How a nose job works (step-by-step) [Shannon O'Brien, MD, Portland]

Eva Sheie (00:00):
You're listening to Where Before Meets After. How is rhinoplasty done and what are the techniques that you do?

Dr. O'Brien (00:08):
Rhinoplasties involve an incision at the bottom of the nose and inside the nose. And through that, you can correct some of the bony shape. You can reduce or smooth out a bump on the back of the nose. You can change the cartilages at the tip. If somebody feels like their nose is too wide, you can make incisions along the side of the nose in what's called the alert groove. And that allows you to sort of narrow the nostrils a little bit. You can change the shape of the nostrils some. You can improve symmetry. Some people have a twisted tip that you can kind of straighten out. All these things involve different types of support or suturing or what have you that goes on inside, but it's actually a very complex procedure. And so there are a lot of different tools and tricks that you use along the way.

Eva Sheie (01:06):
How long does it take to recover from rhinoplasty and when can you start to go out?

Dr. O'Brien (01:10):
Most people are feeling like they can go out after rhinoplasty after about a week. At that point, I've got the splint off. Any stitches that they may have are out. They're swelling, although they will still have some for months and months. Usually because rhinoplasties are making things smaller, even when they're swollen, their nose still looks smaller than it was to begin with. And so you can still see a change and they feel presentable. Even bruising is usually mild enough that if you do still have some after a week, it can be covered pretty easily with makeup.

Eva Sheie (01:49):
How often do you see your rhinoplasty patients in that post-op period?

Dr. O'Brien (01:54):
They come in a week out, two weeks out, certainly three months out. And then down the line, we kind of wait till all the swelling's down and we'll see them again. Certainly if they have any questions, but oftentimes it's just to come back and revisit and say, "Yep, it looks great. Looks like what we thought."

Eva Sheie (02:13):
How long should you expect to have some swelling? What does that timeline look like after surgery?

Dr. O'Brien (02:20):
Rhinoplasties take a good year to know that all the swelling is gone. They don't look swollen and unpresentable. It's just that the big reveal is not a single big reveal. It is, "Wow, I can see that change when the splint comes off." And then it's months of allowing the fine swelling and smoothing and softening of the skin around the bone cartilage to all settle out before they actually know that that's their final result.

Eva Sheie (02:53):
So if some kind of revision would be necessary in the future, at what point would you even entertain that discussion?

Dr. O'Brien (03:02):
Usually for revisionary conversations, it's months down the line, six months, maybe, maybe closer to a year. It just depends on how much swelling it feels like is still there, what it is that we're talking about. The skin at the tip of the nose has an oilier component and it's thicker and it holds onto swelling a lot more than some of the thinner skin and the upper nose and around the face. And so certainly if people feel like their tip was supposed to be smaller and they're three, four, five months out and they have sort of thicker, oilier skin, they're not done. And so that conversation really just has to be pushed out until they are at a place where you can really feel like that swelling is down enough and then you can have that conversation.

Eva Sheie (03:55):
Is there anything non-surgical that you can do to change the shape of someone's nose?

Dr. O'Brien (04:00):
There are a lot of people that do the liquid rhinoplasty or add a lot of filler, but I think the risk is high and it doesn't take very many times of getting filler in your nose before it starts to add up to why didn't I just have surgery in the first place financially because they continue to have to come back. And especially if somebody's young, they're looking at years and years of doing the filler and taking on the risk of adding filler to the nose. And I think that that tends to sway people just to move forward with surgery.

Eva Sheie (04:29):
What's your approach to rhinoplasty?

Dr. O'Brien (04:33):
So when I'm assessing a patient for rhinoplasty, I do think it's important to really not only hear what their goals are, but also to try to preserve them as a person and their heritage, their ethnicity. And sometimes people say, "I have my dad's nose and I wish I didn't," and because they have this bump on their nose. And that's a fair thing to change, but I mean, when somebody comes in, a lot of times their face, their features, they look a certain way and they shouldn't have the same nose as everybody else. They should have the nose that is maximized for their beauty, not just made to look like somebody else's.

Eva Sheie (05:20):
Thanks for listening. I'm your host, Eva Sheie. Follow the show and submit questions for our experts at wherebeforemeetsafter.com. Where Before Meets After is a production of The Axis.