The Griffiths' approach is to perform the surgery in such a manner that the ultimate appearance will be natural. A nose that looks as if it has been subjected to change (that is, looks like a "nose job"), in our opinion, is not a good rhinoplasty and falls short of the aesthetic result which should be achieved by such surgery.
Each patient is treated individually, as each nose is unique. Your rhinoplasty will be tailored to your face and particular wishes. It is important that your goals are not only feasible, but also, in our experience, appropriate for your facial aesthetics.
Your participation and cooperation is of the utmost importance. Following the doctors' instructions is an integral part of ensuring a successful result. After the technical portion of thh surgery, the nose must undergo a healing process which could extend for as long as six to twelve months. During this time, it is extremely important that the healing process be controlled as much as possible. It will be necessary for you to visit with Dr. Griffiths for office evaluation and treatment frequently, especially during the first month following your surgery.
GENERAL INFORMATION
Primary Rhinoplasty is the term applied to the correction of a nasal deformity resulting from inheritance, injury, or a growth disturbance of unknown cause. In rhinoplasty, the structure of the nose beneath the skin, consisting of bone and cartilage, is altered by partial removal, reshaping and /or adding material, grafts or foreign material. The skin of the nose is then molded over the altered bone and cartilage.No removal of the skin is done, so no external scars are visible. All of the surgery is performed through incisions within the right and left nostrils in the mucous membranes or internal linings of the nose.
Occasionally, incisions may be required on the exterior of the nose, through the skin, for certain deformities (such as large or wide nostrils). These incisions are made in the crease of the nose where it meets the face. The scars which form are usually very difficult to see, however, a small risk exists that some visibility of the scars may occur. If this procedure is necessary, Dr. Griffiths will discuss this matter more fully with you.
Secondary Rhinoplasty or Reconstructive Surgery of the Nose, the nasal deformity may be a result of an injury, the aftermath of a tumor removal or a result of poor healing from a prior rhinoplasty. In order to reconstruct the nose, it is necessary to take cartilage from the ears or internal nose, or bone grafts are taken from the internal nose, facial skeleton, or skull. At times, scar removal is necessary and one or more operative procedures may be indicated.
The results following the reconstructive surgery are generally not as good as those following primary rhinoplasty due to the pre-existing scar tissue which interferes with healing and the failure of bone or cartilage grafts which prove necessary to improve the appearance and function of the nose.
PRELIMINARY INSTRUCTIONS PRIOR TO RHINOPLASTY
1. Do not become sunburned or overexposed to sun two weeks before surgery.
2. Do not take medication, especially aspirin, for two weeks prior to the surgery. Please inform Dr. Griffiths if you take any medication whatsoever, including diuretics, weight pills, Anacin, Excedrin, Motrin, Advil, birth control pills, marijuana use, etc. The use of such pills or drugs prior to surgery will have an adverse effect on the results. It is very important not to take any medications unless directed by Dr. Griffiths.
Dr. Griffiths, he may want you to take some of your daily medications with a sip of water on the morning of surgery.
3. Wash your hair with Phisohex the day prior to surgery. Wash your face thoroughly the night before and the morning of your surgery with Phisohex and do not apply any make-up after doing so, prior to surgery.
4. Use Afrin Decongestant 12 hour the morning before surgery, three puffs each nostril.
5. Prescriptions: Dr. Griffiths will give you a prescription for an antibiotic, pain reliever and possibly a sedative. Please pick them up the day prior to your procedure.
YOUR SURGERY
Anesthesia: The surgery is performed under local anesthesia with sedation or general anesthesia. A Board Certified (MD) Anesthesiologist will be in constant attendance to administer the anesthesia to ensure safety and comfort.
The surgery generally takes 2 hours. It may be performed in the hospital or in our fully accrediated ambulatory surgical center or in the hospital associated with other procedures. The Center is certified by the Acceditation Association of Ambulatory Health Care (AAAHC) which is approved by the Medical Board and the Legislature of the State of California. Plan to be in the office at least 4 hours.
NOTHING TO EAT OR DRINK 8 HOURS PRIOR TO YOUR SURGERY
Clothing: Wear light comfortable cothing that is easy to take off and put on ( sweat pants, sneakers, polo shirt, etc.).
Ride Home: You must arrange a ride home and someone to be with you at all times the first night of surgery. Arrange to be dropped off and give the contact number of this person to call approximately 30 min. prior to your discharge.
Contact Lenses: Please remove contact lenses and bring your glasses.
Jewlery/Watches/Valubles: Please leave at home, the office is not responsible for protecting them or in case of loss.
Following the surgery, the nose will be casted with a plastic splint, in order to maintain the repositioned bones placement in their proper orientation and to prevent swelling of the nose. The cast will stay in place for five (5) to seven (7) days. The nostrils will be packed with a tampon, which will make it necessary for you to breath through the mouth. The packing will be removed by the doctor one to three days after the surgery.
YOUR CONDUCT AFTER DISCHARGE FROM THE HOSPITAL/SURGICAL CENTER/OFFICE
1. Upon arriving home, you should:
a. Take your medication, as directed.
b. Follow the diet prescribed by Dr. Griffiths. The purpose of the diet is to prevent swelling and bruising. This being achieved, your nose will heal more rapidly, discomfort will be considerably less or absent, and the end result will be far better.
c. Cold water gauze compresses (not freezing cold) should be applied to the eye areas on return from the hospital. These may be continued for 24 hours after you return home, in order to prevent swelling and to limit the amount of bruising. Remember, do not apply ice directly to the eye areas or to the nose.
d. Do not blow your nose for 10 days, you may suck the mucous back into your mouth. You may use afrin nasal spray for the congestion. Please wash your nose with saline nasal spray (Ocean/Ayr) as often as you desire but at least three times a day 4- 5 puffs.
e. Sneeze with your mouth open.
f. Avoid striking or bumping your nose, or rolling on it while sleeping. Most importantly, SLEEP ALONE, on your back, using two pillows with a form-fit head pillow or bolster to prevent your head from turning.
g. Do not wear glasses for two months following surgery, or until consulting with Dr. Griffiths. If it is necessary for you to wear glasses, place scotch tape around the bridge of the glasses and stick them to your forehead, ensuring the bridge of the glasses is held above the nasal bridge.
h. Do not chew hard; do not eat foods which are too hot.
Taping of the nose will be done following the removal of the cast, usually on the third to fifth post-operative day. Taping of the nose will be continued by Dr. Griffiths until such time as he feels your nose has properly molded. At that time, Dr. Griffiths will instruct you on the proper taping of your nose at night. Taping of the nose before bedtime, after instruction by Dr. Griffiths, will continue until such time as the nose achieves its final form.
Some noses, because of their nature, continue to swell for a considerable period of time, particularly those noses afflicted with allergies. This swelling can lead to scar tissue formation which, in turn, can result in a nasal deformity. Therefore, follow-up visits to check this problem are necessary at frequent intervals, and taping, if ordered, is mandatory to prevent this complication of the healing process.
j. When instructed, your nostrils may be cleaned with cotton applicators and hydrogen peroxide (3%). Lubricating jelly may be applied in both nostrils to prevent drying of the mucous membrane. Always remember, never overapply either the peroxide or the lubricating jelly; a little is better than a lot. Of utmost importance ( K-Y Jelly).
k. After Dr. Griffiths removes the tape, the skin of the nose can be cleaned gently and thoroughly with any mild soap.
l. Avoid exposing the nose to the sun for six weeks following the surgery. If it is necessary for you to go out in the sun, after the six-week period, sunscreen should be used. Remember, you should avoid both direct sun and reflected sun. Sun can reflect off walls, water, snow, and sidewalks, and can also pass through glass windows. This is especially true for the driver of a car to recognize, since the reflected rays of the sun through the window of a car can be more dangerous than direct exposure to sunlight.
m. Do not shower for one week after surgery or until the cast is off. While the tape in on, you may shower and then blow dry the tape with cool air if it gets moist…abvoid getting the tape wet. Sponge bathing is permissible.
n. Hair can be washed after the first week. A hot air dryer should not be used for two weeks following surgery; when a dryer is necessary after the first week, it should be a cold dryer.
o. There may be no swimming for one month, and no diving for two months. Rest is most important and should be enforced during the first week following surgery.
p. There should be no excessive talking or activity.
q. Avoid all emotional excitement, since it can lead to hemorrhage as well as excessive swelling. Take the tranquilizers prescribed by Dr. Griffiths. Do not take a long car trip.
r. Eat before going to the office for your post-operative visits in order to avoid weakness and fainting as a result of hypoglycemia.
s. Do not discuss your surgery with anyone other than your family, since old wives' tales do more harm than good.
t. Do not attempt to evaluate your nose for at least six months. The final result may not be evident for six months to a year. Taping as mentioned above, in selective cases, may be necessary for six months or more in order to achieve a good result. This is only done in the evening, before retiring.
u. With respect to diet, continue the diet prescribed by Dr. Griffiths until he notifies you otherwise. It may be necessary to remain on the special diet for one to three weeks in order to control swelling. When the diet is relaxed, four major rules must be followed:
i) Do not drink unless you are thirsty;
ii) Do not eat or drink anything five hours before going to bed;
iii) Do not use salt–only salt substitutes;
iv) Try to eat only foods low in sodium.
v. If bleeding should occur from the nostrils: Rest on two pillows, put ice directly on the back of the neck and the upper lip. If this does not control the bleeding, call Dr. Griffiths immediately.
HOW YOU FEEL AFTER SURGERY
After surgery, your nose will be swollen for two to three weeks. This is more apparent once the cast is removed and before taping begins. Your eyes may be swollen and red, and may tear excessively. Occasionally, a red spot will develop in the white part of your eye, and this may last for two to four weeks. Cold compresses will greatly lessen the chance of swelling and bruising. Remember, do not apply ice directly to the eyes, use only cold-water compresses made by dipping a clean, lint-free facecloth in water which has been chilled with ice.
Pain after surgery is not common, although some discomfort is. If pain occurs, medication prescribed by Dr. Griffiths should be taken. If pain does not occur, it is best avoid the use of pain medication. Generally, any discomfort will be relieved by the cold compresses or Tylenol. If you have a low pain threshold, it may be necessary to take narcotic pain relievers. If you are aware that you do have a low pain threshold, please inform Dr. Griffiths of this so the medications can be prescribed. For individuals with moderate to high pain thresholds, the pain medication routinely prescribed by Dr. Griffiths is generally sufficient to control your discomfort following surgery.
Breathing through the mouth is associated with some discomfort and occasionally a sore throat, dryness, or irritation. These discomforts can ben relieved by frequent mouthwashes with any of the usual over-the-counter preparations or with the use of Lemm-glycerin swabs. This discomfort can also be relieved by eating frozen bananas, sucking on lifesavers, or gently chewing gum. If your mouth is excessively dry in the morning, place a pan of water in your room or use a cold vaporizer.
Redness which may develop in your eye(s) may take three to four weeks to disappear. Bruising generally takes two to three weeks to resolve, while the swelling around the eye is usually gone within two weeks. Your skin may turn yellow or orange, but this should not be feared, since this is the normal reaction of the body to the breakdown of blood underneath the skin surface following surgery.
If you do become black-and-blue, STAY OUT OF THE SUN. Exposing your skin to sun too soon may result in permanent pigmentation around the lower eyelid area. If your eyelids are already pigmented, there is a small chance that, after nasal surgery, increased pigmentation may occur, on a temporary or permanent basis. Only in rare cases does pigmentation persist after the disappearance of bruising.
Remain in touch with Dr. Griffiths at all times during the post-operative healing period for any real or imagined problems.Always remember that the success of the surgery is a fifty-fifty endeavor; fifty percent on the part of Dr. Griffiths, and fifty percent you. Your complete cooperation will make for an easy post-operative convalescence and excellent result, rather than merely a good one.
COMPLICATIONS OF SURGERY
In accordance with the legal doctrine of informed consent promulgated by the California courts, it is necessary to advise you of the possibility of complications after surgery. These complications are rare, and can include any consequence of a major operation. Every safety precaution will be taken to ensure the successful outcome of your surgery and any complication which might occur will be managed as the need demands.
Possible complications include but are not limited to:
- Bleeding
- Infection
- Poor Cosmetic Results
- Scaring with lump/bump/callus formation
- Crooked Nose
- Poor Breathing
These complications are rare.
Consent and Arbitration Agreements
Dr. Griffiths will review this information with you and be sure that you are as completely imformed as possible. Dr. Griffiths utilizes medical-legal arbitration in his practice. This does not prevent you from claiming negligence and filing a medical malpractice suit. It does streamline the proceedings and you give up your right to a Jury Trial. The proceedings will be hear infront of an agreed upon arbitrator.
Dr. Griffiths will request that you sign a consent form and an arbitration aggreement
Payment:
The fee has been agreed upon with Dr. Griffiths. Please bring Full Payment at the time of the pre-op appointment or on the day of surgery. Acceptable forms of payment: Cash, Cashier’s Check, Personal Check (requires 7 days advance payment to clear), or Credit Card .
The Payment includes:
- Surgeon’s Fee
- Assistant’s Fee
- Anesthesiologist Fee
- Operating Room Fee
- Nursing/Supplies/Medication Fee
- Post-operative Visits
Note: The surgeon’s fee for any re-operation which may be necessary will be included in this price. Anesthesia and Supply fees are not which would be an extra charge.
Please Write Down Your Questions and Bring Them to Your Pre-Op Appointment to Review with Dr. Griffiths.
