Nose Surgery Washington DC/McLean/Tyson’s Corner

Introduction

Rhinoplasty, or surgery to reshape the nose, is one of the most common of all plastic surgery procedures. Dr. Baker has a large rhinoplasty practice in which he performs over fifty rhinoplasties a year and has authored a textbook on rhinoplasty surgery. Rhinoplasty can reduce or increase the size of your nose, change the shape of the tip or the bridge, narrow the span of the nostrils, or change the angle between your nose and your upper lip. It may also correct a birth defect or injury, or help relieve some breathing problems. During your consultation, Dr. Baker will use illustrations from his Rhinoplasty Atlas to illustrate how the procedure is performed and you can see before and after images of his patients. You will also review 3-D images of your current nose and computer images of the desired changes to ensure that Dr. Baker knows exactly what your goals are. Dr. Baker does not post patient images on his website out of respect for patients’ privacy, but he does have before/after books in his office you can review at your consultation.

If you are considering getting a rhinoplasty in Washington, D.C., this information will give you a basic understanding of the procedure: when it can help, how it is performed, and what results you can expect. It cannot answer all of your questions, since a lot depends on your individual goals and your consultation with Dr. Baker.

Dr. Baker’s Credentials for Rhinoplasty:

  • Professor of Plastic Surgery, Medstar Georgetown Department of Plastic Surgery
  • Director, Medstar Georgetown Center for Facial Restoration
  • Medical Director Inova Craniofacial Program (Dr. Baker treats patients with noses that are much more difficult to manage than standard cosmetic patients)
  • Authored textbook on rhinoplasty
  • Authored multiple peer-reviewed manuscripts on rhinoplasty
  • Samuel Stahl Rhinoplasty Award for Best Paper at the Annual Rhinoplasty Meeting
  • American Society of Maxillofacial Surgeons Visiting Professor on Rhinoplasty
  • Instructor American Society of Plastic Surgeons Rhinoplasty Courses
  • JAMA Facial Plastic Surgery Rhinoplasty article was most cited article of 2015
  • Pioneer in measuring outcomes and patient satisfaction in rhinoplasty (Face Q)

The Best Candidate for Rhinoplasty

Rhinoplasty can enhance your appearance and your self-confidence, but it will not necessarily change your looks to match your ideal, or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them with Dr. Baker. The best candidates for rhinoplasty are people who are looking for improvement, not perfection, in the way they look. If you are physically healthy, psychologically stable, and realistic in your expectations, you may be a good candidate. Rhinoplasty can be performed to meet aesthetic goals or for reconstructive purposes-to correct birth anomalies, post-traumatic deformities, or breathing problems.

Evaluation

Before you undergo a rhinoplasty in Washington, D.C., remember that good communication between you and Dr. Baker is essential. In your initial consultation, Dr. Baker will ask you about your aesthetic goals, evaluate the structure of your nose and face, and discuss the possibilities with you. Dr. Baker will also explain the factors that can influence the procedure and the results. These factors include the structure of your nasal bones and cartilage, the shape of your face, the thickness of your skin, your age, and your expectations. Two-dimensional and three-dimensional images will be obtained and these will be used to help both you and Dr. Baker clearly identify your surgical goals. Dr. Baker also employs an outcome measure tool called the Face Q that objectively measures patient satisfaction. Using this tool has enabled him to improve patient satisfaction in his practice. Dr. Baker’s practice has been selected as one of several practices in the United States to assist the Plastic Surgery Foundation in evaluating patient’s satisfaction after aesthetic facial surgery. He has been using this tool since its inception and finds it very helpful in optimizing his ability to achieve high levels of patient satisfaction.

Additionally, Dr. Baker will explain the techniques and anesthesia he will use. He will use illustrations from his textbook, Rhinoplasty, to show you normal nasal anatomy, the recommended procedure, and how the procedure is performed. Dr. Baker finds that thorough patient education results in a smooth postoperative course in the majority of patients. Dr. Baker does not post patient images on his website out of respect for patients’ privacy, but he does have before/after books in his office you can review at your consultation. Do not hesitate to ask Dr. Baker any questions you may have, especially those regarding your expectations and concerns about the results.

Be sure to tell Dr. Baker if you have had any previous nose surgery or an injury to your nose, even if it was many years ago. It is also helpful to bring previous operative notes and photos before and after previous surgeries to your visit to Dr. Baker.

What Is a Rhinoplasty?

Rhinoplasty is the procedure that changes the appearance of the nose, improves the breathing through the nose, or achieves both of these goals. A rhinoplasty is performed under general anesthesia and usually takes about one to two hours, though complicated procedures may take longer. The supporting framework of the nose is approached through small incisions, and the nose is then sculpted to the desired shape. The nature of the sculpting will depend on your aesthetic and functional goals. Finally, the skin is redraped over the new framework.

When the surgery is complete, surgical tape or a splint will be applied to help your nose maintain its new shape. Rarely, nasal packs or soft plastic splints may be placed in your nostrils to stabilize the septum (the dividing wall between the air passages). Most patients are comfortable going into the public within 7-10 days after surgery.

Dr. Baker provides the following types of rhinoplasty in Washington, D.C.:

Cosmetic Rhinoplasty – This is a rhinoplasty that is performed in a patient with no underlying functional airway problems. The patient typically will be able to identify aspects of their nasal appearance they would like changed or enhanced. During the consultation, Dr. Baker will make sure he can meet the your expectations and also use three-dimensional imaging to demonstrate what you would like to achieve through surgery.

Revision Rhinoplasty – The revision rhinoplasty is a rhinoplasty being performed after one or more previous rhinoplasties have been performed. These usually take more time and are more difficult than primary rhinoplasties. Given Dr. Baker’s subspecialization in craniomaxillofacial surgery and his practice at Georgetown University Hospital, a large portion of his rhinoplasty practice consists of secondary or revision rhinoplasties.

Nonsurgical (Filler) Rhinoplasty – Fillers offer a method to make subtle changes to nasal form either in primary or revision rhinoplasty. In areas that are undercontoured, a filler is injected in the office to add volume or definition in nasal form without the need for anesthesia and surgery. Filler is used to enhance symmetry, increase subtle degrees of nasal tip projection, and elevate the bridge of the nose. While filler is useful in subtle changes, it is important to note that the structure of the nose is cartilage and bone. Therefore large degrees of dimensional change created with filler will give the nose a soft, doughy appearance that is inconsistent with normal nasal from.

Functional Rhinoplasty – The functional rhinoplasty is for patients who have functional problems breathing through their nose. This commonly occurs after trauma, previous facial surgery, developmental abnormalities, or other causes. The goal of this operation is to restore or improve proper nasal function. In cases of trauma, it is also the goal to restore the pre-injury appearance of the nose. If a patient is undergoing rhinoplasty for functional reasons and has cosmetic concerns too, the two procedures are easily combined in one surgery.

Congenital Rhinoplasty – Patients afflicted with congenital anomalies such as cleft lip, Binders syndrome, frontonasal dysplasia, and others frequently require rhinoplasty to achieve normal facial proportions and nasal appearance. Rhinoplasties in these patients are the most difficult Dr. Baker treats. However, the skills gained from these difficult cases are applied to cosmetic patients and the aesthetic principles in cosmetic patients are employed in those with congenital anomalies.

Preparing For Your Surgery

Dr. Baker will give you specific instructions on how to prepare for your rhinoplasty in Washinton, D.C., including guidelines on eating and drinking, smoking, taking or avoiding certain vitamins and medications, and washing your face. Carefully following these instructions will help your surgery go more smoothly. While you are making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days if needed.

Although Dr. Baker operates at multiple hospitals, he typically performs his rhinoplasties at Georgetown University Hospital (Washington D.C.) because of the sophisticated instruments and tools that are not available at other local hospitals or surgery centers.

Anesthesia

Dr. Baker performs rhinoplasty under general anesthesia. He does not do rhinoplasty under sedation because he feels it is not as safe due to the fact that blood or saliva may trigger spasm of the vocal cords under sedation creating an airway problem. With general anesthesia, you will have a protected airway and sleep through the operation.

Risks and Complications

When rhinoplasty is performed by a qualified plastic surgeon, complications are infrequent and usually minor. Nevertheless, there is always a possibility of complications, including infection, nosebleed, or a reaction to the anesthesia. You can reduce your risks by closely following Dr. Baker’s instructions both before and after surgery. When rhinoplasty is performed from inside the nose, there is no visible scarring at all; when an open technique is used, or when the procedure calls for the narrowing of flared nostrils, the small scars on the base of the nose are usually not visible. In about one case out of twenty, a second procedure may be required-for example, to correct a minor deformity. Such cases are unpredictable and happen even to patients of the most skilled surgeons. The corrective surgery is usually minor.

Recovery

After surgery-particularly during the first twenty-four hours-your face will feel puffy, your nose may ache, and you may have a dull headache. You can control any discomfort with the pain medication prescribed by Dr. Baker. Plan on staying in bed with your head elevated (except for going to the bathroom) for the first day.

You will notice that the swelling and bruising around your eyes will increase at first, reaching a peak after two or three days. Applying cold compresses will reduce this swelling and make you feel a bit better. Patients usually report that they feel a lot better than they look. Most of the swelling and bruising should disappear within two weeks (some subtle swelling-unnoticeable to anyone but you and your surgeon-will remain for several months).

A little bleeding is common during the first few days following surgery, and you may continue to feel some stuffiness for several weeks. Dr. Baker will probably ask you not to blow your nose for a week or so, while the tissues heal. If you have nasal packing, it will be removed after a few days, and you will feel much more comfortable. By the end of one or two weeks, all dressings, splints, and stitches should be removed.

Most rhinoplasty patients are up and about within two days, and able to return to school or sedentary work a week or so following surgery. It will be several weeks, however, before you are entirely up to speed. Dr. Baker will give you more specific guidelines for gradually resuming your normal activities. They are likely to include these suggestions: avoid strenuous activity (jogging, swimming, bending, sexual relations-any activity that increases your blood pressure) for two to three weeks. Avoid hitting or rubbing your nose, or getting it sunburned, for eight weeks. Be gentle when washing your face and hair or using cosmetics. You can wear contact lenses as soon as you feel like it. Glasses are not usually worn until the splint is off. They will have to be taped to your forehead or propped on your cheeks for about four to six weeks, until your nose is completely healed.

Dr. Baker will schedule frequent follow-up visits in the weeks to months after surgery, to check on the progress of your healing. If you have any unusual symptoms between visits, or any questions about what you can and cannot do, do not hesitate to call Dr. Baker.

Your New Look

In the days following surgery, when your face is bruised and swollen, it is easy to forget that you will be looking better. Day by day, your nose will begin to look better and your spirits will improve. Within a week or two, you will no longer look as if you have just had surgery. However, healing is a slow and gradual process. Some subtle swelling may be present for months, especially in the tip. The final results of rhinoplasty may not be apparent for a year or more. In the meantime, you might experience some unexpected reactions from family and friends. If you have met your goals, then your rhinoplasty is a success.

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