredibly well, to the point where after maybe 3-6 months patients often tell me that even they have a hard time seeing it.
WHAT IS THE RECOVERY LIKE?
Most patients, after going through the process, would probably say it wasn’t as bad as they feared going into it. The biggest complaint overall is stuffiness, not usually pain. Most would compare it to having a head cold. The first few days are probably the worst for most patients and then it tends to be pretty smooth sailing from that point on.
The most important part of the recovery is to prevent accidental trauma to the nose. You will have a cast on the nose and you must keep it dry. I have patients sleep elevated 45 degrees and wedged in with pillows or using a neck pillow so they don’t roll over and smash the nose.
I typically see patients on post operative day 4 to remove sutures and then on post operative day 7 to removed the cast and internal splints (little tubes with holes essentially).
is postoperative visit painful?
Most patients are very nervous about this part again generally most would say that it was less painful / stressful / difficult than they expected.
The columellar sutures are removed from the front of the nose on the first post operative visit. Most would describe this sensation akin to having nose hairs pulled out.
The second post operative visit is at one week and this is when the splints and cast are removed. This is usually even easier than the first visit.
what will my nose look like?
The nose will look very swollen initially, but you will notice the basic framework and changes to the nose immediately. At one week, there still is a very significant amount of facial swelling as well. Most of this will settle out over the next few weeks, but the nose will continue to undergo generally subtle changes over the entire first year.
I tell patients as a ballpark that the nose will look okay (70% of swelling gone) at 2 weeks, better at 2 months (90% of swelling gone) and close to final by 6 months. You definitely have to be patient.
HOW LONG IS THE RECOVERY?
This depends on which aspect of the recovery you consider. Dr. Murray requires at least one week of from school / work. You will be able to eat whatever you want and walk around, but you need to take it easy. There is also a 3 week limit on heavy lifting or strenuous exercise to limit the risk of any bleeding that could arise.
Most people are ready to return to their normal life at the one week point, however you may still be bruised and quite swollen at this point.
If your appearance is not important or critical for you, then you should be fine at one week. However, anyone who doesn’t want the potential visibility of under eye bruising or anything noticeable should probably plan on being out 10-14 days just in case.