PATIENT FAQS & PATHWAY

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How long will the operation take?

Septorhinoplasty can take from one to four hours depending on what is required. Open operations take longer and modern techniques invariably utilise cartilage graft methods. This is particularly the case in revision procedures when harvesting of rib cartilage may also be required.

Will I be able to go home on the same day?

Most patients are done as day case and therefore will be able to go home towards the end of the day. However, this depends on the individual and if for anaesthetic or surgical reasons there is a need to keep the patient under observation overnight, then this is not usually a problem. Patients who also come from far away may also wish to stay one night for extra nursing care.

What type of anaesthesia will be used?

In the vast majority of patients, a full general anaesthetic is given so the patient is completely unconscious and is unaware of the procedure. In addition to this, during the operation, local anaesthetic is infiltrated into the tissues which reduces bleeding and gives a degree of postoperative pain control. In rare instances where a very small adjustment needs to be made, this can be done under local anaesthetic with or without intravenous sedation.

What medicines will I need to take home?

Most commonly, painkillers which include nonsteroidal anti-inflammatory such as Diclofenac together with moderate painkillers such as Co-dydramol are prescribed. You may also be prescribed a course of antibiotics, particularly if graft material has been used. An antibiotic ointment such as Bactroban is often given and this is applied inside the nostrils and across the incision in an open rhinoplasty.

What do I need to do preoperatively?

Should any changes in your general health occur prior to the operation, you should inform the office of London Rhinoplasty as soon as possible. If an upper respiratory tract infection has occurred, then it is perhaps best to delay surgery until you have recovered from this. On the day of surgery, you will be advised to come to the hospital having been nil by mouth from midnight the night before or at least six hours prior to any operative time given. Nil by mouth means no water as well.

However, you may brush your teeth provided you spit out any water. You should not chew gum prior to the procedure. If you are taking any important medications, please ask for advice as to whether this should be taken prior to the admission time. Although most patients are carried out as day cases, it is always wise to bring a bag with overnight clothes in case discharge has been delayed. Prior to your operation, it is useful to obtain gel packs which can be bought from most pharmacists.

These cooling packs are refrigerated prior and applied to the eyes in the postoperative period to minimise bruising.

What do I do in the postoperative period?

You will obviously need to rest after your operation and recover from the anaesthetic and this can take a variable amount of time. Some patients have postoperative nausea and the intake of fluid and foods help to metabolise the anaesthetic agents. You may develop a sore throat as a result of the use of general anaesthetic intubation but these symptoms will usually disappear in seven to 10 days. Use of a throat pack may also result in temporary mouth ulceration.

In the postoperative period, try and sleep a little upright if possible, maybe using a V-shaped pillow to keep you upright. Also use the cold gel packs described above to put gentle pressure over the eyes and minimise the likely postoperative bruising which will occur. You will need to take your medications regularly as prescribed including application of the ointment with a cotton bud.

Instructions will be given to you before departure. It is not uncommon to feel nauseous after a general anaesthetic but if this continues for more than 24 hours with vomiting, then you should inform the hospital where you had your procedure. Facial bruising rises to a peak approximately three to four days after the surgery but by the first postoperative appointment (day 7), much of the bruising will have disappeared. In very rare instances, discolouration around the eyes may remain for a prolonged period of time.

What are the costs for my surgery?

Costs for your surgery include those for surgical fees, fees for the anaesthetist, and those for the hospital facilities. In addition to this, you will be charged for takeaway medications at departure. In instances where biological materials are required for grafting purposes, this will also be charged as an extra. You will be given a quotation from London Rhinoplasty as to the likely costs. In the unlikely event of needing a revision procedure, there would be no extra costs from the surgeon however there will be a fee payable to the anaesthetist and the hospital provider.

Will my medical insurance cover the costs of surgery?

This would depend very much on the nature of your insurance policy. Most insurance policies will not cover pre-existing conditions but however if problems have arisen as a result of an injury during the term of your insurance policy, then the costs for treatment will be covered. At the end of your consultation with Mr Patel, a report can be provided which we can send to your insurance company with details of the surgical intervention required and you are then advised to make your own enquiries as to your level of cover. Please note that all charges relating to your surgical treatment is the patient’s responsibility in the event that the insurance company fails to reimburse charges.

When can I resume work?

Most patients were able to return to work, particularly in the office environment, approximately two weeks after their operation date. However, this is a very individual matter and some may return earlier and some may take longer to make a full recover. You will be seen at weekly intervals postoperatively and final decisions on return of work can be discussed. As a minimum however, you should advise your employer that a period of two to three weeks to make a full convalescence will be required.

When can I resume exercise?

Following rhinoplasty surgery, you are advised not to perform any active exercise for a period of six weeks until most of the tissues and bones have healed. Light exercise however is permissible after three weeks but this should not involve any type of weight training.

What about smoking?

You are strongly advised to give up smoking approximately a month prior to any surgery and for a minimum period of three to six months following any operation to give you the best chances of healing. There is an adverse effect of cigarette smoking on the healing process, particularly if graft materials are used to reconstruct the nose.

Am I too young or too old to have surgery?

It will be quite rare to operate on a girl under the age of 16 and a young man under the age of 17-and-a-half as until this time the nose has not fully grown. There is also the factor of psychological maturity. There are, however, exceptions to every rule and this can be discussed in detail. At the other end of the scale, there is no actual time limitation for nasal surgery. This would depend very much on the indication for surgery and general medical condition.

Can I use herbal remedies to help the healing process?

At this moment, there is no hard evidence of the benefits of substances such as arnica to help the healing process. However, it is unlikely to interfere with the healing in the postoperative period and therefore patients are permitted to use these herbal supplements if required.

Are steroids injections required in the postoperative period?

Occasionally, there is excess soft tissue swelling particularly in what is called the supratip area. Subdermal injection of a very small and weak solution of steroid can help to reduce the swelling. The risks of complications using steroid in this manner are small but potential risks include thinning of the skin, formation of prominent veins, infection and increased risk of cartilage absorption. Therefore, careful consideration will be given should this be required.

Are steroids injections required in the postoperative period?

Occasionally, there is excess soft tissue swelling particularly in what is called the supratip area. Subdermal injection of a very small and weak solution of steroid can help to reduce the swelling. The risks of complications using steroid in this manner are small but potential risks include thinning of the skin, formation of prominent veins, infection and increased risk of cartilage absorption. Therefore, careful consideration will be given should this be required.

What happens if I am dissatisfied with the outcome of surgery?

Clearly the intention of any nasal surgery is to improve both the aesthetic appearance of the nose and/or the nasal airway. However, operations are not without risk and there is a 5% chance of needing to have a revision procedure. The actual risk of needing further surgery depends on what exactly needs to be done and can therefore be individually assessed. It is strongly advised that a period of time be allowed to elapse so that the final result can be appreciated and this can take anything from 12 to 18 months. Thereafter, any revision surgery can be discussed.

PATIENT FAQS & PATHWAY

Either following a referral from your GP or after deciding you wish to consider a rhinoplasty, you should contact our office to make an appointment to see Mr Patel.  There are a number of clinic locations and times to suit your schedule.  Initial consultations take approximately 40 minutes which will include photography.

During the initial consultation, a medical history will be taken and you will be examined possibly including endoscopy of the inside of the nose using local anaesthetic spray.  This procedure is not painful.  Photographs are then taken at the end of the consultation.  At this stage, an initial surgical plan can be discussed.  You will then be advised to make a further appointment about a week later by which time your photographic images will have been morphed so that you will be able to see the likely outcomes possible.  This is a great opportunity of discussing in detail,  your particular preferences and desires and a chance for Mr Patel to show you what he thinks can be achieved.  Discussions will also take place about the risks of surgery.  It is ideal when the patient brings with them a relative or close friend as advice given during the consultation can easily be forgotten.  Questions on any aspects of the proposed surgery are encouraged and answered in full.

The patient is then advised to consider the proposed surgery and indeed seek further opinions, if required.

If the patient wishes to proceed with surgery, contact by email or phone is made with Mr Patel’s office to discuss possible dates and the location of the operation. If the procedure is to be covered by medical insurance (Mr Patel is registered with all UK medical insurance companies), procedure codes will be given and the patient is advised to obtain authorisation for the operation and post-op consultations/procedures. A full quotation can be supplied on request. Please note that any shortfall of payment due to failure to pay by the insurance company will require the patient to settle all outstanding fees.

If there is a long delay between the last consultation and the surgical procedure (greater than three months), a preoperative consultation is advised so that any last minute questions can be answered and the nature of the procedure can be re-discussed.

On the day of surgery, please bring all admission documents, any imaging studies such as a CT or MRI scans and all current medications. Although most operations are done as day cases, some patients need to stay overnight, so bring an appropriate amount of clothing.

You will arrive at the hospital around 0700 (times may vary) and the operation will usually be done the same morning. Please bring some reading materials with you or watch television in case of any delays.  The nursing staff will admit you to the ward and go through some administrative and nursing procedures.  Mr Patel and his anaesthetist will arrive approximately 30 minutes prior to the operation time and go through the procedure, if needed, and any hospital consent forms are signed.  The anaesthetist will go through the process of inducing anaesthesia.  After the operation, you will be taken to the Recovery Suite.  Once you are fully alert, you will then return to the Ward. You will be reviewed postoperatively and arrangements for departure from the hospital discussed. You will stay for a minimum of six hours to ensure full recovery from the anaesthesia has occurred. All postoperative medications such as painkillers, antibiotics and antibiotic ointment will be given to you on departure. You will have a cast over the nose and possibly biodegradable nasal packs inside your nose. This will necessarily result in a degree of nasal blockage and some of the packing material may come out over the next few days, which is normal.  There will be a variable amount of bleeding and nasal discharge and it is normal for a nasal bolster to be applied to the base of the nose for the first 48 hours. You are advised to keep the nasal cast dry when bathing. Arrangements will be made for your review appointment about a week after the operation.

Some things to remember following surgery:

  • Bruising increases over one to two days after surgery but normally reduces significantly by Day 7.
  • You may develop a sore throat after surgery.  This is due to mild ulceration resulting from the anaesthetic process.
  • Take painkillers regularly for the first two to three days and then take painkiller medication as required.
  • Be liberal with the use of antibiotic ointment intranasally.
  • Take painkillers before the outpatient visit in order to minimise discomfort when removing the cast and sutures.
  • Please keep all postoperative consultations to ensure that healing has taken place and minimise the chances of complications.