If you're considering rhinoplasty
Rhinoplasty, or surgery to reshape the nose, is one of the most common of all plastic surgery procedures. Rhinoplasty can reduce or increase the size of your nose, change the shape of the tip or the bridge, narrow the span of the nostrils, or change the angle between your nose and your upper lip. It may also correct a birth defect or injury, or help relieve some breathing problems.

If you're considering rhinoplasty, this information will give you a basic understanding of the procedure-when it can help, how it's performed, and what results you can expect. It can't answer all of your questions, since a lot depends on the individual patient and what Dr Lista thinks is best for you. Dr Lista encourages his patients to come to their consultation with a list of questions to about anything you don't understand.

At the Plastic Surgery Clinic we perform approximately 75 to 100 rhinoplasty procedures per year. This makes Dr Lista a very experienced rhinoplasty surgeon. Dr Lista has one main philosophy when performing rhinoplasty: to make all his patient’s noses look soft and natural, and perform the operation as safely as possible. We want the patient’s nose to look natural and non-operated on. Dr Lista strives to avoid making his patient’s noses look artificial or pinched. Today, a number of new techniques are helping plastic surgeons to provide patients with more precise results and quicker recovery times.

The best candidate for rhinoplasty
Rhinoplasty can enhance your appearance and your self-confidence, but it won't necessarily change your looks to match your ideal, or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them with Dr Lista.

The best candidates for rhinoplasty are people who are looking for improvement, not perfection, in the way they look. If you're physically healthy, psychologically stable, and realistic in your expectations, you may be a good candidate. Most patients want to look better but don’t want the whole world to notice that they have had their noses operated on. Dr Lista specializes in making the patient’s nose suit the rest of the face. Other people may notice that you look better and may think that you are rested, or that you have changed your hair, but they should not think that you have had a rhinoplasty. The differences will be noticeable to you or when you compare before and after photographs but not be that noticeable to others.

The Office Visit
Dr Lista sees all his patients personally before surgery. If the patient lives in the Toronto area he prefers to see his patients twice, if possible, before their operation. In the consultation process we spend considerable time obtaining a careful history and physical examination. Rhinoplasties are very individualized procedures. In your initial consultation Dr Lista will evaluate your nose, including the skin and underlying bone and cartilage, and discuss your goals for the surgery. We also spend a long time discussing the patient’s desires, goals and expectations. It is important that the patient discuss with Dr Lista their desired result. Not all expectations can be accomplished with surgery and it is important that these issues are carefully discussed before surgery. Photographs can be helpful in this regard and at The Plastic Surgery Clinic we have computerized digital imaging, which allows Dr Lista to show the patients examples of how they may look after surgery.

How Rhinoplasty is performed
Most rhinoplasty procedures are performed at The Plastic Surgery Clinic. Dr Lista performs all of the procedures personally. He does not have any assistants or students assist with your surgery. Dr Lista is Chief of Plastic Surgery at the Trillium Health Center (The Mississauga Hospital) so your operation can also be performed at the hospital if you prefer. The operation is performed either at our clinic or in the hospital. Your operation may be performed under local anesthesia with sedation or under general anesthesia. At the Plastic Surgery Clinic general anesthetics are administered by specialist physicians who are board certified in the specialty of anesthesia. These doctors give the anesthetic, stay with the patient during the entire operation and are with the patient while they are waking up. The operation takes several hours. A friend or relative will need to come and pick you up and stay with you for 24 hours.

Preparing for your surgery
Dr Lista will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. Carefully following these instructions will help your surgery go more smoothly. If you smoke, it's especially important to stop at least two weeks before and after surgery; smoking inhibits blood flow to the skin, and can interfere with healing.

The surgery
Rhinoplasty usually takes an hour or two, though complicated procedures may take longer. During surgery the skin of the nose is separated from its supporting framework of bone and cartilage, which is then sculpted to the desired shape. The nature of the sculpting will depend on your problem and your surgeon's preferred technique. Finally, the skin is redraped over the new framework.

Usually rhinoplasty is performed from within the nose, making their incision inside the nostrils. In this way, there are no external incisions visible on or around the nose. Occasionally an "open" procedure is required, especially in more complicated cases. In such cases a small incision is pleased across the columella, the vertical strip of tissue separating the nostrils.

Incisions are made inside the nostrils or at the base of the nose, providing access to the cartilage and bone, which can then be sculpted into shape.

If your nostrils are too wide, Dr Lista improves the angle between the nose and upper lip.Trimming the septum can remove small wedges of skin from their base, bringing them closer together.

After your surgery
After surgery-particularly during the first twenty-four hours-your face will feel puffy, your nose may ache, and you may have a dull headache. You can control any discomfort with the pain medication prescribed by Dr Lista. Plan on staying in bed with your head elevated (except for going to the bathroom) for the first day.

You'll notice that the swelling and bruising around your eyes will increase at first, reaching a peak after two or three days. Applying cold compresses will reduce this swelling and make you feel a bit better. In any case, you'll feel a lot better than you look. Most of the swelling and bruising should disappear within two weeks or so. (Some subtle swelling-unnoticeable to anyone but you and your surgeon-will remain for several months.)

A little bleeding is common during the first few days following surgery, and you may continue to feel some stuffiness for several weeks. Dr Lista will ask you not to blow your nose for a week or so, while the tissues heal.

Nasal packing will be removed after a few days and you'll feel much more comfortable. By the end of 10 to 14 days the external splint or cast will be removed.

Getting back to normal
Most rhinoplasty patients are up and about within two days, and able to return to school or sedentary work a week or so following surgery. It will be several weeks, however, before you're entirely up to speed.

Dr Lista will give you more specific guidelines for gradually resuming your normal activities. They're likely to include these suggestions: Avoid strenuous activity (jogging, swimming, bending, sexual relations-any activity that increases your blood pressure) for two to three weeks. Avoid hitting or rubbing your nose, or getting it sunburned, for eight weeks. Be gentle when washing your face and hair or using cosmetics.

You can wear contact lenses as soon as you feel like it, but glasses are another story. Once the splint is off, they'll have to be taped to your forehead or propped on your cheeks for another six to seven weeks, until your nose is completely healed.

Dr Lista will schedule frequent follow-up visits in the months after surgery, to check on the progress of your healing. If you have any unusual symptoms between visits, or any questions about what you can and can't do, don't hesitate to call.

All surgery carries some uncertainty and risk
When rhinoplasty is performed by a qualified plastic surgeon, complications are infrequent and usually minor. Nevertheless, there is always a possibility of complications, including infection, nosebleed, or a reaction to the anesthesia. You can reduce your risks by closely following Dr Lista’s instructions both before and after surgery.

After surgery, small burst blood vessels may appear as tiny red spots on the skin's surface; these are usually minor but may be permanent. As for scarring, when rhinoplasty is performed from inside the nose, there is no visible scarring at all; when an "open" technique is used, or when the procedure calls for the narrowing of flared nostrils, the small scars on the base of the nose are usually not visible.

In about one case out of ten, a second procedure may be required-for example, to correct a minor deformity. Such cases are unpredictable and happen even to patients of the most skilled surgeons. The corrective surgery is usually minor.

Your new look
In the days following surgery, when your face is bruised and swollen, it's easy to forget that you will be looking better. In fact, many patients feel depressed for a while after plastic surgery-it's quite normal and understandable.

Rest assured that this stage will pass. Day by day, your nose will begin to look better and your spirits will improve. Within a week or two, you'll no longer look as if you've just had surgery.

Still, healing is a slow and gradual process. Some subtle swelling may be present for months, especially in the tip. The final results of rhinoplasty may not be apparent for a year or more.

In the meantime, you might experience some unexpected reactions from family and friends. They may say they don't see a major difference in your nose. Or they may act resentful, especially if you've changed something they view as a family or ethnic trait. If that happens, try to keep in mind why you decided to have this surgery in the first place. If you've met your goals, then your surgery is a success.