The consultation
The consultation with a view to cosmetic surgery is one of the pillars for obtaining a good result.   The definition of a good result is a satisfied patient. A satisfied patient is a patient who has made himself understood and has understood. Who has made himself understood by his surgeon by a very detailed description of the unsightly elements of his nose that disturb him and that have made him decide on surgery; by the possibility of expressing his desire, his dream nose, but above all his fears. The surgeon listens, understands and will choose a surgical technique adapted to the patient's desires and his profile analysis. We have a technique adapted to obtain a more pronounced tip lift; for a tip drop the technique will be different, for a morphological change of the tip, the technique and the approach will also differ.  To lower the height of a nose bridge more or less or to reduce the length of a nose more or less may be decided according to the patient's desires.  It is thus essential to listen in order to come as near as possible to the result desired by the patient.

Who has understood  the explanations of the surgeon  who, after having listened attentively to him and after having examined him, will answer the different questions that they have, will sometimes question the opinion of the patient who may be mistaken on the analysis of the entire face, and who will frequently emphasize certain aspects of his face that explain his impressions, but who above all will give him the limits of our art.  Thus certain patients who have thick skin on the nose tip will be disappointed to learn that we are limited in the sharpening of this tip despite the most advanced techniques.  However, having understood this, they will not be disappointed by the result because in most cases the slightly sharpened nose will better correspond to the facial proportions.
This is done through an analysis of patients who have already undergone surgery and by the same technique proposed by the surgeon. These before and after photos can give a concrete view of a result for a specific problem. For instance a prominent nose bridge leads to a projection of the nose; the adapted technique will be its reduction. The before and after photos show the efficacy of this technique, independently of the form of the face. The photographs shown will be either in relation to the same technique proposed or in relation to the similarity of the nose morphology. However, most faces are not alike.Certain patients prefer simulation of a cosmetic correction of the nose on their own photographs. This can be done using a computer simulation program.

Naturally this is just an insight. Since the computer simulation is fictive it will not take into account the skin texture, thickness and its capacity to retract. Although imprecise, the simulation can correct a profile, removing a bump and give the patient an idea of his new profile. The examination will be carried out by palpation of the nose, the skin, its cartilages.The examination of the bite, that affects a profile, is important.  Nasal endoscopy allows us to diagnose a nasal deviation, hypertrophied inferior turbinates, polyps, sinusitis or even hypertrophied adenoids.  This examination is important not only to correct a functional problem of nasal obstruction, snoring or chronic sinusitis, but also to guarantee an aesthetic result. Frequently we see patients who have already had a rhinoplasty and who have an unattractive nasal deviation for the simple reason that the deviated septum has not been corrected. This must be done in certain cases, even if the patient does not complain of nasal obstruction.  After the surgeon explains the procedure, instructions for before and after, and complications however rare they may be, the secretary gives the patient documents.

- An informed consent form that confirms in writing all the complications described in the medical literature, that the patient must sign on the day of surgery
- A price quote detailing the price of the hospital stay to be paid to the hospital and the price of the surgery to be paid to the surgeon. The secretary will explain the advantages of a possible coverage of the functional part of the surgery.
- An appointment for an anesthesia consultation.
- A blood test

 The day of the surgery
The patient is admitted to hospital on the day of the surgery on an empty stomach (i.e. he will not have eaten solids or drunk liquids for 6 hours) with his dossier and his medical test results. He must shower and wash his hair on the morning of the surgery. With the requested blood tests, x-rays, scanner examinations, if necessary and the report of the anesthesia consultation if it has been carried out.  After the administrative reception you are seen by the surgeon and the anesthetist. A few questions, a few answers, signing the informed consent form of the surgeon and the anesthetist and the surgery can begin. The informed consent form is signed just before the surgery, but it was given to the patient and explained on the day of the consultation in order to give the patient the time to read it and to ask the questions that it raises. Serious complications are extremely rare but it is important to be aware of them before taking any decision about surgery.

Anesthesia:
Rhinoplasty is performed under general anesthetia. This means that the patient is fast asleep, does not see or hear or feel the surgery. Sometimes under potentiated local anesthesia, which means that the patient is made drowsy by drugs administered by drip under the supervision of the anesthetist who participates in the procedure. Local anesthesia is performed by the surgeon. The surgery: lasts from 1 to 2 hours.

AFTER THE SURGERY
As soon as you wake up the anesthetist reminds you that your nose is blocked by dressings and you must breathe through your mouth. You are sent to the recovery room under the supervision of qualified personnel until you wake up completely after about 1 hour and return to your room. The most frequently heard complaints immediately after the surgery are the unpleasant feeling of blocked nose and the pressure exercised by the splint on the nose which sometimes causes pains easily assuaged by the usual painkillers, a feeling of nausea and sometimes vomiting without consequences and due to the general anesthesia. During the hospital stay, normally for one night, bags of frozen peas are placed on your eyelids to reduce bruising of the eyelids. The compress placed on your nose, which serves to absorb the blood, is changed regularly. The next day, a resin splint on your nose that will be removed after a week, dressings in the nose which will be removed either before you are discharged or 2 days later. In certain cases swabs can be used that dissolve after a week or even in other cases no dressings are used, reducing the aftermath of the surgery You go home with a splint on your nose, sometimes a swab in each nostril, bruising around your eyes, a hospitalization report and a prescription in one hand, and someone to accompany you holding the other hand.

The bruising around the eyelids increases the next day and gradually fades, disappearing after a week. During this week, you should avoid even the smallest nose injury. Do not sleep with your nose against the mattress, do not play with a baby in your arms, his first reflex will be to touch the plaster like he touches glasses, do not blow your nose, avoid any intensive sports activity. Likewise you should not drink alcohol and do not eat or drink anything too hot. If a columellar strut graft has been placed, do not eat raw fish or meat, and use mouthwash after each meal. 48 h after the surgery, removal of the dressings. Although certain patients say otherwise, while this act is unpleasant, it should not be painful. With the use of an anesthetic gel the dressings come out spontaneously, without need to pull them and this takes a few seconds.

From the removal of the dressings the improvement is felt every day through the gradual reduction of the swelling, disappearance of tearing and by the improvement of nasal breathing.  The splint is removed one week after the surgery at the clinic. It is not painful. Moisten the splint during the day, the splint will come away easily and painlessly. While swollen, the nose already shows the desired changes. The swelling will disappear after a month and the final result will be obtained between six months and one year.  The nose remains fragile for a month. During this time you should not participate in group sports where the risk of nose injury is more frequent. The part of the nose that takes the longest to assume its form is the tip. According to the work performed, this is frequently fibrous, hard to the touch and will be the last to take the shape of the underlying reshaped cartilage. It is sometimes necessary to inject cortisone under the skin of the tip if the fibrosis still looks spherical four months after the surgery. This injection, which is slightly painful, is given at the clinic, at the insertion site and generally has no adverse effect if the indication is correct. The first result is visible after a month, the final result after 6 to 12 months. This is explained by the time taken for the skin to mold itself to the new internal architecture.

At the end of 6 months, frequently less, sometimes more, but never more than nine months, you have a new nose. The result is not passed on from one generation to the next. For your next baby, you will have to wait 16 or 17 years for him to go through the same ordeal to finally look like you.


Pain:
Pains from this type of surgery are more of the type of headaches due to the nasal obstruction and the feeling of nasal pressure because of the splint.These pains are assuaged by painkillers.

Scar:
There is no visible scar for most rhinoplasties.
A small scar in the middle of the columella in the case of invasive surgery
In the case of nasal correction a scar in the groove of the nasal wing

Complications

The imperfections of the results
The perfection of the result can be judged only by the actual patient. This is why his satisfaction will depend on a good understanding between the patient and the surgeon. What the surgeon must understand are the personal aesthetic concerns of the patients and he must be able to apply the most recent techniques in his possession to achieve the desired result. What the patient must understand, and it is of course the surgeon's role to explain it to him, are the limits of our art, however sophisticated it may be, in relation to the specific features of the actual patient’s nose, face, skin and cartilage.

Some examples
A sometimes minimal congenital asymmetry of the face must be detected at the consultation. It will remain after the procedure and will lead to the continued impression of a deviated nose. If the patient has understood this at the consultation, this impression will be negligible and he will be satisfied. For injured noses with a very old deviation, a skin memory prevents us from obtaining a perfectly straight nose. The persistent deviation is barely visible but if the patient is not warned he may be disappointed by the result. A wide intercanthal distance (between the eyes) gives the impression of a wide nose root that will remain obviously after the procedure. It is important to show this to the patient at the time of the profile study and to help him understand the specific features of his face.

Retrognathism or prognathism (chin too far backwards or forward) must be emphasized with resultant aggravation of the profile. According to the bite, orthodontic correction or maxillofacial surgery together with rhinoplasty can optimize the profile.  Skin thickness and its underlying cartilage limits us in obtaining a sharp nose tip. The most frequent complication is the nosebleed, above all in the case of procedures on the septum and the turbinates, requiring the reinsertion of the dressings in any emergency department. Accordingly, you should not travel far from a hospital or fly during the first 15 days.

Serious Complications
Fortunately these are very rare. Most frequently this is an exceptional case described in the literature. Thus meningitis due to a meningeal breach by radiated fracture, is extremely rare, but will require emergency hospitalization, antibiotic treatment by infusion and endoscopic closing of the breach.

Loss of sense of smell, ocular complications and finally obstruction of the lacrimal sac that may require endoscopic reopening.
Fortunately, Dr. Hazan has never had these types of complications, but his endoscopic training will allow him to resolve such complications personally.

Thus meningitis due to a meningeal breach by radiated fracture, is extremely rare, but will require emergency hospitalization, antibiotic treatment by infusion and endoscopic closing of the breach.
Loss of sense of smell, ocular complications and finally obstruction of the lacrimal sac that may require endoscopic reopening.
Fortunately, Dr. Hazan has never had these types of complications, but his endoscopic training will allow him to resolve such complications personally.

Grafts and implants