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FAQ

Please Explain the terms Rhinoplasty?

Please explain Septoplasty?

Please explain Septorhinoplasty?

What is a Revision Rhinoplasty?

What is open Rhinoplasty versus closed Rhinoplasty?

How old do I have to be to have a Rhinoplasty?

When would a surgeon use grafts from the ear or Rib?

Am I a good candidate for Rhinoplasty?

How do I choose a surgeon?

Is digital imaging important?

What is the cost of Rhinoplasty?

Will the Ministry of Health (OHIP) or my insurance cover all or part of the procedure?

What type of anesthetic is used during the procedure?

How long is the procedure?

Will I have nasal packing?

How long do I have to take off work/ school?

What will I look like at two weeks after surgery when I return to work?

What about exercise and sports after Rhinoplasty?

When will I see the results?

Can I have another plastic surgery procedure at the same time as my Rhinoplasty?

When can I wear glasses after Rhinoplasty Surgery?

How often does a Patient need a Revision Rhinoplasty after Surgery with Dr Solomon?

When are injectable fillers used in Rhinoplasty?

Does Dr Solomon use Gortex in Rhinoplasty?

How can your surgeon keep the risk of surgery to a minimum?

How will my surgeon assess my nose?

What kind of planning does the surgeon do for my surgery?

Should I expect a perfect result from this surgery?

Will Rhinoplasty surgery affect the skin on my nose?

Does Dr Solomon perform non-Caucasian Rhinoplasty surgery?

How frequently does Dr Solomon perform revision Rhinoplasty surgery?

How does Dr Solomon narrow the tip of the nose?

How does skin type affect Rhinoplasty?

I want to reshape my nose but am afraid that I will scar from the external incision. Is there a way of achieving the same result without an external incision?

Please Explain the terms Rhinoplasty?

A. Rhinoplasty is a term used to describe surgery done to reshape the nose. This procedure may be done to reshape the nose for cosmetic reasons or to be restorative or functional in nature.

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Please explain Septoplasty?

A. A Septoplasty is a surgical procedure on the midline partition of the nose. This is usually done to improve nasal breathing but may also be necessary to straighten the external appearance of the nose. A deviated septum is a common condition where the midline partition of the nose is obstructing the breathing passage. This may alone be the problem affecting nasal function or may be one of number of conditions that can cause nasal congestion.

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Please explain Septorhinoplasty?

A. Septorhinoplasty Surgery is when both septoplasty and Rhinoplasty procedures are done together. Other terms used for nasal surgery include dorsal resection which refers to reduction of the bridge of the nose. Reduction of Nasal Fracture is a term referring to repositioning of the nasal bones after trauma.

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What is a Revision Rhinoplasty?

A. Revision Rhinoplasty is a procedure done to correct problems inadequately corrected or arising from previous Rhinoplasty surgery.

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What is open Rhinoplasty versus closed Rhinoplasty?

A. Open Rhinoplasty is when a small incision is made across the bottom structure of the nose between the nostrils called the collumella. The skin and soft tissue is then elevated off the underlying structures of the nose giving the surgeon an excellent view of the nasal anatomy. This procedure is performed by Dr Solomon on select cases that he feels would benefit from the improved exposure. Such cases may be the crooked nose or some revision surgeries or when a lot of tip modification is desired.

Closed Rhinoplasty describes Rhinoplasty surgery when all the incisions are made inside the nose. This leaves no external scar. This type of surgery is done on the majority of Dr Solomons Rhinoplasty patients.

Dr Solomon will discuss both options and which type of surgery he feels is most appropriate for your particular case.

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How old do I have to be to have a Rhinoplasty?

A. In general the minimum age in women is 14 or 15 and a few years older in men. For women menstruation will indicate physical maturity. The ideal age is highly variable however depending on physical and emotional maturity. There is no upper age limit for Rhinoplasty. The only important variable in terms of upper age limit is good general health.

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When would a surgeon use grafts from the ear or Rib?

A. In reconstructive Rhinoplasty surgery when cartilage is needed to build up certain parts of the nose grafts will be needed. In Dr Solomons practice the most common to obtain cartilage for grafting are from the patients ear or Rib? Ear cartilage is generally curved and soft. It can be excellent for grafting the nasal tip or camouflaging areas of the nasal bridge. Rib cartilage is generally much stronger and better for grafts needed for strength.

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Am I a good candidate for Rhinoplasty?

A. You are a good candidate for Rhinoplasty if you are in good general health. You have a definable problem with your nasal appearance and have a reasonable expectation of what surgery can achieve. Emotional well being is crucial for patients considering Rhinoplasty surgery. Patients that are not emotionally stable may find the procedure very difficult to go through as well any problems that may arise from the surgery may seem over whelming. If a patient has any existing physical or psychological problem they must ensure that these are treated prior to considering this surgery.

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How do I choose a surgeon?

A. In Canada, surgeons who perform Rhinoplasty are usually board-certified in either Otolaryngology-Head or Neck Surgery with possibly a second board certification in Facial Plastic Surgery or Surgeons who have board certification in plastic Surgery. There are surgeons well qualified from either of these specialties who perform Rhinoplasty. While Board certification is an important prerequisite it may say little about what the surgeon actually does in his practice. For instance a plastic surgeon may focus his or her practice on hand or breast surgery and do little Rhinoplasty surgery. Similarly a Head and Neck surgeon may perform cancer surgery but not Rhinoplasty. Clearly the best choice is a surgeon who dedicates his practice to the art and science of Rhinoplasty surgery. As Rhinoplasty is a very challenging surgery it is important that your surgeon be focused and experienced in this procedure. Finally a surgeon who performs this procedure should be able to do both internal and external nasal surgery and not rely on the skill of other surgeons to perform any part of the Rhinoplasty. This is important as the external and internal nose are intimately linked both cosmetically and functionally.

A surgeon who performs Rhinoplasty frequently should have many photos of previous patients to share with you. While he/she may be only showing you his “best results” at least you know that these are his results and he is capable of producing the kind of change that you are looking for. As no two noses are alike you won’t likely find your nose in the portfolio but there should be noses similar to it.

Your surgeon should carefully analyze your nose inside and out and have a clear plan for how he intends to approach it. The quality of your communication and rapport with your surgeon is most important here. You want to make sure that your surgeon is someone who listens and takes your concerns seriously.

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Is digital imaging important?

A. While digital imaging is not a guarantee of your result it is likely the best way for you and your surgeon to communicate what the ultimate goal should be. Some surgeons rely on photographs which the surgeon may modify with drawings or cut outs. In the day of advanced computer technology I believe the best tool to ensure that the surgeon and patient share a common goal is computer imaging software. While this technology is expensive most serious Rhinoplasty surgeons generally will offer this service to there prospective patients.

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What is the cost of Rhinoplasty?

A. There are no set fees for cosmetic surgery. The cost of the procedure varies depending on the complexity of the case, In Toronto the cost of a primary Rhinoplasty can vary from $3000- $12000, revision procedures generally cost more. The average cost of Rhinoplasty at our clinic starts at $5500 for Canadian residents.
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Will the Ministry of Health (OHIP) or my insurance cover all or part of the procedure?

A. The Ministry of Health will usually cover the portion of the procedure that is done to correct a breathing problem (septoplasty or turbinate reduction). Sometimes the Ministry of Health will cover septorhinoplasty to straighten a deviated nose when this occurs as the result of trauma or congenital birth anomaly. This requires prior approval from the ministry. Private insurance plans generally do not cover cosmetic surgery. In cases where there is a functional and cosmetic component involved the patient will be charged only for the cosmetic surgery and the functional surgery will be billed to OHIP.

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What type of anesthetic is used during the procedure?

A. Most of the time a light general anesthetic is used although local with deep sedation may be appropriate in some cases. Most surgeons find this is the most comfortable way for a patient to have this procedure. A qualified anesthesiologist will be present in all cases where anesthesia is used.

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How long is the procedure?

A. This varies depending on what needs to be done anywhere from 1-3 hours.

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Will I have nasal packing?

A. Small tampons generally are used in Rhinoplasty surgery. Dr Solomon will determine the need for packing during your surgery. The packing used is minimal and is removed the following day by Dr Solomon. In crooked noses he may place plastic splints inside the nose to maintain a straight septum for 5 – 7 days.

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How long do I have to take off work/ school?

A. A Septoplasty is a surgical procedure on the midline partition of the nose. This is usually done to improve nasal breathing but may also be necessary to straighten the external appearance of the nose. A deviated septum is a common condition where the midline partition of the nose is obstructing the breathing passage. This may alone be the problem affecting nasal function or may be one of number of conditions that can cause nasal congestion.

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What will I look like at two weeks after surgery when I return to work?

A. Although everyone heals at a different rate most people will have very few signs of surgery at two weeks after Rhinoplasty and feel comfortable returning to work. At this time most of the bruising has gone but there may be still some dark circles under the eyes that can be covered up with make up. There is usually some swelling on the tip of the nose and along the sides of the bridge. This will mostly be obvious to you and your surgeon but not the average person in the public. The patient shown here is just over two weeks after extensive septorhinoplasty using an external approach with surgery on the bridge, tip and with osteotomies. Her results are typical of healing at this stage.

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What about exercise and sports after Rhinoplasty?

A. You may start most exercise 2 weeks after Rhinoplasty. Low intensity exercises are advised for the first few weeks such as walking or elliptical trainer. More active exercises can be considered at about 3-4 weeks after surgery. Any sport where you risk getting hit in the face is best delayed for 6 weeks after Rhinoplasty.

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When will I see the results?

A. The swelling in the nose can take some time to go away to reveal the final results. You will see a major change at 2 weeks after surgery and at about 2 months the majority of swelling is gone. It can take up to a year to see the ultimate outcome. Every nose is different and therefore depending on the extensiveness of your surgery as well as the approach of surgery used you may have a shorter or longer recovery than average.

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Can I have another plastic surgery procedure at the same time as my Rhinoplasty?

A. It is not uncommon for Solomon to perform other procedures while the patient is having Rhinoplasty. In Some cases sinus surgery is performed at the same time as Rhinoplasty if indicated. As well chin augmentation. Lip enhancement, blepharoplasty (eyelift), otoplasty (ear setback) or even a facelift can be performed in conjunction with Rhinoplasty surgery.

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When can I wear glasses after Rhinoplasty Surgery?

A. Generally it is advised to avoid using glasses for a minimum of four weeks after Rhinoplasty Surgery. Contact lenses can be used shortly after surgery. Glasses can leave imperfections on the nose and affect ideal healing of the nasal bones if used to soon after surgery.

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How often does a Patient need a Revision Rhinoplasty after Surgery with Dr Solomon?

A. Dr Solomon generally quotes up to ten percent of patients may need a minor revision after surgery with him. He will determine the need for this in consultation with each patient as they go through the healing period.

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When are injectable fillers used in Rhinoplasty?

A. Injectable fillers used for filling scars or for improving wrinkles can also be used to correct subtle imperfections of the nose. There are a number of fillers on the market. Some fillers are permanent in nature. This is not ideal for all patients and Dr Solomon will assess you to see if you are a candidate for this treatment.

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Does Dr Solomon use Gortex in Rhinoplasty?

A. Gortex is a synthetic product that is used in many types of surgery. It has a good safety profile but can have side effects. If used correctly Gortex can help in certain types of Rhinoplasty to create excellent results which may otherwise be difficult to achieve with standard cartilage grafts used in Rhinoplasty. The biggest risk of gortex is the about a 1-3 percent infection rate.

If Gortex becomes infected it must be removed. Dr Solomon Generally prefers to use a patients own tissues in Rhinoplasty. In some complicated cases where cartilage is limited or would require surgery on other parts of the body such as the ear or the rib, gortex may be offered as an alternative. As Dr Solomon offers both surgery using patients own tissue and synthetic implants the patient will review all options and choose the one that makes the most sense for there individual needs.

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How can your surgeon keep the risk of surgery to a minimum?

A. Communication between the Surgeon and Patient are crucial to ensure a good outcome. Dr Solomon will try to understand clearly the goals of each and every patient prior to surgery. This will be confirmed with computer imaging during consultation prior to surgery. Once the clear Plan is established with you, Dr Solomon will perform the procedure with great care, and provide all after care as needed.

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How will my surgeon assess my nose?

A. The Rhinoplasty surgeon should evaluate the entire nose. First the surgeon will ask what you hope to accomplish. The surgeon should ask about possible nasal symptoms such as a nasal congestion or nasal discharge. The surgeon will ask if you ever injured your nose or had prior nasal surgery. Then the surgeon will fully examine your nose. This will involve an assessment of the internal nasal anatomy and the external appearance of the nose. Generally the surgeon will use a metal speculum to visualize the inside nasal anatomy. This will include visualization of the nasal septum, and the inferior turbinate. Other aspect of the inside of the nose may require an assessment with a nasal fiberoptic telescope. This is generally followed by an external assessment of the nose. Dr Solomon generally will describe how your nose currently fits in relation to the other features of your face. He will assess the length, the width, the projection the bridge and the nasal tip. He will tell you which features are less than ideal and which features are attractive and should be preserved. Dr Solomon generally will palpate the nose to feel the skin and underlying structures of the nasal tip and bridge. This is often crucial in preoperative planning for Rhinoplasty surgery. Finally Dr Solomon will summarize his findings and advice you of your potential options with Rhinoplasty surgery.

With computer imaging, Dr Solomon shows the patient an imaging result that is the goal for surgery, and he wants to be sure that the patient agrees to the goal. The patient understands that this is not a guarantee, but that this is a shared goal of the surgery.

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What kind of planning does the surgeon do for my surgery?

A. Dr Solomon will review your case during your consultation. He will discuss a surgical plan. He will review your case again with computer imaging. Finally he will review your unique situation the day of surgery and just before surgery. This will ensure that Dr Solomon not only has an idea of what the surgical goal is but how to achieve it. Excellent results in Rhinoplasty rely on Rhinoplasty Surgeons ability to assess, appropriately plan and perform the technical procedure. A Passion for this procedure by the surgeon ideally will lead to the best results for patients.

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Should I expect a perfect result from this surgery?

A. Perfection is not a good measuring stick in Rhinoplasty. If a surgeon is highly critical of there work they may find miner imperfections in many cases. Subtle imperfections may also be appreciated by the patient. The goal of surgery is to achieve a happy patient and substantial esthetic improvement in each case. Dr Solomon will tell all his patients that miner imperfections can occur up to ten percent of cases due to healing. If there is an imperfection that he can improve after a year of healing he will offer this to you as a miner revision operation at no cost. Dr Solomon is dedicated to try to give you the best result he can.

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Will Rhinoplasty surgery affect the skin on my nose?

A. While Rhinoplasty surgery generally does not affect the skin of the nose in the long run patients may experience temporary changes to the nasal skin.

After surgery the nasal skin may appear oily and some patients may develop acne on the nose especially if they have a prior history of acne.

Some patients may also notice development of telangiectasia small blood vessels on the nasal skin. If telangiectasias are a concern there are treatment options available.

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Does Dr Solomon perform non-Caucasian Rhinoplasty surgery?

A. Specializing in Rhinoplasty surgery in Toronto, Dr Solomon has a large multicultural clientele. Dr Solomon performs many Rhinoplasty surgeries on patients of African American, Asian, South East Asian descent. Rhinoplasty for each of these patients has different challenges compared to most Caucasian Rhinoplasty operations. Patients of non Caucasian descent may desire building up there nasal bridge and strengthening there nasal tip and narrowing the nasal base. Dr Solomon has a large experience with these types of cases and will be able to offer various surgical options in consultation.

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How frequently does Dr Solomon perform revision Rhinoplasty surgery?

A. Dr Solomon performs over 200 Rhinoplasty surgeries a year. Approximately twenty to thirty percent of his surgical practice is revision Rhinoplasty surgery of patients who had undergone surgery by other surgeons?

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How does Dr Solomon narrow the tip of the nose?

A. Generally narrowing the tip of the nose is accomplished by either reshaping the existing cartilage of the nose by trimming the cartilage or changing the cartilage shape.

Some soft fatty tissue can also be removed under the skin to improve nasal tip definition. Permanent sutures can be placed to narrow the shape of the cartilage of the tip. Finally cartilage can be added with nasal tip grafts to actually improve nasal tip definition. Dr Solomon at the time of the consult will determine which method he thinks would work best in your situation.

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How does skin type affect Rhinoplasty?

A. Skin thickness is one of the most important factors affecting Rhinoplasty results. If a patient has thin skin changes to the cartilage of the nose will almost certainly change the appearance of the nose. While having thin skin is considered an attractive feature any imperfection resulting from surgery will be noticeable as well. Therefore its a double edge sword. The surgeon needs to let you know this and perform the surgery as perfectly and delicately as possible to ensure a good result.

Thick skin patients are difficult to obtain dramatic changes with Rhinoplasty. They still can benefit from Rhinoplasty surgery but the results may be less dramatic as the skin covering the nose may camouflage some the changes to the underlying structures of the nose. An expert Rhinoplasty surgeon will generally have different methods available to give patients the best result depending on their skin type. Dr Solomon believes that if a surgeon uses only one procedure cookie cutter Rhinoplasty then they will not be able to achieve a good result in all skin types. Dr Solomon will make a detailed study of your nose and individualize the procedure he feels will work best in your situation.

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I want to reshape my nose but am afraid that I will scar from the external incision. Is there a way of achieving the same result without an external incision?

A. Rhinoplasty surgery can be performed with or without and external incisions. Open Rhinoplasty surgery involves making a scar across the bottom partition of the nose called the collumella.

This operation has many benefits as it affords the surgeon excellent exposure of the patients nasal anatomy.

The scar generally if sutured well, will heal nicely and leave an almost invisible scar. Closed Rhinoplasty surgery can be performed on many if not the majority of Rhinoplasty cases. This surgery has all the incisions inside the nose and no externals scar. The surgery is ideal when the surgeon believes they can achieve all the desired result with this approach. The choice of type of Rhinoplasty will often depend on the surgeons experience with both methods and their prior nasal surgical training. Dr Solomon has expertise in both methods allowing him to offer you either depending on your needs. He uses closed surgery in most Rhinoplasty cases and is able to achieve excellent results with this method. In certain situations Dr Solomon will prefer an open Rhinoplasty method. If you have a tendency to produce hyertrophic or keloid scars closed surgery will often be advised to avoid any additional risk from an external nasal incision.

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