Announcer (00:01):
You are listening to Head On with your host, board certified plastic surgeon, Dr. Bahman Guyuron, the pioneer of a life-changing surgery for permanently eliminating migraines and a specialist in plastic surgery of the face, head and neck.

Dr. Guyuron (00:19):
Selection of the right rhinoplasty surgeon is absolutely crucial. And the reason is if the initial operation is not done properly or the patient doesn't heal properly, the second operation becomes a little bit more difficult. Often it requires harvesting cartilage from the ear, rib that is a little more complicated, doable, but more complicated. Because of that, it is important that the patient choose the right surgeon and that starts with the proper investigation. And the most important aspect is to understand the surgeon's experience. And I can tell you that almost invariably experience translates to more success in rhinoplasty because it is the most complex, most demanding surgery and it takes a long time to heal. So understanding how often the surgeon does the procedure is very, very important. And the reality is that the more we do it, the better results are. And that would be the first thing that I would investigate.

(01:41):
Second, looking at the pictures in the internet, looking at the pictures in the patient albums in the surgeon's office, and more investigation. Unfortunately, internet can be deceiving, but obviously today it's a dominant portion of referral sources. So looking at the scoring and the internet reviews is very important. If anybody has a hundred percent perfect reviews, that means that there's something wrong. Nobody can make everybody happy, every patient happy, but the majority has to be positive. And if there are majority positive, occasional negative results, we can be dissuaded by that. So those are the important, and asking the surgeon question and then also a conversation with the surgeon. How detail oriented they are when they are examining you, and how often they find the defects or flaws that others did not refer to? How focused they are on the function aspect of the nose? All of those are very important factors in selecting the right surgeon so you don't have to have a second operation.

(03:05):
One other important factor in selection of the rhinoplasty is to look at the pictures of the patients. And those of us who are experienced have done many of these. If you look at our website pictures, no two noses are alike because we match the noses to the faces. That is what is going to create a natural looking nose. I don't have a prototype nose that goes on every patient's face, whether the face is large, small, male or female. And you also will see that there's actually a difference between a male nose, a female nose, appropriately. And that's actually a crucial part of selection of a surgeon that not every nose looks exactly alike. A rhinoplasty consultation process starts me asking the patients to tell me about their sources of discontent, what is that they don't like about their noses? And obviously that's the beginning of the understanding because if they see something that I don't agree with it, we are on the wrong page.

(04:24):
So that's the beginning. That rarely is the case. Almost always they see what I see and I see a lot more. So after I listen to the patients, actually before even they come to see me, they complete a functional form, two pages of functional form about their breathing, their headaches, their migraine headaches, and how often they wake up in the morning with the dry lips, things like that. That is going to help me to decide whether there is an underlying functional issue. And then when I sit across the patient, as I mentioned earlier, I watch their faces while I'm talking. I'm watching their faces to see if their lips are closed in a relaxed position in repose. Then I step by step, analyze their face and the nose because again, the nose has to match the face and record it in a computer file. Then I come close to the patient and examine the inside of the nose.

(05:39):
And then I discuss with the patients what are the things that I see and commonly their complaints are two or three concerns are two or three, but I'm going to point out at least 10 or 15 areas where I see flaws. And then I discuss the course as to what is going to be happening, how we do the surgery, and whether this is commonly, actually I'm doing this through a virtual consultation because that's where most of my patients come from, but I also have a lot of local patients. If the patient is not sitting across me, I'm watching them on the video and the out of town patients come in town only one day before surgery, we do the surgery the next day and they go home the following day so they don't stand. As I mentioned earlier and on intown patients, again, I've finished the conversation, we take the life size pictures and start working on it.

(06:46):
It takes a while to prepare the pictures and most patients come back for a second visit, which is a pre-op visit. And during that visit, I show them the life size pictures and discuss with them, make sure that again, we are absolutely on the same page before we go to the operating room. These are life size pictures that we obtain, my photographer obtains, and we do have a software in-house software that is developed based on studies that I have done and also craniofacial principles that some of those have been around for 400 years. But I put all of those together and created a system where we go through 16 steps to get to an end point that gives us an outcome and a drawing that shows how much change we need to make wear to create a nose that goes with that face. Again, it is relative to the forehead, lips, chin, cheeks, all of those make a difference in what was it that we're going to be doing with the nose. There's no extra charge for it even though that's the most time consuming part of the analysis. But in my view, it's a requirement. I have never done a nose surgery without life size pictures and analysis unless there's a minor revision. Unfortunately, in this analysis, we cannot demonstrate what the nose is going to look on the front view perfectly, but we show the profile changes down to quarter of a millimeter on the front view. Mostly we are focused on the direction width and symmetry of the nostrils, and those are the things that I discuss with the patients. I clearly indicate to the patients that this is a drawing, cannot be resolved, cannot be guaranteed. But if they want they can take a picture, take home. I can't give the pictures to them because I'm going to be using it in the operating.

(08:59):
They're sort of my blueprints, but they can take a copy of picture of it and replay it at home and look at it as long as they want to. Patients who are from out of town, they come early in the morning so we can prepare the pictures and I meet with them in the afternoon to go through the same process and then they go to the surgery the next day. Those out of town patients or in town patients who have scheduled the surgery, I see them couple of weeks before just to make sure that we're on the same page as I mentioned. And that's a crucial part of rhinoplasty success, being on the same page, having matching goals. And then we go to the surgery the next day on for all of the patients, a couple of weeks in couple of weeks with the patients who are from in town and those individuals go to the recovery room, then go home afterwards or the out of town patients go to the recovery room for an hour or so, then go to the hotel.

(10:08):
I see them the next day, they'll go home. Most patients, whether they undergo closed or open rhinoplasty, will recover socially, can resume their social activities within eight to 10 days. And couple of days of earlier or later recovery is not going to be consequential over the long-term followup. So we have to really be focused on what the nose is going to be looking a year later, five years later. And because of that, again, to choose one technique over is not really justifiable, but most patients recover within essentially the same timeframe in terms of being able to go back to work or resuming their social calendar. There's actually phases of recovery for every rhinoplasty patient and we try to control that to the best of our capabilities. There's going to be some swelling, some bruising in the early stages, which within the first two days may get worse in their first 48 hours and they start getting better.

(11:28):
But those of us who are experienced use some medications during the surgery to control that magnitude of swelling and bruising during the surgery and usually can do that actually as soon as I open the nose, I know what is it I'm dealing with and use medications to moderate that course of swelling and bruising. And that bruising and swelling is going to be about seven, eight days. And most patients during that period of time are going to have a nose splint to control the frame and two internal tubes that majority of us use. That helps the septum, the partition in the middle of the nose to heal in the proper position. And those tube will come out first in about seven, eight days and splint will be removed. And I have streamlined in such in such a way that majority of my patients, I'm out of town and out of country, can actually go back home the next day and they remove the bandages and 99.9% of my patients can do that.

(12:45):
And if they're not comfortable doing that, we arrange for them to have a bandages removed. Beyond that, again, they will refrain from strenuous activities, avoid extraneous activities, heavy exercises, playing tennis, jogging, consuming for three weeks, and gradually get back to normal activities in three weeks. They can do whatever they want to except for wearing glasses over the nose frame without some support, meaning there should be some support on the bones so that the glass would not squeeze the bones together for five weeks thereafter. There's no limitation. They can resume everything that they do and it usually takes about a year for most noses to look the way we are hoping that they're going to look, meaning a healed and for the swelling to go away, but the initial swelling, the major part would be gone as I mentioned in seven, eight days. And for some noses that are really thick, have thick skin, the nose may take as long as two or three years to assume the shape that is going to ultimately assume. If anyone is interested in a rhinoplasty consultation, you can call our clinic Zeeba Clinic (440) 461-7999. Again, 4 4 0 4 6 1 7 9 9 9 or you can go to my website, dr bahman guyon.com and you can actually make your appointment through the internet. We are here to serve the patients.

Announcer (14:42):
Links to learn more about Dr. Guyuron and anything else mentioned on this podcast are available in the show notes. Head On is a production of The Axis T-H-E-A-X-I-S.io.