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Rhinoplasty FAQs

Q – What is a rhinoplasty?

Rhinoplasty is a term given to the surgical procedure intended to improve the shape, size, and function of the nose. A complete procedure will address every aspect of its appearance. This typically involves reducing a hump, straightening the nose, making the nose smaller, improving the definition and symmetry of the tip, and raising the tip into a more pleasing position. Other details can also be addressed, including narrowing the nostrils or nasal base and supporting a nose that has lost its structure.

A rhinoplasty may also be performed to improve breathing. This is usually done at the same time that the outside appearance is improved. Techniques that help breathing include septoplasty, or straightening the structure inside the nasal airway, placing supporting grafts that open the nasal valves, and improving the support of flaccid nostrils. This portion of a rhinoplasty is usually covered by insurance.

Q-What are the different types of rhinoplasty?

In general there are two types or surgical approaches to a rhinoplasty. The first is the endonasal technique. This is the classic technique where incisions are placed completely inside the nose. Although this is an excellent option for patients with a minimal deformity or a simple cosmetic concern, it is limited by the amount of exposure the surgeon can achieve. The more common technique is an external technique that utilizes a small incision placed between the nostrils. This provides the surgeon with excellent exposure allowing for the precise placement of grafts and detailed refinement of the nasal tip. The small incision is placed in such a way that it is virtually imperceptible even a few weeks after the procedure. During your consultation, each of these methods will be discussed in detail and the best option for you will be decided.

Q-Will insurance cover the cost of a rhinoplasty?

Although all insurance companies are different, most will provide coverage for patients who have a functional breathing problem or a severe nasal deformity resulting from trauma or medical condition. Insurance companies will not cover a rhinoplasty performed for cosmetic purposes.

Many patients with breathing problems also elect to undergo a cosmetic procedure at the same time. By doing so, insurance will assist in paying for that portion of the procedure, operating room costs and anesthesia fees that is associated with correction of the function of the nose.

Q-At what age should I consider a rhinoplasty?

Younger patients can consider surgery after they have reached puberty and the nose has completed growth. This is usually around the age of15 in girls and 16 in boys. Otherwise, a rhinoplasty can be performed at any age in adults.

Q-How long does the procedure take?

The typical length of time required to perform a rhinoplasty averages about 2 hrs. This depends on the severity of the deformity and the surgical technique chosen. Revision surgery generally requires a longer operating time.

Q-What is a primary rhinoplasty?

A primary rhinoplasty is performed on patients who have never had nose surgery before. The nose will not have scar tissue or complex abnormalities seen in revision rhinoplasty patients.

Q-What is a revision rhinoplasty?

Revision rhinoplasty is performed on patients who have already had a rhinoplasty by another surgeon. The revision surgery is performed to correct a problem that was not addressed during the previous surgery or for those who have developed scarring or breathing difficulties.

Q-What will happen during a consultation for rhinoplasty?

During your consultation, Dr. Sandel will discuss in detail your expectations regarding the procedure. A complete medical history and nasal examination will be performed. You will also have your pictures taken and digital computer imaging will be done. This will allow you to see the results in your appearance after changing the shape of the nose and improve communication between you and Dr. Sandel regarding your cosmetic goals.

Q-Where does the rhinoplasty procedure take place?

Rhinoplasty may take place in an outpatient surgical center, or a hospital.

Q-What type of anesthesia is usually used for rhinoplasty?

The type of anesthesia commonly used is either local anesthesia with sedation or general anesthesia.

Q-How much pain is associated with this procedure?

Sharp pain is uncommon after the procedure. The patient should expect a dull ache during the first few days. This can be controlled with a light prescription pain medication that can be quickly replaced by over-the-counter medications.

Q-Will I have packing in my nose after the rhinoplasty?

Dr. Sandel does not routinely pack the nose after nasal procedures. He uses a technique that prevents bleeding without the use of packs.

Q-What is the recovery like after rhinoplasty?

After your procedure, a splint will be applied to the nose. You will also have a small drip pad under the nose to catch drainage that will occur. On the first day after surgery, you will be seen in the office and the drip pad will be removed. You will be asked to apply cold compresses to the nose and face over the next several days. The nasal splint will be removed after 7 days. After this point you may continue to have swelling that will gradually subside with time.

Q-How much time will I need to take off from work?

Patients may wish to take one week off from work, although some may wish to return sooner with the nasal splint in place.

Q-When can I begin to exercise after my rhinoplasty procedure?

Patients may be able to return to light exercise after one week. Full strenuous activity or exercise should be avoided until 2-3 weeks.

Q-What are the risks or complications of rhinoplasty surgery?

Complications after surgery are rare but may include bleeding, infection, and incomplete correction of the nose. There are risks associated with having anesthesia that will be discussed by your anesthesiologist at the time of the surgery. There is also the potential that you may require additional surgery or a second procedure.

Q-What should I look for in a surgeon to perform my rhinoplasty?

Rhinoplasty is one of the most difficult and complex cosmetic procedures to perform. It requires a level of skill and attention to detail that are only achieved after extensive training specifically in nasal surgery. It is of the utmost importance that you do your homework and carefully choose the surgeon to perform your procedure. Your surgeon should have a background in Otolaryngology, Head and Neck Surgery. Unlike any other specialty, surgeons board certified by the American Academy of Otolaryngology have undergone years of training in the surgical treatment of diseases of the nose, both inside and out. Their surgical training is exclusive to the face, head and neck, which encompass some of the most difficult anatomy in the human body.

In addition, he or she must also have fellowship level training in cosmetic surgery certified by the American Board of Facial Plastic and Reconstructive Surgery. A facial plastic surgery fellowship goes one step beyond the traditional residency training to give that person experience in state of the art procedures in cosmetic surgery. This level of training usually puts them at the forefront of the specialty and makes them leaders of the field of facial plastic surgery.

Forehead Lift FAQs

Q. I am interested in rejuvenating my eyes. Why should I also consider a forehead lift?

In some patients, a part of rejuvenating the eyes involves repositioning the eyebrows and softening the forehead lines. Low-lying eyebrows can affect the amount and redundancy of the upper eyelid skin. This sagging of the forehead pushes excess skin onto the upper eyelid. If a patient simply had surgery of the upper eyelid without addressing the forehead, the low-lying position of the eyebrow will be accentuated, resulting in a tired appearance. The goal of refreshing the eyes is to open them, making you look less tired. A forehead lift can play a large role in this.

Q. Will my eyebrows look too pulled? I don’t want to have a surprised appearance.

If the forehead lift is done properly, the eyebrows will simply be elevated into a more natural position. This lift will soften the horizontal lines of the forehead and open the outer portion of the eyes.

Facelift FAQs

Q. What types of facelifts are performed by Dr. Sandel?

There are several different types or techniques used to perform facelifts. Although each patient is different, the most common facelift technique used is called the SMAS flap technique combined with a corset platysmaplasty. This provides patients with a long lasting lift without giving them an unnatural or pulled appearance. The muscle layer just beneath the skin is called the SMAS (superficial musculoaponeurotic system). This is the layer that is lifted. The skin is simply re-draped over the lift in a very natural way.

The corset platysmaplasty is a term used to describe the treatment of the neck and the angle beneath the chin and jawline. This is the key to defining the chin-neck angle, getting rid of the bands of skin, and supporting the facelift. Only a very small incision beneath the chin is required.

Q. What incisions are required in order to perform a facelift?

Facelift incisions are made so that they can be hidden as completely as possible. The most noticeable scarring can occur in front of the ear. Because of this, Dr. Sandel designs this incision to hug the earlobe in a natural skin crease, extending inside the front of the ear, and curving around into the hairline. In men, this incision is left in front of the ear to avoid facial hair growth on the ear. The incision behind the ear is placed just above the ear crease to prevent scar bands. It is then gently extended into the hairline high enough to not be noticeable.

There is also a small incision placed just beneath the chin in order to effectively treat the neck. The incision is placed in the lower chin crease and is virtually invisible after it heals.

Dr. Sandel wants patients to be to able to style their hair any way they like after the procedure. Thus, it is crucial to keep scarring minimized and well hidden.

Q. What is the recovery period like after a facelift?

Dr. Sandel suggests that patients expect to be off work or in a restful environment for the first week after the surgery. Many patients will have mild to moderate swelling and bruising in the lower face and neck during this time period. The second day after surgery, we encourage our patients to shower and wash their hair. You may be taking a mild prescription pain medication during the first few days. This can be quickly exchanged for an over the counter pain reliever as the patient is able.

After the first week, all sutures are removed. You will be asked to continue to keep your incision sites clean with peroxide and moist with Aquaphor on a daily basis. On the tenth day, we have our patients undergo a complementary make up sessions. At this point, you will feel like yourself and be interested in returning to work. Although you may have some residual swelling, most people around you will not notice. The healing process will continue for the next few months, and we will follow your progress for one full year.

Q. Does Dr Sandel perform a one-hour or “lunchtime” facelift?

Although some patients are candidates for cheek lifts, neck lifts, or treatment of the jowls it is almost impossible to obtain a full facelift result with a one-hour minimal procedure. Many of these types of “minimum” facelifts are skin-only lifts or suture lifts. These procedures do little to address the neck and jowls. They also have a much greater tendency to break down after a short period of time and thus not give lasting results. If it sounds too good to be true, it probably is.

Dr. Sandel’s philosophy is to only offer treatments that have proven results. His goal is to provide results that last. In the long run, it can be much more expensive to undergo multiple small or “minimal” procedures rather than have your cosmetic concerns addressed appropriately the first time.

Q. What are the risks or complications associated with a facelift?

Although very rare, there are risks associated with any procedure. The risks specific to facelifts include bleeding or hematoma formation, infection, skin breakdown (especially in smokers), mild loss of sensation, and the possibility of a repeat operation. Dr. Sandel takes great care to minimize these risks throughout your surgery and during your time of healing. He will go through these in detail at the time of your consultation.

Midface Lift FAQs

Q. What is a midface lift and how is it different than a facelift?

A facelift usually addresses the lower 1/3 of the face and the upper 1/2 of the neck. A midface lift is more of a cheek lift (middle 1/3 of the face). Many times the midface lift is performed in conjunction with a lower eyelid blepharoplasty.

Q. Who is a candidate for a midface lift?

Candidates for a midface lift are those who desire an improved appearance in the tone, firmness, and youthfulness to the midface and cheeks. These patients generally have cheeks that droop below the cheekbone. This pulls on the lower eyelid making it appear elongated. A hollowness can also be found beneath the eyelid (where the cheek should be).

Eyelid Surgery (Blepharoplasty) FAQs

Q. What is a blepharoplasty?

Blepharoplasty, also known as eyelid surgery, is a surgical procedure which involves the removal of excess fat, skin and muscle of the eyelids. It is performed in order to correct droopiness of the upper eyelids and puffiness or bags of the lower eyelids. The surgery can be perfomed in many different ways depending on the problem that needs to be corrected. Discuss your concerns with Dr. Sandel and he can explain the differences of each technique. This procedure is commonly performed on both the upper and lower eyelids but may be performed independently.

Q. Who is the best candidate for blepharoplasty?

Good candidates for blepharoplasty include men and women who are interested in improving the appearance of their eyes. Your eyes can say a lot about you, your health, and your well being. Commonly patients wish to look less tired. Patients with excessive upper eyelid fullness and/or skin are excellent candidates. Also, those with puffiness of the lower eyelids, redundant folds of skin, and hollowness of the tear trough are also excellent candidates. All patients should be physically healthy and have realistic goals and expectations.

Q. What can I expect during a consultation for blepharoplasty?

You will meet with Dr. Sandel for the consultation. During the consultation for blepharoplasty, our surgeon will discuss your goals and expectations, take a thorough medical history. He or she should also explain all details of the surgery including the technique, the anesthesia, the facility, the costs and the risks.

Q. Where is blepharoplasty surgery performed?

Blepharoplasty is usually performed in an outpatient surgery center under mild sedation. It can also be performed in the office under local anesthesia in certain circumstances.

Q. What type of anesthesia is used for blepharoplasty?

Blepharoplasty may be performed with either local anesthesia and sedation or with general anesthesia.

Q. How is a blepharoplasty performed?

There are many techniques for upper and lower eyelid blepharoplasty. The upper lid is relatively straightforward. Skin is removed after measuring the proper location of the upper eyelid crease. It is important to be conservative and not take too much skin. The fat pockets are then identified and removed. If you have a drooping upper eyelid border (not skin) then the muscle that pulls the eyelid open may need to be tightened.

The lower eyelid is a little more complicated. Under rare circumstances an incision is made behind the eyelid and fat is taken out of the eyelid. With this technique the skin and muscle are not lifted. This is not appropriate for someone with extensive lower eyelid bads or festoons.

Most of the time a small incision is made just beneath the lower eyelid lash line. This allows fat to be removed in a very precise manner. Also, if there is hollowness between the eyelid and the nose, this fat may be transposed into this location. This is an excellent technique to take fat out of the eyelid and fill the groove sometimes called the tear trough. It can also make the upper cheek look more full. Next, the skin and muscle layer are tightened and supported. Excess skin is removed and redundant fat is excised. Very small sutures are used to close the incision.

Q. How long does it take to perform a blepharoplasty?

Blepharoplasty typically takes between one and two hours to complete.

Q. Are there scars after blepharoplasty?

The incisions made during blepharoplasty will result in minimal scars, though they tend to be well-concealed. They are made in the fold of the upper eyelid or in the inside of the lower eyelid. While the scars may appear slightly pink at first, they will fade to a thin, nearly invisible white line within a few months.

Q. Is blepharoplasty a painful procedure?

Some tightness and soreness of the eyelids can occur, but pain medication can be prescribed to help control any discomfort that patients experience.

Q. What is the recovery like after blepharoplasty?

Patients may experience some tightness or soreness of the eyelids right after surgery which can be controlled with prescription medication. In addition, some dryness, itchiness, burning, excessive tearing, sensitivity to light, and blurred or double vision can occur during the first week. To help reduce swelling and bruising, it’s best to keep the head elevated as much as possible and to use cold compresses during the first few days. Bruising may take anywhere from ten days to two weeks to fully fade. Sutures are usually removed within 7 days, while reading may be resumed within two to three days. Patients who wear contact lenses may do so after two or more weeks. Patients can typically return to work within seven to ten days, though more strenuous activities and alcohol consumption should be avoided for about two to three weeks.

Q. Will I be able to drive myself home after my blepharoplasty procedure?

It’s best to make preparations for someone to drive you home after your surgery.

Q. Will I need someone to help me out at home after my blepharoplasty procedure?

It’s best to make preparations for someone to help you out for the first day or two after surgery.

Q. How much time will I need to take off from work after undergoing blepharoplasty?

Most patients find that they can return to work and most other normal activities within seven to ten days.

Q. When can I exercise after undergoing blepharoplasty?

Vigorous exercise, strenuous activities and alcohol consumption should be postponed for about three weeks.

Q. What are the risks or complications that can occur with blepharoplasty?

Some of the potential complications associated with blepharoplasty are as follows: bleeding, difficulty in completely closing the eyes, dry eyes, infection, pulling down of the lower lids, slight asymmetry in healing or scarring, swelling at the corners of the eyelids, temporary blurred or double vision, and whiteheads.

Q. Does insurance ever cover the cost of blepharoplasty?

Blepharoplasty procedure performed solely for cosmetic purposes are typically not covered by insurance. However, some degree of coverage may be available in cases where drooping of the upper lids interferes with vision.

Q. Is it possible to get financing for a cosmetic procedure?

Financing is available for many plastic surgery procedures.

BOTOX®Cosmetic FAQs

Q. How does BOTOX®Cosmetic Work?

BOTOX® Cosmetic is a purified protein produced by a bacterium called Clostridium botulinum. The protein is taken up by the motor end plate (where a nerve contacts a muscle). It then inhibits the release of a neurotransmitter into the nerve terminal. This prevents the nerve signal from reaching the muscle therefore preventing muscle contraction.

Q. Is BOTOX® Safe?

BOTOX® has been used around the world in millions of people for both cosmetic purposes as well as medical treatments. There have been no reports of side effects or complications during routine use. It has been approved by the FDA since 2002.