1. Thoroughly reading and understanding these Facts and Pearls will help improve your chances of undergoing a “successful” Rhinoplasty, being happy with your new nose, and moving on with your life.  Denying these Facts and Pearls may result in disappointment and heartache.
  2. Rhinoplasty is THE most complex of all cosmetic surgeries due to factors such as:
    • The visibility of the nose in the middle of the face.  There is no room for surgical error as the Rhinoplasty results are clearly visible to the whole world and cannot be hidden with makeup or clothing.
    • Rhinoplasty is an operation performed in 3-dimensions, on a 3-dimensional structure, that will heal over time, in 3-dimensions.
    • During Rhinoplasty, changes of millimeters or less will have profound effects on the final appearance of the nose, and the face, and the “character” of the person.
    • After a Rhinoplasty, the nose continues to mold and change for the life of the patient. Results on the Operating Room table vary from results after 1 week, 1 month, 1 year or even 10 years, after a Rhinoplasty.  The Rhinoplasty Surgeon much have the knowledge, vision, and expertise, to plan for these changes over time, and create a nose that looks good at all points throughout the life of the patient.
    • Rhinoplasty is the only operation where very small changes in bone, cartilage, and soft tissue, interact with the overlying skin to shape the result of the surgery.
    • In Rhinoplasty, beauty as well as function is important in determining “the final result.”  A beautiful nose created by a Plastic Surgeon, with resultant nasal airway obstruction is a disastrous outcome.
    • Scar tissue is inevitable, and healing forces can and will affect the results of a perfect Rhinoplasty. Miniscule amounts of scar tissue have no consequence on the outcome of most surgeries but they may necessitate a small Revision Rhinoplasty or “touch up” after nasal reshaping surgery.
      • A skilled Rhinoplasty Specialist Surgeon, using excellent surgical judgment and technique, can minimize these issues but no one can guarantee a “perfect result.”
        • A Perfect result should be one where the nose is vastly improved from its pre-operative state and the patient’s face looks more balanced after the Rhinoplasty.  That is truly a “perfect result.”
  3. Revision Rhinoplasty is even more complex than primary Rhinoplasty due to various factors:
    • Abundant Scar tissue
    • Lack of native cartilage and bone
    • Presence of foreign sutures or implants at times
    • Distorted tissue
    • Complex patient emotions associated with previous disappointing Rhinoplasty results
    • Possible lack of sources of cartilage which may have been used by the previous Plastic Surgeon
    • Stiff, thinned out, or scarred skin and soft tissue envelope.  This may limit the ability of the skin to nicely drape back over the revised nose.
  4. Many Board Certified Plastic Surgeons do not feel comfortable with the intricacies of Rhinoplasty and do the “right thing” and refer Rhinoplasty patients to more experienced specialists.
  5. Other Board Certified Plastic Surgeons do not fully appreciate the intricacies of Rhinoplasty.  Some will perform primary Rhinoplasty but refuse to perform Revision Rhinoplasty.
  6. Board Certified Facial Plastic Surgeons are expert surgeons with at least 6 years of surgical training focused exclusively on the face.  They are usually Board Certified Head & Neck Surgeons with additional specific Fellowship training on the face and nose.  They are usually Board Certified by the American Board of Medical Specialties through the ABOTO, as well as the ABFPRS.
  7. Board Certified Plastic Surgeons are expert surgeons with at least 6 to 7 years of surgical training spread out on the entire body with a relatively small portion focused on the face. They are usually Board Certified by the American Board of Medical Specialties through the ABPS.
  8. Otolaryngologists (ENT), also known as Head & Neck Surgeons, are expert surgeons with 5 years of surgical training focused on the face, head and neck exclusively.  They are Board Certified by the American Board of Medical Specialties to perform “Plastic Surgeon on the Head and Neck Area.”  The field of “Plastic Surgery” was invented by an Otolaryngologist.  The Father of Modern Rhinoplasty was also an Otolaryngologist.
  9. Oral-Maxillofacial Surgeons are expert surgeons and dentists with 4 years of surgical training concentrating on the bony facial architecture, especially the mandible and dentition.
  10. Oculoplastic Surgeons are expert surgeons with 5 years of surgical training focused exclusively on the surgery of the eyes, eyelids and peri-orbital area.
  11. Craniofacial Surgeons are expert Reconstructive Pediatric Plastic Surgeons with many years of training focused on the complex surgery of the skull and facial bones.  They concentrate on pediatric birth defect corrective surgery.
  12. Cosmetic Surgeons are a mixed group of surgeons and non-surgeons performing elective cosmetic procedures and surgery.  Many Internists, Dermatologists, OBGYNs, and others have entered the field of “Cosmetic Surgery.”  There is no such specialty as “Cosmetic Surgery” as there is no residency program for cosmetic surgery.  This is a relatively newly coined term supported by the new American Board of Cosmetic Surgery, which is not an ABMS Board nor it is validated in any States.
  13. Rhinoplasty Surgeons are expert, super specialized Plastic or Facial Plastic Surgeons who have dedicated the vast portion of their practice and life to the cosmetic and functional surgery of the nose.
    • The complex nature of Rhinoplasty demands a specialist who performs this surgery on a near exclusive basis. “Dabbling” or occasionally performing Rhinoplasties is risky and often results in poor outcome.
    • According to American Society for Aesthetic Plastic Surgery, the average number of Rhinoplasties a Board Certified Plastic Surgeon performs is about 12 per year.  While a true Rhinoplasty specialist should perform well over 75 Rhinoplasties each year.
  14. The best time to get the best result is at the time of the Primary Rhinoplasty.  Each subsequent Revision Rhinoplasty is complicated by limitations such as mentioned above (#2).
  15. The price range for Rhinoplasty in the United States is anywhere from $3000-$15,000.
  16. The price range for a Revision Rhinoplasty in the United States is anywhere from $5000-$30,000.
  17. Geographic location and surgeon expertise determine the price.  Although very high prices do not always guarantee good outcome, very low prices often do result in compromise of the nose by inexperienced surgeons and need for major revision.
  18. There is always a 5 – 50% risk of revision in Rhinoplasty.  This means that at least one out of every 20 patients undergoing Rhinoplasty or Revision Rhinoplasty will need a subsequent surgery.  *There is not a single honest Plastic Surgeon in the world with a revision rate of zero!  It is impossible and it does not exist.*
  19. REASONS FOR REVISION RHINOPLASTY ARE:
    • Poor surgical technique from lack of understanding of the nose by a Plastic Surgeon
    • Poor post-operative care of the patient and lack of proper follow-up
      1. Due to uncooperative patient or neglectful doctor
    • Poor patient healing and variable scar tissue contracture
    • Rare post-operative complications affecting planned healing
    • Poor doctor-patient communication before surgery.  Lack of Computer Imaging.  Doctor and patient not being on the same page!
    • Unrealistic patient expectations
    • Body Dysmorphic Disorder
  20. Types of Revision Rhinoplasty:
    • Minor Revision:
      • These occur about 5-10% of the time even after having the best possible Rhinoplasty by a skillful Rhinoplasty specialist.  These are minor touch-ups due to healing forces.  These are inevitable but not a big deal.
    • Major Revision:
      • These are unfortunately way too common and these have nothing to do with unpredictable healing.  These are due to gross surgeon error or lack of pre-op communication between doctor and patient.  Major structural revisions have to be done in these types of cases.  These should not commonly occur in skillful Rhinoplasty Specialists’ hands. 
  21. There is no such thing as “the perfect nose.”
  22. There is no such thing as “the best Rhinoplasty surgeon in the world”
    • There is a group of dedicated Rhinoplasty Specialists around the world who all work hard to create beautiful and safe noses.  But each has a different aesthetic and artistic taste. And not every surgeon always succeeds 100% of the time in achieving his intended surgical goals.  But every one of them should be safe and not destroy the nose.  And everyone of them should create a better nose than the starting point. 
      • i. Patients who understand and accept these facts are the happiest patients post-operatively. 
      • ii. Patients who seek “perfection” are never happy and continue to undergo Revision Rhinoplasty after Revision Rhinoplasty.
  23. Up to 20% of patients seeking nasal reshaping surgery are not good candidates for surgery.  These reasons include:
    • Medical conditions creating increased risk such as patients with “easy bleeding disorders,” severe heart or lung disease, or seizures and falling spells. 
    • Patients who have not done enough research and have not adequately thought about the risks of Rhinoplasty. 
    • Patients with unrealistic expectations:
      • Patients seeking a “perfect nose.”
      • Patients who think their nose is more important than other patient’s nose
      • Patients who think having a “nasal deformity” has significantly hindered their life, work, marriage, etc…
        1. Although many patients do gain increased self-confidence after a Rhinoplasty and end up having a better “quality of life,” the ones who believe a better nose will drastically change their life, work, or social situation, are not good candidates for Rhinoplasty.
      • Patients on the quest for “The Best Rhinoplasty Surgeon.”
      • Self absorbed individuals.  Narcissistic Personalities.
      • Patients with BDD (Body Dysmorphic Disorder).
      • Patients who do not take pride in, or work toward, improving other aspects of their physique and physical appearance, but for some reason desire a better nose.
        1. Good hygiene, proper attire, and proportional weight are all much more basic steps towards a better, more attractive appearance without the risk of elective nose surgery.
          • A patient who comes to the Rhinoplasty consult with questionable hygiene, sloppy attire, unhealthily obese but demands a better nose should always raise doubts and suspicions of unrealistic and disproportionate emphasis on the nose.  A nose is just a nose in many respects.
  24. There will always be swelling after a Rhinoplasty.
    • The initial swelling will subside to the point that patients are often “supermarket ready” in 7-10 days.  This means that after nasal splint removal, most patients will look good enough to not raise any suspicions of having undergone a nose job by the casual observer.
    • The nose should look very “normal” within a month or less after surgery.
    • Subtle swelling will take up to 1-3 years to resolve.
  25. There will be varying amounts of bruising after a Rhinoplasty
    • Most of the time, the bruises are gone or easily covered with makeup a week after Rhinoplasty
  26. The nose will heal how it wants to.  Even the best surgical technique cannot always guarantee a great outcome.  But in the proper specialized surgical hands, the results should be much better after surgery than before surgery.
    • Perfect symmetry is often impossible and unrealistic after a Rhinoplasty
  27. Rhinoplasty is not a very painful surgery
    • Packing is what makes patients uncomfortable after a Rhinoplasty
      • Packing is not always necessary after a Rhinoplasty
        1. “Dr. Naderi does not routinely pack the nose”
    • Most patients stop taking pain medicine within 2 days after Rhinoplasty if the nose is not packed
  28. Realistic and relaxed patients are the happiest patients.
  29. Patients with confidence and high self-esteem are the happiest patients
    • Patients with excessive self-worth (narcissistic personality patients) are poor surgical candidates.  This group is often limited to male Rhinoplasty patients although it can include women.
  30. Rhinoplasty is a surgical procedure with risks. 
  31. Your nose is your nose.  You cannot have a relative’s nose or a celebrity’s nose.  You may inform your surgeon of your taste in what you like, and what you do not like, but your goal should never be for your nose to look like someone else’s nose.
  32. Computer imaging is crucial to doctor-patient communication so that there are no surprises after cast/splint removal.
  33. A nose job does not have to look fake or “done.”  A skilled Rhinoplasty specialist surgeon can create very beautiful and natural looking noses
  34. A nose can be natural looking and beautiful at the same time.  These are not contradictory goals.
  35. A specialist surgeon who performs a single surgery (Rhinoplasty) more than any other surgery will have a higher chance of providing successful outcomes for his patients.