MEDICAL EVALUATION FOR NASAL SURGERY

If you do not like the way your nose looks, that is a good reason to see a surgeon specializing in cosmetic and functional nasal surgery. While you may be primarily concerned about the appearance, your surgeon wants to evaluate both the form and function. The history and examination determines if surgery is indicated and what can be accomplished. As physicians, we want to know whether you have injured your nose or have had previous surgery. It is important for me to know what you would like your nose to look like and for you to know what is possible. Good communication is essential for a happy outcome.

I will examine the skin and the three major sections of the nose and assess the size and shape of the nose in relation to other facial contours. I then will tell you what surgery is needed and whether aesthetic or functional improvements are possible. I look at your nose in terms of a triangular structure from the front, the side and the base. Your nasal appearance may not conform to the ideal triangle from either side or the base view. I will discuss with you the possible changes that can made through surgery and answer your questions.

Anyone having difficulty breathing should see a nasal specialist. I want to know how well your nose is functioning before considering nasal surgery of any kind.  A history and examination enables me to determine if an internal problem exists and whether it requires medical or surgical treatment.

NASAL HISTORY
I will want to find about allergies or recurrent nasal and sinus infections. I will want to know if you have difficulty breathing through one or both sides, if medications are helpful, and whether you have been using nasal sprays.

THE NASAL EXAMINATION
When I examine your nose, the internal anatomy is readily visible with good lighting.   I will look for swelling, deviation of the septum (the wall between the two nasal chambers), enlarged turbinates (the humidifiers which swell and shrink with allergy or chronic inflammation) or any other problems.  Nasal function can be impaired when swelling or structural problems block the internal triangles of the nose. I will discuss your diagnosis with you and recommend a surgical procedure that can restore normal nasal function.

SURGICAL CONSIDERATIONS Both the appearance and function of the nose must be considered together. When the size of the nose is reduced for aesthetic reasons, the size of the breathing passages will also be reduced. Whether or not this affects your breathing depends upon the internal structure of your nose. In the best case, a nose that is too large with no internal problems and has ample room for breathing allows for the best opportunity for improved aesthetic appearance. This typically does not occur in some element of an abnormal nasal chamber internally, either due to enlarged turbinates or deviated septum, as if often the case. In these instances, internal and external surgery are done at the same time.

PREPARING FOR SURGERY
After I have determined that nasal surgery is indicated in your case, you and I will decide whether it will be done with local anesthesia or general anesthetic. Nasal surgery can be performed in a surgery center or a hospital. When surgery is performed under local anesthesia, the patient is awake during the procedure but not aware that the operation is bring performed, since the area around the nose has been numbed by the actual local anesthetic. A sedative during the operation helps the patient relax and liquid medication inside the nose allows for shrinkage of the lining and complete anesthesia. During the operation the patient may be aware of sounds, but will have no feeling of any discomfort whatsoever. Under general anesthetic, the entire body is "asleep", including the nose. The patient does not see, feel or hear anything. An injection in the vein puts the patient to sleep. During the operation a tube is connected to an anesthesia machine and is put in the airway to deliver oxygen and an anesthetic agent. Although general anesthesia involves slightly higher risk and cost, it may be necessary for your particular nasal problem.