Rhinoplasty (Nose Reshaping)

NOSE RESHAPING AND CORRECTION OF
DEVIATED NASAL SEPTUM

PROCEDURE DESCRIPTION
The procedure is done on an outpatient basis under sedation and local, or general anesthesia.

STANDARD RHINOPLASTY: Incisions are made inside the nostrils. The nasal bones, cartilage, and soft tissues are reshaped to improve the external contour.

EXTERNAL RHINOPLASTY: Frequently used for difficult or larger noses. Involves one external incision across the columella (strut between the nostrils). Bones, cartilage, and soft tissues are reshaped under direct vision.

TIP-PLASTY: If only the nasal tip is abnormal, it may be corrected with either a standard or external approach.

SEPTOPLASTY: The crooked septum is straightened through incisions inside the nose.

Large nostrils may be reduced through tiny incisions at the outer base of the nostrils with either type of rhinoplasty.

RECUPERATION AND HEALING
The patient goes home with an external cast or splint in place. The nose may be packed for several days. Splints are usually removed in 7-10 days.

Initial discomfort is easily controlled with oral medication.

Majority of swelling and bruising subsides progressively over 2-4 weeks.

External sutures (if any) are removed in 4-6 days. Internal sutures dissolve.

Semifinal result is evident in 3 months. Final result is evident in 12-14 months.

An additional procedure that might enhance the result is Chin Enlargement.

INTENDED RESULTS
More attractive nasal shape. Nose in better proportion to other facial features.

Reduction of nasal obstruction -- ability to breath better.

OTHER OPTIONS
An additional procedure that might enhance the result is Chin Enlargement.

INSURANCE GUIDELINES
This procedure is not covered by insurance if being done for cosmetic reasons. If the nasal deformity is due to a recent injury, insurance coverage may be available. Septoplasty is frequently covered by insurance. The office staff will be able to assist in obtaining preauthorization.

WHO IS A CANDIDATE?
If you have an abnormal appearance of the nose as a result of birth defects, injury, or disease.

If you have a nasal obstruction due to a deviated nasal septum (divider between the two sides of the nose).

If you have a nose that is cosmetically unattractive or does not "fit" with other facial features.

MAKING SENSE OF CERTIFICATION

Almost everyone has heard that they should look for "board certification" when seeking a qualified plastic surgeon (or any other physician for that matter). Most people don't really understand exactly what this means and what is involved in becoming "board certified."

Even fewer people know about certification of operating facilities, who certifies them and what protection such certification offers. We believe patients need this information to make informed choices in their search for the right surgeon, surgery facility and anesthesia provider.

At our office, we have gone to great effort and expense to ensure the highest standard of safety for our patients. As you consider plastic surgery, we hope the following information will help you to evaluate the choices available to you.

CERTIFICATION OF YOUR SURGEON
The American Board of Medical Specialists (ABMS) is the agency which oversees sub-specialty boards. More than 100 "boards" have been submitted to the ABMS for formal approval, but only 24 have met their strict educational and examination criteria. They are as follows:

Allergy and Immunology	Orthopaedic Surgery
Anesthesiology	Otolaryngology (ear, nose and throat)
Colon and Rectal Surgery	Pathology
Dermatology	Pediatrics
Emergency Medicine	Physical Medicine and Rehabilitation
Family Practice	Plastic Surgery*
Internal Medicine	Preventive Medicine
Medical Genetics	Psychiatry and Neurology
Neurological Surgery	Radiology
Nuclear Medicine	Surgery
Obstetrics and Gynecology	Thoracic Surgery
Ophthalmology	Urology

* The American Board of Plastic Surgery is the only ABMS board that has traditionally overseen the training and certification of cosmetic and reconstructive surgeons.

You may call the ABMS at 1-866-275-2267 to see if your surgeon is certified by the American Board of Plastic Surgery. Give them the name of your surgeon and they will tell you if and when he or she was certified. Certification by other boards does not give you the same protection. Other boards have less strict criteria for certification and some require only a fee. A few of the boards which have not been approved by the ABMS are as follows:

Aesthetic Plastic Surgery	Plastic Esthetic Surgery
Cosmetic Plastic Surgery	Dermatologic Surgery
Facial Cosmetic Surgery	Ophthalmic Plastic Surgery

You may also want to call the local hospital and ask the Medical Staff Office secretary whether your surgeon has privileges to perform the proposed procedures in the hospital.

ANESTHESIA OPTIONS
Whenever you are heavily sedated or have general anesthesia, you put your life in someone else's hands. Much of that responsibility falls to the person administering the medications and monitoring your vital signs. You need to know the qualifications of the person assuming that responsibility. Their training can range from specialization after earning a medical degree (anesthesiologists) to specialization after nursing training (nurse anesthetists) to nursing training only.

We have chosen to use board-certified anesthesiologists for all of our general anesthesia and for monitored anesthesia care. Some of our anesthesiologists are board certified in at least one other specialty as well. We choose physicians who are in active practice at a hospital because we believe their skills will be at the highest level in the event of an emergency.

OTHER ANESTHESIA PROVIDERS
CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA): A CRNA is an RN who has completed an additional two years of specialized training in anesthesiology. Their certification is also overseen by each state's Board of Nursing. In contrast to an RN, a CRNA is able to administer general anesthesia.

YOUR SURGEON: In some centers your surgeon may actually be the person administering the medications to make you drowsy during your surgery. Almost never does he or she personally monitor your vital signs. This is usually done by a member of his staff, most often a nurse.

REGISTERED NURSE (RN): Each state has its own Board of Nursing, but there is a great deal of common requirements between states. He or she is licensed to administer intravenous drugs at the direction of the surgeon and monitor your vital signs.

CERTIFIED PLASTIC SURGICAL NURSE (CPSN): These nurses have worked full time for a minimum of two years in the field of plastic surgery before they are eligible to take a national certifying exam.

CERTIFICATION OF THE OPERATING FACILITY
At the present time there are few local, state or federal laws requiring office-based operating rooms to be certified. Any physician may perform any procedure in an office as long as basic fire and safety codes are met. No level of sanitation, patient care, monitoring or peer review is required. Unfortunately, tragic consequences have occurred because of faulty equipment, lack of trained personnel and inadequate emergency equipment. As a result, there will most likely be requirements imposed in the future, but for now certification is purely voluntary.

MEDICARE:
An agency of the Federal Government with very strict requirements as to personnel, procedures and equipment.

AMERICAN ASSOCIATION FOR THE ACCREDITATION OF AMBULATORY SURGERY FACILITIES.
This accreditation certifies that the surgery facility meets nationally recognized standards through an accreditation program operated by the experts who set and evaluate the standards.

ACCREDITATION ASSOCIATION FOR AMBULATORY HEALTH CARE:
An alternative national accrediting body that most insurance companies recognize.