Question: What is a rhinoplasty?
Answer: Rhinoplasty is surgery to reshape the nose. In the United States, approximately 50,000 rhinoplasties are performed each year. Common requests include making a nose smaller, reducing the bridge of the nose, narrowing the nose, making changes to the nasal tip, lifting a droopy tip, and others. Also, a significant number of patients who suffer nasal fractures later seek rhinoplasty.

Question: My nose is too big. Can you make it smaller?
Answer: Yes! Also, Dr. Becker treats patients whose noses are too short, too long, too narrow, too wide, twisted, and so forth. Please see the Photo Album for examples.

Question: I'm not sure what I need to have done, I just know I don't like my nose!
Answer: We understand! Some patients know how they want their nose to look, but other rhinoplasty patients just know they don't like their nose, and just want someone to help them! We understand this and will take the time to work with you to help you have a happy outcome.

Question: How do I know if I am a candidate for rhinoplasty?
Answer: If you do not like the way your nose looks and are willing to undergo a surgical procedure, and if you are in good physical and mental health, then you are eligible for a rhinoplasty consultation. The next step is to meet with a skilled surgeon to see if surgery can meet your expectations. Dr. Becker talks with you in detail and examines you. Then, he explains his realistic expectations for your surgery and will let you know if he thinks you are a good candidate.

Question: How old do I have to be to have a rhinoplasty?
Answer: Most rhinoplastic surgeons prefer to wait until an individual has completed his or her growth spurt. This means age 14 or 15 for girls, and a little later for boys. Of course, this is a generalization: it is very important to consider the individual's emotional and social maturity level and to make sure that he/she really wants a rhinoplasty.

Question: How old is too old to have a rhinoplasty?
Answer: If you are in good physical and mental health, age is not a factor. Rhinoplasty in the 40s and 50s is relatively common. Perhaps the oldest patient for whom Dr. Becker has performed a rhinoplasty was in her 70s. This particular patient was healthy and was troubled by nasal obstruction that required surgery. She told Dr. Becker that she did not like her "droopy" nose and that if she was going to have surgery for her breathing, then she wanted her old nose back! See her result in the Photo Album.

Question: I can't breathe well through my nose. Can you fix this?
Answer: Yes. This is a common complaint. Fortunately, we are usually able to substantially improve nasal breathing. A number of the patients in the Photo Album had this problem. Many times, patients request improvement in breathing and appearance.

Question: Do you do Computer Imaging?
Answer: Yes. Computer imaging is a very helpful way to communicate surgical goals. It is important for the surgeon to know what the patient wants to accomplish, and the patient must know what the surgeon envisions as a goal for the surgical result. Computer imaging is extremely useful to communicate this information, and we therefore perform computer imaging on virtually all patients prior to surgery.

Question: Where does Dr. Becker perform surgery?
Answer: Dr. Becker performs surgery at Pennsylvania Hospital, a member of the University of Pennsylvania Health Network. Dr. Becker performs rhinoplasty in Pennsylvania Hospital's state-of-the-art, certified and accredited outpatient unit. It is also of historical interest that Pennsylvania Hospital is America's first and oldest hospital.

Question: Do I have to stay overnight in the hospital?
Answer: No, this is outpatient surgery. Dr. Becker's patients typically go home after surgery; or, when they are from out-of-town, they stay at one of a number of fine hotels in the area.

Question: What kind of anesthesia is used?
Answer: Dr. Becker performs rhinoplasty with the patient under general or sedation anesthesia. These days, he is finding that more patients seem to prefer general anesthesia, but either way is fine with Dr. Becker. Under sedation, your nose and surrounding areas will be numb and you will drift in and out of sleep. With general anesthesia, you will be asleep for the entire procedure. How long does a rhinoplasty take?
Answer: Depending on the complexity, 1-2 hours. Dr. Becker will be able to tell you how long yours will take after he has examined you.

Question: Is there a lot of pain or nausea?
Answer: Not typically. Time after time, Dr. Becker's patients are surprised at how little pain and how little nausea there is. After-surgery, pain is usually well-controlled with a mild narcotic. We are especially proud of our anesthesia team, who provide expert anesthesia that keeps after-surgery nausea to a minimum.

Question: Is there any nasal packing?
Answer: If Dr. Becker only makes changes to the outside of your nose, then NO. But, if Dr. Becker does some work for nasal breathing that requires straightening the septum, then small nasal packs are placed inside each nostril and are removed the VERY NEXT MORNING.

Question: What is recovery like?
Answer: We suggest that patients take a week off from work. Patients tell us that recovery is uneventful. Typically, there is little pain and little nausea. A little bleeding is common, and your nose will be stuffy. Dr. Becker will ask you not to blow your nose for about 1 week. Your main job after surgery is just to rest.

You will notice some swelling and bruising around your eyes that typically begins to disappear within a few days. Resting with your head elevated helps speed this process. By the time your nasal bandage is removed in 6 days, much of the bruising has resolved, and it should completely disappear by 2 weeks.

As noted, Dr. Becker will typically remove your nasal bandage in 6 days. There are no stitches to remove, because Dr. Becker uses dissolvable stitches.

Most surgeons provide their patients with detailed after-surgery instructions. A copy of the instructions that Dr. Becker provides to his patients after surgery is attached here.

Question: How long is the recovery period?
Answer: The "recovery period" is approximately one week. It takes just a few days to recover from anesthesia. There is typically some swelling and some slight bruising that is dramatically reduced by 1 week. Patients wear a small nasal bandage for 6 days.

After removal of the small nasal bandage (or "splint"), most patients are presentable in public. Most of Dr. Becker's patients return to work the very next day after nasal splint removal. As noted in the patient instructions, there are restrictions on activity for a few more weeks after that. And of course, there is continued healing and reduction of swelling that continues to take place, quickly at first and then gradually for at least a year.

Question: I have heard that it can take a year to see my final result. Is this true?
Answer: While the major changes will be apparent immediately, the more subtle changes do take time to become apparent. This is the case because healing is a relatively slow, gradual process. We typically advise patients that it takes one year for 80% of the healing to take place.

Question: Will insurance cover my surgery?
Answer: If your requests are of a functional nature (for example, you cannot breathe through your nose), many insurance companies will cover the part of the surgery that is required to correct these problems.

However, any requests that relate simply to change of appearance are generally not covered by insurance companies, and do require a cosmetic surgery fee. We will not discuss our fees over the Web or over the phone; but, in general, patients have found our fees to be reasonable and fair.

Question: What is Dr. Becker's philosophy toward rhinoplasty?
Answer: Dr. Becker takes a conservative approach to rhinoplasty. He avoids over-aggressive resection maneuvers, focuses on maintaining structural support, and seeks a natural "unoperated" appearance.

Question: Can I see examples of your work?
Answer: YES. Please see the Photo Album. Also, Dr. Becker would be happy to show you additional pictures in the office. Additionally, some patients wish to hear from some of his previous rhinoplasty patients to talk about their experience -- we are happy to accommodate this request.

Question: Does Dr. Becker do a lot of this kind of surgery?
Answer: YES.

Question: What should I bring to my first visit?
Answer: Come with some thoughts about what you would like changed about your nose. Come with a written list of questions. Be prepared to tell us your medical history, any past surgeries (including all prior nasal surgeries), current medications, drug allergies, and so forth.

Question: What kinds of questions should I ask my surgeon?
Answer: In addition to whatever questions you might have, a few questions to consider, to be included in your list, are added here:

	What percentage of your patients are satisfied with your work?
	I understand that even the best surgeons have complications. What is your revision rate?
	What specific types of complications have you had in rhinoplasty?
	Please give me examples of the types of revisions you have needed to do on your patients?
	May I see examples of your work - both primary and revision rhinoplasty?
	May I speak with a patient who has undergone rhinoplasty by you in the last few years?

Question: What should I expect in the way of communication with Dr. Becker?
Answer: After Dr. Becker has completed a careful examination, he will attempt to convey realistic expectations about what the patient can expect his or her nose to look after surgery. He will also comment about nasal breathing.

To the extent that it is possible, it is essential that the surgeon understands what the patient wants, and that the patient understands what the surgeon is planning. With this in mind, Dr. Becker has a clear conversation with his patients on this subject. Also, Dr. Becker reviews Computer Imaging with most patients to improve communication, to make sure the patient and surgeon are "on the same page.''

With computer imaging, Dr. Becker shows the patient an imaging result that is the goal for surgery, and he wants to be sure that the patient agrees to the goal. The patient understands that this is not a guarantee, but that this is our shared goal.

Question: What kind of planning does Dr. Becker do for each rhinoplasty?
Answer: Careful pre-surgical planning is an important part of rhinoplasty. Dr. Becker typically "performs" each surgery at least 6 times:

• first (mentally) during the patient's first office visit,
• again upon additional reflection,
• a third time after careful review of the preoperative photography,
• a fourth time just prior to the actual surgery,
• a fifth time is the ACTUAL surgery, and then
• the sixth (and more) times after the surgery as review, "post-surgery analysis."

Question: I live far away; how do I arrange to see you and to have surgery?
Answer: You can contact Dr. Becker's office and arrange an appointment. Many patients come for an initial visit and schedule surgery at the end of this initial visit. They then return for their surgery. Occasionally, a patient may wish to come into town for consultation followed by surgery the next day. This is possible but must obviously be arranged in advance.

Question: Do you do surgery on all ethnic groups -- Caucasian, African-American, Asian, and other ethnic noses?
Answer: Yes. Please see the Photo Album for examples.

Question: How does the surgeon go about figuring out what is wrong and then how to fix it?
Answer: There is both a science and an art to rhinoplasty. There are certain approaches, techniques, etc., that are important. Then, just like artists, athletes, and virtually all professions in life, some surgeons are simply better at rhinoplasty than others.

Skillful, experienced surgeons understand the underlying anatomic causes of the various problems occurring in revision surgery. Understanding the anatomic cause provides a guide to the correct approaches to repair.

Question: How does Dr. Becker do a rhinoplasty?
Answer: The two approaches are the endonasal or "closed" rhinoplasty (all incisions hidden inside the nose) and the external or "open" rhinoplasty (all incisions EXCEPT one small incision are inside the nose. In open rhinoplasty there is one small incision across the columella (the skin between the nostrils). This incision is generally extremely difficult to see, and is only 3 or 4mm long!

Dr. Becker performs both endonasal (closed) and external (open) rhinoplasty. In his experience, the closed approach is more suitable for some noses, while the open technique is more suitable for others. The approach Dr. Becker picks is based on what he thinks will provide the best outcome for you, and based upon a detailed discussion about the technical aspects of your procedure.

Since every nose is different and has unique surgical requirements, Dr. Becker discusses the options with each patient and is happy to describe his surgical plan in detail.

The patient below underwent an open rhinoplasty. Can you tell?

EXAMPLES: use the ones from BeckerCenter - You used to have an open vs closed example in surgical techniques, but don't know which to use here.

Fortunately, there are no major disadvantages to either approach. However, each approach has special advantages for specific situations. Since every nose is different and has unique surgical requirements, Dr. Becker discusses the options with each patient and am happy to describe my surgical plan in detail.

Question: Where are the incisions?
Answer: The incisions are just inside your nostrils, where they are hidden from view. The exception is the open rhinoplasty, where an additional small (3 to 4mm) incision is made across the tissue between the nostrils.

Question: What kind of advanced technology and modern techniques does Dr. Becker use to achieve faster healing and more precise surgery?
Answer: Dr. Becker has designed a number of specialty instruments for rhinoplasty. These instruments are smaller to allow him to perform more exact surgery. For example, the "standard" osteotome (bone knife) for cutting the nasal bones is relatively large - - too large in Dr. Becker's opinion. Dr. Becker's research team measured the thickness of the nasal bones (only 2.5 to 3 mm) and have introduced a 2.5 mm and 3.0 mm guarded osteotome (manufactured by Microfrance), that we now use exclusively. We find that there is the least amount of trauma when these small instruments are used, and subjectively patients seem to have less bruising and heal faster.

In the operating room, Dr. Becker uses the Becker/Toriumi Rhinoplasty Instrument Set, manufactured by Medtronic Corporation and especially designed for minimally traumatic rhinoplasty surgery.

Question: I have heard that Dr. Becker teaches rhinoplasty to other board-certified doctors? Where do they come from?
Answer: Dr. Becker is the director of the University of Pennsylvania Aesthetic & Functional Rhinoplasty Course. This course has attracted surgeons from over 38 states and 11 countries.

Dr. Becker has also published a textbook on the subject of rhinoplasty. Surgeons have come from as far away as Sweden and Japan to study rhinoplasty from him and to observe his techniques.

Question: Can I have other cosmetic surgery at the same time as a rhinoplasty?
Answer: Yes. Perhaps the most commonly performed cosmetic procedure in conjunction with rhinoplasty is cosmetic eyelid surgery, or blepharoplasty. Shown here is a patient who had a rhinoplasty and blepharoplasty. For more information about this and other surgeries, see www.BeckerCenter.com. CLAUDIA, Use the browlift patient from Becker Center that has front and lateral views, she has short hair and is middle-aged.

Question: I have heard that sometimes surgeons recommend a chin implant to patients seeking a rhinoplasty.
Answer: If your chin is small, your facial plastic surgeon may point this out even if you only wanted your nose changed! The reason is that the size of the chin changes the way you perceive your nose.

It is important that you understand this, even if you decide not to change your chin. If your nose is big, a small chin makes it look even bigger. Your surgeon may talk to you about making your nose smaller and making your chin a little bigger to create facial balance. This is illustrated in the diagram below. But remember, if you like your chin, you don't have to change it!

Question: What can I do before surgery to decrease the risk of complications?
Answer: Choose your surgeon carefully. (See Choosing a Plastic Surgeon.) Once you have chosen a surgeon, have a candid discussion with the surgeon regarding your goals and expectations of surgery. A discussion of the potential complications is critical, so that you understands the small but real risks of a complication. Although most complications are relatively minor and correctable, more serious and debilitating complications do occur. Your surgeon will give you instructions for before and after surgery - be sure to follow them.

Question: Is there any way to be certain that I won't have a complication?
Answer: NO. Even if your surgeon does things well, a complication can occur. Just as an airplane can encounter unexpected turbulence, unanticipated technical problems can occur during surgery that can lead to a complication. Surgery is not an exact science, and results cannot always be anticipated. Despite careful pre-operative analysis and meticulous attention to surgical detail, unacceptable results may still occur.

Cosmetic surgical procedures have been repeated successfully countless times and are dependable when executed by skillful, experienced surgeons. Plastic surgery is a combination of art and science, and as such can be subject to unpredictables -- usually (but not always) minor in nature.

No surgical procedure should be taken lightly; a slight but real risk is involved in all surgery. Fortunately, the overwhelming majority of plastic surgery results are highly satisfactory and pleasing when accompanied by careful presurgical planning, meticulous surgery, and full patient cooperation.

Question: Why does rhinoplasty have the ability to make people feel better about themselves?
Answer: It is indisputable that rhinoplasty is a positive experience for the vast majority of patients. Many studies show that the great majority of rhinoplasty patients benefit psychologically from the operation. Studies have shown that rhinoplasty can result in the disappearance of a preoccupation with the nose. Dissatisfaction is commonly replaced by pleasure -- and feelings of inferiority (when they exist) are often replaced by self-confidence. Anxiety and awkwardness in social situations often diminishes.

But, why is rhinoplasty successful? In other words, why does it produce positive psychological benefits? Many complex psychological explanations have been suggested for this, but one thinker on the subject maintained a more concrete opinion: "We should not underrate the importance of actual beauty in human life." This philosopher went on to say: "Beauty can be a promise of complete satisfaction; our own beauty or [lack of it] will not only figure in the image we get about ourselves, but will also figure in the image others build up about us and which will be taken back again into ourselves. The body image is the result of social life."

Question: Any suggested reading?
Answer: There are a number of popular textbooks on facial plastic surgery, and specifically rhinoplasty. For those interested in reading more on this subject, Dr Becker recommends The Face Book: The Pros and Cons of Facial Plastic Surgery. This text was prepared for the interested non-physician by the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS), and may be obtained through your local bookstore or by calling the AAFPRS at 703 299-9291.

Please read & familiarize yourself with these instructions both BEFORE & AFTER surgery. By following them carefully you will assist in obtaining the best possible result from your surgery. If questions arise, do not hesitate to communicate with me and discuss your questions at any time. Take this list to the hospital with you and begin observing these directions on the day of surgery.

1. Do not blow nose until instructed. Wipe or dab nose gently with Kleenex if necessary.
2. Change dressing under nose (if present) until drainage stops.
3. The nasal cast will remain in place for approximately one week and will be removed in the office. Do not disturb it; keep it dry.
4. Avoid foods that require prolonged chewing. Otherwise, your diet has no restrictions.
5. Avoid extreme physical activity. Obtain more rest than you usually get and avoid exertion, including athletic activities & intercourse.
6. Brush teeth gently with a soft toothbrush only. Avoid manipulation of upper lip to keep nose at rest.
7. Avoid excess or prolonged telephone conversations and social activities for at least 10-14 days.
8. You may wash your face - carefully avoid the dressing. Take tub baths until the dressings are removed.
9. Avoid smiling, grinning, and excess facial movements for one week.
10. Do not wash hair for one week unless you have someone do it for you. DO NOT GET NASAL DRESSINGS WET.
11. Wear clothing that fastens in front or back for 1 wk. Avoid slipover sweaters, T-shirts and turtlenecks.
12. Absolutely avoid sun or sun lamps for 6 weeks after surgery; heat may cause the nose to swell. Thereafter, use sunscreens.
13. Don't swim for one month, since injuries are common during swimming.
14. Following removal of the dressing, the nose, eyes, and upper lip generally show some swelling & discoloration - this usually clears up in 2-3 weeks. In certain patients it may require 12-18 months for all swelling to completely subside.
15. Take only medications prescribed by your doctor(s).
16. Do not wear regular glasses or sunglasses which rest on the bridge of the nose for at least 4 weeks. We will instruct you in the method of taping the glasses to your forehead to avoid pressure on the nose.
17. Contact lenses may be worn beginning 2-3 days after surgery.
18. After the doctor removes your nasal cast, the skin of the nose may be cleansed with a mild soap or Vaseline Intensive Care Lotion. BE GENTLE. Makeup may be used as soon as the bandages are removed. To cover discoloration, you may use "ERASE" by Max Factor, "COVER AWAY" by Adrien Arpel, "ON YOUR MARK" by Kenneth, or other makeup as directed by our office.
19. DON'T TAKE CHANCES! - If you are concerned about anything you consider significant, call me.
20. When we remove your splint, your nose will be swollen and will remain so for several weeks. In fact, it takes at least one year for all swelling to subside.