Elevate Magazine, January / February 2010

Case No. 3: The Professional
Ashley*, 29 - Rhinoplasty performed by Dr. Gregory Antoniak

I haven't told anyone about my rhinoplasty, except my parents. People tell me I look great, but no one seems to realize I've had something done! It's a subtle change—and that's exactly what I wanted. Although I'd never really liked my profile, I didn't do anything about it until last year, because I wanted to be able to afford the surgery. Timing was important to me, as well.

As it turned out, my biggest challenge was finding the right surgeon. Rhinoplasty seems especially risky, because you can't hide any mistakes. By the time I went to see Dr. Antoniak, I'd already done lots of research and seen two other surgeons in the Ottawa area.
When I told Dr. Antoniak I avoided smiling because I thought it accentuated the size and shape of my nose, I didn't feel judged — I felt supported and understood. In short: I knew I could trust Dr. Antoniak with my face.

Since I'm a teacher, it made sense to have surgery during sum¬mer vacation. At the Ottawa Hospital, Riverside campus, Dr. Antoniak reduced the bump on my nose, refined the tip and made my nostrils smaller. He also did a septoplasty so my breathing is much better now.
Post-surgery, I was able to walk and eat right away. I had some pain but nothing unbearable; although, I was a little shocked when the splint was taken off and my nose was still swollen. Fortunately, two weeks later I was good to go! (To be honest, I was really OK before that too—it just took me some time to get comfortable with my new nose.) I'm much happier today. I don't feel the need to hide my profile when I'm smiling or laughing—such a relief!

If I had any advice to give someone considering the proce¬dure, I'd say be patient and give your nose time to heal. Think of it this way: A small swollen nose is better than a large unswollen one, any day!

* name may be changed to protect patient.

Elevate Top 10 Nose-y Questions answered by facial plastic surgeons Dr. P. A., Dr. Gregory Antoniak and Dr. P. S..

1. How can rhinoplasty help me?
Dr. P. A: We can resculpt your nose, so it's smaller, straighter, narrower and more symmetrical. The tip can be refined and nostrils reshaped, too. Bone may be trimmed and cartilage reduced, shifted and used to augment areas that need it.

2. Is it right for me?
Dr. P. A: Your nose must be done growing, and it's also important to be realistic—a rhinoplasty will give you more self-confidence, but it won't solve long-standing emotional problems. Improvement, not necessarily perfection, is the most realistic goal.

3. Who pays for it?
Dr. P. A: Provincial health care will pay for rhinoplasty to repair dam¬age caused by injury or birth defect. In Ontario, reconstructive surgery is covered within two years of the injury, or in the case of a birth defect, up to age 19 (a septoplasty is always covered). Otherwise, your rhinoplasty is consid¬ered cosmetic, and you will have to pay for it—but you can claim a portion as a tax credit.

4. What should I look for in a surgeon?
Dr. P. A: Rhinoplasty is the most technically demanding facial surgery, so the more experienced your surgeon, the more likely you will get a harmonious result. Since you want your outer appear-ance to reflect your inner self, it's also crucial to have a good rapport with your doctor.

5. What will my new nose look like?
Dr. Gregory Antoniak: Up until a few years ago, I would sketch to help patients see their desired result. Ninety percent were happy with this approach, but the other 10 per¬cent had problems visualizing. Using special software, I now make changes to a patient's photo right onscreen during a consultation. It clarifies what a patient really wants, and I can use the photos in the operating room.

6. What should I do before surgery?
Dr. Gregory Antoniak: At the pre-op meeting I use Confirm, an interactive computer program, to ensure a patient is up to speed regarding surgery, recovery and possible outcomes. Surgeons also need to know about any medications, vitamins and supplements you're taking. And we advise about what meds to stop taking before surgery, such as blood thinners and anti-inflammatories.

7. What can I expect on surgery day?
Dr. Gregory Antoniak: Arrive at the clinic about 90 minutes before the procedure to get prepped for surgery. The actual operation takes between an hour and 90 minutes. Patients can usually choose between conscious or unconscious seda¬tion for a straightforward rhinoplasty. A general anesthetic is used for more complicated surgery, which might also include septoplasty or chin augmenta-tion. Expect to spend another 90 min¬utes in observation. Have someone pick you up and look after you for the first two to four days.

8. Any tips for an easier, speedier recovery?
Dr. P. S.: Sleep with your head elevated with pillows, and cool compresses will reduce swelling. Keep your nose moist with a saline spray and a lubricant such as Polysporin, for at least a week. Expect some nasal congestion, as well as swelling and bruising around eyes. Many patients don't need their prescribed painkillers and are comfortable with over-the-counter medications. Avoid wearing glasses for a month, and don't drive until the swelling around your eyes subsides.

9. When will I see results?
Dr. P. S.: The nasal splint and external sutures (if used) are removed within 10 days. After two weeks, most of the swelling settles, and you'll look fine enough to resume your daily activities. You can engage in light exercise starting at three weeks, but avoid contact sports for at least two months, as minor injury might damage the results. By one month you'll be closer to your final look. Some swelling may continue for up to a year -- . usually in the tip if it's been refined.

10. What is a "second rhinoplasty"?
Dr. P. S.: In up to 10 percent of my own rhinoplasty cases, revision surgery is needed to treat minor imperfections arising from the initial procedure. It can vary in complexity from minor surgical tweaks to complex surgery. These cases can be very challenging for the surgeon, but gratifying for the patient. Rhinoplasty is a complex operation, patients must be aware that they might require more than one procedure for optimal results

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