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Updated 06/13/07
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Nose
Reshaping (Rhinoplasty)
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Dr.
Michael Kremer, M.D., featured as an "Expert
in Munich" for cosmetic rhinoplasty
in the March 2003 issue of "PRINZ"
city magazine

translated
from PRINZ head article "Operation
Beauty / The Experts in Munich / Nose",
p 88, with friendly permission by PRINZ
Munich:
DR.
KREMER
CLINIC FOR
COSMETIC PLASTIC SURGERY...
SURGICAL EXPERIENCE Dr. Kremer (board-certified
plastic surgeon), US-trained in
craniofacial surgery with 100-150
rhinoplasty procedures per year is an expert
in cosmetic nose reshaping.
TECHNIQUES Atraumatic, bloodless
surgical techniques with minimal scar
formation from the US and Brazil...
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For
many people, a prominent, asymmetric,
bumpy or undesirable nose leads to
extreme self-consciousness. One of
the most common of all cosmetic
procedures, rhinoplasty
(nose surgery) is used to improve
the appearance and possibly the
function of the nose.
If
you're considering nasal reshaping,
the following information will
provide you with a good
introduction to the procedure.
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For
more detailed information about
how this procedure may help you,
we recommend that you schedule a
personal consultation with Dr. Kremer / Dr. Zettl.
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What
are some of the most common
benefits of the surgery ?
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Rhinoplasty
can correct a variety of
conditions including an
over-sized nose, a hump on the
bridge or an undesirable shape
of the nasal tip.
Both frontal and profile views
of the nose are corrected to
complement other facial
features, and to provide a
harmonic balance of
proportions.
Rhinoplasty
can also be used to correct
for breathing problems caused
by narrow or partially
obstructed nostrils, a
deviated septum or
hypertrophied turbinates.
Children
with congenital
cleft lip and palate
deformities are candidates for
early and repeated nose
reshaping procedures in order
to enhance their social
functioning and integration
among peers.
If you are self-conscious
about your nose, this surgery
can open up new possibilities
for changing your appearance
and your self-image.
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What
will happen at the initial
consultation?
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During
the consultation, Dr. Kremer / Dr. Zettl
will discuss the changes that
you would like to make in your
appearance. Because the
appearance of your nose is a
matter of personal perception
and preferences, you will need
to discuss your concerns in
detail with Dr. Kremer / Dr. Zettl.
Dr. Kremer / Dr. Zettl may also point out
other problems areas. For
example, some patients who
want rhinoplasty also have
weak chins or flat cheekbones.
In these cases, chin
or cheekbone
implants might be considered
as a part of the operative
plan.
A directed physical examination
of your nose and other facial
features will be done during
your visit. This will involve
identifying functional as well
as cosmetic issues. It is
important for you to provide
any history of trauma or
surgery that you have had to
your nose. You should also
inform Dr. Kremer / Dr. Zettl of any allergy problems.
Computer imaging is a very
useful adjunct to visualizing
what you may look like after
the procedure. While not a
guarantee of results, it is a
great benefit in preoperative
planning.
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How
is a rhinoplasty performed?
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Rhinoplasty
is usually performed under a general
anesthetic. Incisions are made
inside the rim of the
nostrils. Soft tissues of the nose
are then separated from the
underlying structures, and the
cartilage and bone causing the
deformity are reshaped.
The exact nature of that
sculpting depends on your
particular problem, and should
be discussed at the
consultation. If the nose is
being reduced in size, the
nasal bones are carefully
fractured.
Breathing problems may be
improved by a procedure called
septoplasty,
in which the obstructions are
removed.
There are two major ways to
perform a rhinoplasty: the
closed and the open
techniques. The open technique
includes an incision across
the columella, the small skin
between the two nostrils. With this type of
rhinoplasty, the swelling
takes significantly longer to
subside. The scar is most
often quite small and fades
rapidly, however, it may
always be visible. The closed technique
does not require an external
incision, heals more quickly
and is associated with less
postoperative swelling than the open
technique.
Dr. Kremer / Dr. Zettl
almost always perform
the less aggressive closed
rhinoplasty technique.
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How
long does the surgery take?
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The
procedure usually takes
1.5-2.5 hours, but on rare
occasions it may take longer.
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Will
I need to stay in a hospital?
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Not
necessarily. This procedure
can be performed in the
hospital or in an outpatient
surgical suite.
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How
much pain is there?
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Surprisingly,
there is very little pain
after rhinoplasty and most
patients require only mild
analgesics. A frequently applied
nasal packing as well as the
postoperative swelling obstruct
the nasal airway for a couple of
days, which by some Patients is
appreciated as unpleasant. In
certain patients Dr. Kremer / Dr. Zettl
may
be able to not insert a nasal
packing. Dr. Kremer / Dr. Zettl will decide
from case to case.
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What
can I expect after surgery?
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An
external
splint will be applied and the nose will be
packed lightly with a
medicated gauze. The
stitches within the nose are self-absorbing
and do not require removal. No
stitches have to be
removed.
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What
is the recovery period like?
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Although there is
some pain in the first 24
hours, after this there is
usually just a feeling of
pressure and stuffiness. You
will still look puffy and
swollen. You should keep your
head elevated above the level
of your heart for the first
few days to reduce swelling.
Bruising around the eyes is to
be expected, usually peaking
around 72 hours and subsiding
in 7-10 days.
Cold
compresses will help to reduce
the swelling around the eyes.
You may have a little bleeding
too, so you will probably want
to change your gauze bandages
a few times a day for the
first several days.
After
2-3 days, the nasal packing will be removed.
After 2 weeks the nasal
splint will be removed. You will still need
to be careful to not blow your
nose for about two weeks. Eyeglasses
should be taped to the
forehead, off the bridge of
the nose, for the first 6
weeks.
You
may not be completely back to
normal for several weeks. Your
nose might be numb, especially
if there have been
considerable changes made to
the tip. You should be gentle when
washing your face, and avoid
strenuous activity for about 4
weeks.
Read
our Postoperative
Care Form from the comfort of
your home NOW!
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What
is the long term outcome like for most
people?
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It
is common to feel dissatisfied
with the appearance of the
nose in the immediate
post-operative period. At this
point, the nose is still quite
swollen, and much of the
detail is still not visible
enough to appreciate. It is
wise to take a wait-and-see
approach since the elasticity
of the tissues, the blood
flow, the thickness of the
skin and the appearance of the
nose will change significantly
during the first three months
– even up to the first year. It is important to be
patient during this period of
time. Rushing to perform a
second operation during the
first nine to twelve months is
almost always a mistake.
Many
people seem to blossom with
positive personality changes
after this procedure. A new
sense of confidence is the
most frequently observed
change. Temporary blues after
the procedure have also been
reported by some patients as rhinoplasty
changes the appearance that
you’ve grown accustomed to.
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Risks
and limitations:
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Rhinoplasty
will provide significant
improvements in the appearance
of the nose for the vast
majority of patients although,
in occasional cases, a
secondary correction may be
required. There are risks with
all surgical procedures. You
should discuss all benefits
and risks with Dr. Kremer / Dr. Zettl.
Read
our Specific
Surgical Risks Form from the
comfort of your home NOW!
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Be
sure to:
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- Tell
Dr. Kremer / Dr. Zettl about any
allergies you have (to
foods, drugs,
environmental elements)
- Tell
Dr. Kremer / Dr. Zettl if you have a
history of bad scarring,
such as keloids.
- Tell
Dr. Kremer / Dr. Zettl about all
medications, herbal
supplements or natural
supplements you are taking
(both prescription and
non-prescription)
- Carefully
follow any instructions Dr. Kremer / Dr. Zettl
gives you
regarding eating and
drinking and smoking.
- Avoid
aspirin and
aspirin-containing
medicines for two weeks
prior to surgery.
- Arrange
for someone to drive you
home after surgery or
after discharge from the
hospital.
- Please
inform Dr. Kremer / Dr. Zettl
immediately in case you
should experience fever or
symptoms of an infection
after surgery.
- Please
use a cooling mask or ice
packs to reduce swelling an
discomfort after surgery.
- Refrain
from strenuous physical
activities during the first
days after surgery.
The
information on this web site
is only intended as an
introduction to this procedure
and should not be used to
determine whether you will
have the procedure performed
nor as a guarantee of the
result.
The
best method of determining
your personal options is to
schedule a personal
consultation with Dr. Kremer / Dr. Zettl.
He will be able to answer
specific questions related to
your situation.
Rhinoplasty Resources: Learn more about rhinoplasty.
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To
schedule your personal consultation
appointment, please call us at
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