Contact the Beverly Hills Rhinoplasty Surgeon

Dr. Nassif's thoughts on non-surgical rhinoplasty:

"I have recently had some patients ask me about non surgical rhinoplasty done with fillers.  While filler and injections are a good temporary fix for a post op irregularities like dents, but I don’t like them for a formal rhinoplasty. The injections can cause some irregularities. However, it maybe ok for an over-resected hump where you need to add more of the hump back."

"For more complicated cases like Open Roof Deformities or Inverted V deformities the patient will need to have a revision surgery."

Before undergoing a surgical procedure like rhinoplasty, certain medical tests are often needed.  These tests are run to identify any issues that may prevent you from having surgery:

Physical: A general physical done by your primary care physician may be required.

Electrocardiogram: An electrocardiogram, also called an EKG or ECG, is done to measure the electrical signals that control the rhythm of your heart.  An EKG tests for any irregularities in your heartbeat as well as evidence of past heart attacks.  Additional testing may be required if irregularities are detected during this test.

Complete Blood Count: A CBC is a blood count test that measures thirteen blood levels in the body.  This blood test can reveal blood deficiencies or disorders that could affect the safety of your procedure and your recovery.  Fore example, inadequate platelet levels can lead to increased bruising and bleeding.  Low hemoglobin levels can slow the healing process.  While low levels of white blood cells can lead to increased infection after surgery.

The following is a list of normal side effects after Rhinoplasty surgery.

Swelling – After surgery, swelling of the nose typically peeks 36 to 48 hours after your procedure.  Swelling is usually the most pronounced in the mornings.  And, while most swelling will reduce after about two weeks, it is common to have swelling for a year after surgery.

Bruising – Bruising is common around the eyes and on the cheeks, especially if the nasal bones have been fractured during surgery.  Bruising peeks about two days after surgery and usually resolves in about two weeks.

Pain – Mild discomfort is common after surgery, but most likely will decrease two to three days after surgery.

Nasal Blockage – It is common to have nasal blockage after rhinoplasty and often feels like a head cold.  Cold-like symptoms typically last for about six weeks after surgery.

Here are a few tips to make your rhinoplasty recovery easier:

• Plan on taking about 10 day to two weeks off of work or school
• A recliner or pillows to prop yourself up on will help you sleep elevated
• Make sure the items that you’ll need as you recover are at waist height, that way you won’t have to bend over to pick up items
• Place a table with the recovery items you need next to your bed, this will help you from having to get up and down when you should be resting
• Make sure to go grocery shopping to stock up on soft foods like soups, pudding, gelatin and protein drinks
• Stock up on books, magazines, cds, DVDs and other items to help keep you entertained while you are recovering

There are a few factors to consider when you are scheduling your rhinoplasty surgery. 

Are you having your surgery done for a special event – a wedding, graduation or reunion?  Be sure to plan on having your procedure several months in advance.  It may take anywhere from six months to a year for swelling to go down.  Everyone’s healing is different.

Nasal obstruction can be due to valve collapse, narrowing of the airway when the bones are fractured, residual deviated septum or big turbinates.  A good examination by your surgeon should help with this.

If you have a nasal valve collapse, you need to have that exact region built up with cartilage (septum, ear or rib).  A good way to diagnose this is to place the hard part of the Q-tip in the airway and elevate the nasal valve and see if your breathing improves. Please note, your doctor should do this. You may also need to have your turbinates reduced.

 In addition to their credentials and experience, feeling comfortable with your surgeon is key to a successful rhinoplasty surgery.  When you are more comfortable with your surgeon, you are more likely to have good communication and a great outcome.  Here are a few things to look for when evaluating a surgeon:

o  Are you encouraged to ask questions?

o  Do you feel the surgeon is really listening to your concerns, or are they offering a one-size fits all approach to surgery?

o  Do you feel comfortable with the surgeon?

o  Did the doctor answer all your questions?

o  Did you feel rushed or did the surgeon take their time to evaluate your nose and go over your concerns?

There are so many questions to ask leading up to rhinoplasty surgery.  Be sure to make a list of questions to go over with your doctor at your pre-operative appointment. Here are some to include:

• Which medications, vitamins, herbs and supplements should you avoid


• What medications should you start taking prior and after surgery


• What medical test do you need to schedule before your procedure


• What can you do to start preparing to recovery, for example what items and medications should you stock up on


• Will you be able to wear eyeglasses after surgery

Before surgery there are a number of things patients should avoid.  Three tips Dr. Nassif always tells his patients are the following:

If our patient is a smoker, we want them to immediately stop smoking.  In face, we ask that our patients stop smoking for at least six weeks before surgery. 

In addition, we want to make sure that patients are not drinking alcohol, since alcohol will thin the blood and cause more bleeding. 

We also don’t want them lying out in the sun getting sunburns or tans before surgery.

Sleeping on your back for a few weeks after surgery is the best way to prevent pressure on your healing nose.

If you sleep on your side, your nose is pressed against a pillow which causes pressure on the nose and could push your new sutures out of shape.  Propping yourself up with several pillows or sleeping in a recliner are great options to help you sleep on your back.

Your medical history is an important part of your rhinoplasty exam, be prepared to talk to your doctor the following:

• Past rhinoplasty procedures
• Other previous surgeries, both cosmetic and non-cosmetic
• Any nasal injuries
• Problems with breathing
• Allergy or asthma issues
• Past and current medical conditions
• Vitamins, supplements and drugs that you are taking
• If you use nasal sprays
• Smoking habits

During a rhinoplasty consultation, you will fill out medical forms and undergo a physical exam of your nose as well as going over several topics relating to your surgery.  For example:

• Your medical history
• What changes you would like to make to your nose
• Why you would like to have a rhinoplasty
• Rhinoplasty techniques and the types of incisions
• Results you can expect from your surgery
• Side effects from surgery, as well as risks and complications
• Length of the procedure
• The type of anesthesia and who will be administering the anesthesia
• Where the surgery will take place – at a surgery center or at a hospital
• Preoperative instructions
• Postoperative instructions
• The length of recovery and healing time before you see your final results
• The number of follow-up visits
• The cost of the surgery and financing options

You'll be advised to not wear any makeup, wigs or jewelry - including your your wedding rings, earrings and watches - on the day of your surgery.

Remove all of your piercings, contact lenses and eyeglasses.

Be sure to discuss issues regarding your eyeglasses with your doctor prior to surgery.  It is recommended that you not wear glasses for about a week after surgery.  In some cases, you maybe be able to tape your glasses to your forehead, this is to insure that your nose is protected while it is healing.

Remember comfort is key the day of surgery.

A shirt, sweatshirt or sweater that zips or buttons up the front will help you avoid having to pull it on or off over your tender nose.

Elastic waistband or drawstring pants, like jogging pants and pajama bottoms, are recommended.  You also should wear shoes that you can slip in and out of easily.

Some of our Rhinoplasty patients are also looking for the latest in injectable fillers for their facial wrinkles and frown lines.  Some new fillers can even be used to add fullness to the cheek and chin areas.

Radiesse, a gel-like injectable filler, can treat many of these problem areas.  It’s thicker than other fillers and great to use for smile lines, chin and cheek augmentation. You can place this product near the bone and it can last up to a year or two.

Radiesse is made out of calcium hydroxyapetite which is much different than a hyaluronic acid (which can be found in Perlane, Restylane, Juvederm).  According to the makers of Radiesse, when injected the dermal filler begins to stimulate collagen production and encourages tissue growth around the injection sites. 

One draw back to Radiesse, it can produce nodules and so it is not used for lips.