Rhinoplasty – Worcester, Boston, Medford, Massachusetts

Where is the surgery performed? Procedures requiring intravenous sedation or general anesthesia (most rhinoplasties) are usually performed in the Day Surgery Unit at Saint Vincent Hospital in Worcester Medical Center, Worcester, MA, or the Massachusetts Eye and Ear Infirmary. We are confident you will find these facilities to be state-of-the-art, comfortable and very patient friendly.

Located in Central Massachusetts, Saint Vincent charges less for cosmetic surgery and anesthesia. Downtown Boston hospitals are generally more expensive. Saint Vincent is located in middle of downtown Worcester and very easy to reach. It is close to I 90, I 290, I 495, I 395, Rt. 9, and Rt. 146. Surgery performed under local anesthesia may be performed in our office operating room in our suite at Worcester Medical Center, Worcester, MA.

We see all our patients the day after surgery to check the nose, clean the nose and change any dressings that need to be changed. If you live more than an hour from Worcester, you might consider staying at one of the reasonably priced hotels just across the street from the hospital.

Recovery: What to Expect You will be given pre and post operative instructions designed to decrease the risk of bleeding, help alleviate your swelling and optimize your comfort. The recovery takes one to two weeks. Most people resume most of their normal activities and return to work within 10 days. We will advise you on when to resume specific types of exercise. Following surgery, a lightweight splint is applied to help protect the nose. The splint is removed in a week. Soft silicone plastic splints may be inserted on either side of the nasal septum at the time of surgery to protect the septum. These are held in place by temporary sutures and are also removed in a week. Usually, there is no packing in the nose. There is always some stuffiness of the nose for a week or two, especially when work has been done on the nasal septum. Your nose will be a bit dry for 6 months or so. We will recommend a saline spray. Pain is generally moderate and is usually well controlled with medication. Bruising occurs around the eyes, but begins to fade within a few days. Discoloration usually disappears within 10 days to two weeks. If you have an ear cartilage graft or temporalis fascia graft (the outer layer of the muscle above your ear), this area may be a bit more uncomfortable than the nose for the first week or so. The ear stays a bit tender even for months and may be a bit numb. Staples used to close these wounds are usually removed at 10 days or two weeks. Sutures behind the ear usually dissolve on their own, as do the sutures to the incisions in your nose. Most are gone in 10 days or so. Sutures under the skin that hold grafts in place can last 4-6 months. Sometime Dr. Bentkover uses a thin, dissolvable mesh under the skin of the nose. This mesh, Vicryl mesh, usually dissolves in 6 weeks.

What are some factors that can affect how my nose heals?
• Thick nasal skin
• Thin nasal skin
• Thick cartilages in the tip
• Thin cartilages in the tip
• Short nasal bones
• Smoking

What are some of the changes that occur after rhinoplasty that may not be predictable before surgery?

• Bleeding and infection. While rare, bleeding or infection are the most common complications of rhinoplasty. Your nose with ooze some blood from the nostrils for the first 4-5 days, but you should call us if there is rapid bleeding or a lot of blood in your mouth. Increased pain and redness after a few days or even after a week can be a sign of infection. You will be on an antibiotic for 7 days. If you have any concerns, you should call us.
• Other severe but rare complications. The nose and nasal septum attach to the base of your skull. While extremely rare, with any type of nasal surgery, functional or cosmetic, there is the possibility of loss of sense of smell, leakage of brain fluid, meningitis or brain abscess. Brain abscess, leakage of brain fluid, and meningitis can be life threatening conditions. Dr. Bentkover is double boarded in Facial Plastic and Reconstructive Surgery and Ear, Nose and Throat surgery (Otolaryngology). He has been operating on noses for over 30 years and has never had any of these complications, but they are well established risks of nasal surgery.
• Persistent swelling and scar formation. As a result of a rhinoplasty, your body forms a thin layer of scar under the skin that adheres to the cartilage and bones below. To some extent, it is the proper formation of this scar that holds in place the changes made to your nose. Depending on your type of skin, you may have persistent swelling in parts of your nose that may require one or more injections with a steroid called triamcinolone (Kenalog) to help the nose heal evenly. These injections are mildly uncomfortable. If you have thick skin or are of Mediterranean decent, you may be more prone to form thick scar tissue under your skin than can lead to some fullness in the profile or width of the nose. The injections usually help alleviate this. If you have external incisions, on rare occasion you may need to have the incision revised. This is usually a 10-15 procedure in the office with local anesthesia.
• Uneven healing of the bones. Especially if your nose is crooked, the bones can trend to drift back to the where they were; because the periosteum (the coating over the bone) is shorter on one side. You may be instructed in compression exercises after the splint comes off to prevent this.
• Irregularities of the bones. Every effort is made at surgery to make sure that the bones are smooth at the end of the procedure. Despite this, there can still be some irregularity of the bones as they heal.
• The height of your nasal profile. As the tip of the nose settles after surgery, sometimes the profile may be a bit higher than desired. If this is a real issue for you and for Dr. Bentkover, he may be able to file the bones a bit more after 18 months.
• Changes in the width of the nose. Imagine your nose as the shape of a long triangular tent. If you take off part of the top of the triangle, the remaining tent is lower, a bit wider and now has an "open roof". If you then bring the sides of the tent in towards each other and re-attach them to the center horizontal supporting beam of the tent, this closes the roof; but the new top of the tent may still be a bit wider than before. This is a reasonable analogy to what happens when the surgeon reduces a bump on your nose to improve your profile. The surgeon files or trims the bone and cartilage to lower the profile and then cuts the bones to bring the sides in to establish a new height to the profile. The center horizontal supporting beam is your nasal septum. Sometimes, grafts called spreader grafts may be necessary to correct some collapse of the internal nasal valves. These grafts are placed between the side walls of the nose and the septum on each side. They can add 1-1.5 millimeters or so of width to the middle of the nose.
• Changes in tip definition. Dr. Bentkover most commonly uses cartilage grafts from your nasal septum to improve the definition of the tip. It often takes 3-6 months before you can start to appreciate the affect of this type of graft. If you have thick skin in your nose it may not be possible to get the amount of refinement that you picture in your own mind. In normal healing, Realistic expectations are very important.

Skin Changes.

• Your nose will be numb for the better part of a year, and some small spots may stay numb. This is not usually an issue. The middle of your palate may be numb for a few weeks.
• Your skin may be a bit red or have prominent blood vessels in it (telangiectasias) after surgery. This is especially true if you skin tends to form these blood vessels in other areas, like the cheeks and chin. It may also be possible if you have Rosacea. It is more common with revision surgery.
• Smokers are at risk for slough (dying) of some of the skin of the nose. This is rare but can happen.
• Your skin may be thicker over the nose after surgery.
• When you go out in cold weather, your nose may turn a bluish color after surgery. This is especially true during the first year after surgery. It is also especially a possibility if you have Raynaud's Syndrome,l a condition where your finger tips turn blue in the cold. We do not recommend skiing or extended periods of other cold weather outside activity during the first year after surgery.
• Your nose will be more susceptible to sun burn for at least the first 6 months after surgery. This can adversely affect the outcome of the surgery. We recommend at least an SPF 60 sunscreen when you are outside in bright sunlight for the first year. If you are going to the tropics, we recommend an SPF 85 or higher. Do not let your nose tan or burn. You may get permanent brown discoloration.
• There may be some slight irregularities of the skin. Most usually clear on their own.

For the convenience of our patients, we have included our Post Operative Instructions below:

Post Operative Instructions

TO AVOID BLEEDING

Do not pick your nose.
Do not blow your nose. Dab the nostrils with facial tissues.
If you must sneeze, do so with your mouth open.
To keep your nasal linings moist and clean: A. Three times daily dab inside the nostrils with a solution of ½ water and ½ hydrogen peroxide and then apply Bacitracin to the same area with a Q-tip in a circular manner. B. Spray saline nose spray, 3 puffs in each nostril at least 5 - 6 times a day.
NO SMOKING for 1 month. Basically, give it up.
No bending, stooping or straining.
Do not strain while having a bowel movement. No alcohol for 7 days.
Avoid hot temperature drinks or hot foods.
Rest and sleep with your head propped up on 2 - 3 pillows.
No aspirin or aspirin related products such as Advil, Nuprin, Motrin, Aleve or ibuprofen should be used for pain relief for 7 days. Use an aspirin substitute, such as Extra-Strength Tylenol or medications prescribed by your physician. Also avoid high doses of vitamin E, gingko biloba, ginseng, garlic tablets and St. John's wart.

AVOID TRAUMA

After surgery, the nasal structures may be weaker than before, temporarily in most cases and permanently in some cases. A nasal injury at this time may severely damage your nose.

AVOID ACTIVITIES DURING WHICH YOU MAY BUMP YOUR NOSE No active swimming or diving for 6 weeks. You may wade, but watch out for other people's heads and elbows.
If you bump your nose, please call us at (508) 363-6500.
No contact sports for at least 5 - 6 months.
Avoid vigorous indoor activities for 10 days.
IMPORTANT: You may have a small pack or sheet of plastic in your nose for a period of time. If it should fall out or be bothersome, please call us at (508) 363-6500