Cosmetic Surgery Los Angeles

The post-operative hyperbaric oxygen helps with healing and decreases swelling, especially after a revision rhinoplasty.  A few days after surgery, a patient goes to a hyperbaric oxygen treatment center.  The patient enters a pressure chamber and 100% oxygen given to the whole body.  Over the course of several treatments, the high level of oxygen has dramatic effects on the cells and speeds up the body’s natural healing process.

Sometimes, Dr. Nassif will recommend taping the tip of the nose and the nasal dorsum at bedtime for six weeks after surgery.  “You can tape over the sides and dorsum of the nose, then gently tape around the tip of the nose.  But, in general, the best thing you can do is to have the tip go through its normal swelling.”

A week after rhinoplasty surgery, we will remove the sutures, the cast and tape from the nose.  We will then re-tape the nose for another week to help prevent some swelling. Typically, there is a lot of swelling of the nose after surgery.  So, it is important that the patient understands that takes time for the swelling to decrease and it will take up to one year to heal.  The tip will be very swollen, sometimes the tip even takes longer than a year to heal

Dr. Nassif explains the use of grafts in the nasal rim area.  “The composite graft from the concha cymba is removed from the ear in a form of a football.  It is composed of skin and cartilage.  These pieces of tissue are placed inside the nostrils which will stent the inside of the nostrils and lower them.  It will also add support to the nasal rim.  These grafts are important because, when removing the alar cartilage, the tip will retract up and cause a short nose.  Cartilage also will be used to lay on the end of the nasal tip, called the infratip lobule.  This will restore the length of the nose.  In addition, if the nose is too short, we will use a septal extension graft.”

According to Dr. Nassif, “Since temporal fascia is soft tissue, I used it to either wrap diced cartilage, when we are rebuilding the dorsum, or to cover pieces of cartilage that I’ll use for camouflage. Temporal fascia also is a great source of tissue to place over the nasal tip after I rebuilt it. Since the skin of the nasal tip following reconstruction can usually not heal properly, you can see any irregularity in the skin. This is because of shrink wrappage of the skin and three dimensional healing of the nose. Fascia helps add an extra layer of protection in the nasal tip.”

According to Dr. Nassif, “If the septum is intact, we will primarily use the septum cartilage and possibly cartilage from one ear.  But, in a typical rhinoplasty where the septum cartilage has been used, we will use rib cartilage.  What will usually happen when rib cartilage is used is that I’ll start removing the temporal fascia, while a plastic surgeon will start removing the rib cartilage.  After I remove the temporal fascia from the temple area, I’ll start excising the ear cartilage for composite grafts.”

When we usually reconstruct an entire nose in a revision, it includes rebuilding the middle vault, which is the middle aspect of the nose, with spreader grafts. 

Spreader grafts add more volume to the middle vault of the nose, especially if you have an inverted “V” deformity.  We will need to add more support to the nasal tip with a columellar strut.  To rebuild the nasal tip cartilages, we will use alar batten grafts.