Dott. Armando Boccieri

1) How should I choose a surgeon?
The choice of a surgeon is crucial for anyone intending to undergo rhinoplasty and the key elements to be taken into consideration include curriculum vitae, qualifications, scientific publications, and the number of operations performed. Importance also attaches to the structure in which the surgeon works and the other members of the surgical team. The interview will certainly shed light on many of these aspects as well as the surgeon’s readiness to help and human dimension. It should never be forgotten that the operation is only one section of a chain, that there are other important links in the preoperative and postoperative period, and that a good physician must ensure that the patient is cared for all the way through the therapeutic process.

2) Will my nose look natural after the operation?
The objective of a natural-looking nose is perhaps the most important in that there is no result worse than a nose that is evidently a product of plastic surgery. Avoiding a turned-up nose is not enough to ensure a natural appearance, however, and the surgeon must also take other elements into account to ensure that the nose blends in with its context. The aspects to be thoroughly examined in practice include the ethnic group to which the patient belongs as well as his or her features, eyes, forehead, chin, cheekbones, nasofrontal and nasolabial angles, thickness of the skin, and age. Adaptation of the nose to all these parameters is the secret of a natural-looking result. The best proof of success is when the patient’s relatives and acquaintances notice an improvement in the face but cannot immediately say where the change lies.

3) What do I have to do before the operation?
If you are taking medicine on a regular basis, tell the surgeon in good time so that it can be decided whether this should be interrupted. For example, it is necessary to stop taking aspirin and the contraceptive pill before the operation, as they can interfere with the mechanisms of coagulation.
It is essential to have nothing at all to eat and drink, not even water, for at least seven hours before the operation. Exposure to the sun should also be avoided for a few days so as not to irritate the skin. Male patients should shave off their moustaches so as to permit correct appraisal of the nasolabial angle during the operation. Dentures and false teeth must be removed before entering the operating theatre so as to ensure complete safety during intubation. Female patients must remove all make-up and items of jewellery before entering the theatre.

4) What will happen to me in the operating theatre?
Patients are provided with the necessary gown to put on in their rooms. Before entering the theater, the patient is wheeled on a gurney to the premedication room for the insertion of a needle in a vein of the arm. A preanesthetic drug is immediately administered endovenously so as to eliminate any anxiety and facilitate the subsequent general aesthetic. The patient is then wheeled into the operating theatre and laid out on the operating table, where the electrodes of the electrocardiograph are positioned on the chest first of all together with a blood pressure cuff in order to monitor cardiac activity. At this point, the anaesthetist uses the needle previously inserted in a vein to administer drugs that immediately induce sleep and permit tracheal intubation. This tube is used to administer gases that maintain the state of general anaesthesia with complete unconsciousness and no perception of pain. Intubation also makes it possible to control the airways safely with no danger of extraneous bodies or blood being inhaled into the lungs.
Emergence from anaesthetic is usually gentle and painless. The patient is taken back to the premedication room, where the anaesthetist is ready to cope with any need that may arise. The patient must only remember to breathe through the mouth as the nose is packed with tampons.
Once the reawakening is sufficiently complete and stable, the patient is taken back to his or her room, where an icepack is applied to the eyes for about two hours so as to minimize bruising and oedema.
It should be stressed that the patient is accompanied in every phase of his or her movements, from leaving the room to returning after the operation, by qualified personnel ready to cope with any need that may arise.
The operating surgeon is also always present and ready for any further questions and clarifications right up to the moment of intubation.

5) How long does the operation take?
The operation can take from one to three hours depending on the indications and the problems to be addressed. Reconstructive or revision rhinoplasty requiring grafts from other parts of the body generally takes longer. Members of family should bear in mind, however, that the length of the patient’s absence from his or her room depends not only on the actual operation but also on the periods of preparation and reawakening. In any case, if the organism is in perfect physical condition, the prolonging of anaesthesia involves no danger at all and the time can indeed prove precious with a view to obtaining excellent results.

6) What discomfort will I have after the operation?
There is generally no pain, just a slight flow of blood and serum that tends to dry up in the space of 24–48 hours. This minimal loss of blood is no cause for concern and should rather be regarded in the first few hours as useful natural drainage that avoids the formation of unwanted hematomas. In nasal surgery, unlike other branches, it is not possible to insert tubes to drain blood. There can be slight bruising beneath the eyes and slight swelling of the eyelids, both of which generally disappear completely in the space of 7–10 days. In the rare cases where nasal packing is required, it is used for three days at most and its removal causes no pain whatsoever due to the use of special small-sized tampons that can be easily slipped out of the nose. The stitches of the columella in cases of open access are removed after 4–5 days. The external nasal splint is removed after 7 days and replaced with thin, flesh-colored paper plasters that already make the results visible. The orally administered postoperative medication prescribed on discharge consists essentially of an antibiotic, an antihistaminic, a cortisone and nasal drops. The improvement in functional-respiratory terms may take up to a fortnight to manifest itself because, in addition to swelling of the mucosa, scabs are often formed in the nasal cavities that impede perfect respiration. These problems are still more evident in the case of operations on the turbinates but then disappear with the abundant use of emollient nasal drops.

7) When will I see the results?
The improvement is already visible after 7 days, when the external nasal splint is removed, but a variable degree of swelling remains, 70% of which disappears in about a month and a further 20% in 3–4 months. The residual 10% can, however, take up to a year to disappear.
In this connection, it is advisable to sleep during the first month with the head higher than the body so as to facilitate the reduction and disappearance of oedema and nasal swelling.

8) When I can practice sport again?
It is generally inadvisable to practice sports for at least a fortnight, after which some light exercise can be undertaken before complete resumption a month after the operation. This interruption serves above all to avoid any trauma to the nasal pyramid, where surgical fractures have been carried out that will take about thirty days to consolidate and heal definitively. It should be noted that after this period the nose is not weakened by the operation but rather, in accordance with the criteria of modern rhinoplasty, as stable as in the preoperative period or even strengthened by the reconstructive grafts.

9) When will I be able to sunbathe?

Exposure to the sun is inadvisable for the first 30 days but can take place after a fortnight as long as it is not unduly prolonged and 100% sunblock is used on the nose. Exposure can then take place gradually with lower degrees of protection. It should be borne in mind, however, that sun and heat slow down the normal disappearance of oedemas and swelling.