Before Surgery

Dr. Bentkover will carefully examine your nose and evaluate your airway. He will discuss with you the way your nose can look in relation to your other facial features. Digital photographs and computer imaging help Dr. Bentkover evaluate your nose and recommend the appropriate changes needed to achieve the desired results. He will ask for your active participation while he evaluates and “morphs” your digital images.  These morphed images are his surgical planning documents.

Our staff will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and medications. If you smoke, we will ask you to quit for at least 1 month before and after your surgery, since smoking may have an effect on how well you heal. You must stop all anticoagulant medications and some herbal preparations including aspirin, ibuprofen, vitamin E, St. John's Wart, gingko, garlic or ginseng 2 weeks prior to surgery. You will be required to take antibiotics to prevent infection. You should shampoo your hair the night before surgery.   We often use Arnica and fresh pineapple juice (contains Bromelein) to help decrease swelling and brusing.

Method of Surgery

The surgery is usually performed under general anesthesia. Since 1983, Dr. Bentkover has performed most of his rhinoplasties through an “open” approach. In most cases, he feels that this gives him more control over the fine tuning of the form and function of your nose. The only visible portion of the incision for this technique is in the area between the nostrils, called the columella. It is generally minimally visible after surgery. The rest of the incision is hidden inside the nose. In an open approach,  the skin of the nose is then elevated from the underlying bone and cartilage. The bone and cartilage are restructured and the skin re-draped over the surface. Patients who have a deviated septum may benefit by correction of this problem at the same time. If your nostrils flare too much, Dr. Bentkover may make an incision at the junction between the nose and the skin of the upper lip to narrow the flared appearance. These incisions also hide very well. It is not unusual to combine rhinoplasty with chin augmentation to further improve your profile.

Closed vs. Open  Rhinoplasty

The difference between the "closed" and "open" approaches is structural and philosophical.  It is about how the surgeon creates the strongest and most consistent nasal architecture and the best looking nose at the same time.  It is not about the incision.  The incision should not be an issue of concern.  This is not an area that most people see.  Usually only you, your surgeon, and perhaps your significant other will see the incision.  The real difference between the two approaches is what the surgeon can see during the surgery and the how the cartilages of the nose are modified. 

In the classic "closed" rhinoplasty, surgeons are taught to remove significant amounts of cartilage to narrow or "thin" the nasal tip.  The problem with this approach is that over time the areas where the cartilage was removed can be replaced by scar tissue that leads to twisting of the nasal tip and difficulty breathing.  Also, the surgeon may not be able to see pre-existing irregularities of the tip cartilages and bones that may become more apparent with the normal development of scar under the skin after a rhinoplasty. 

In an "open" approach rhinoplasty, there are no surprises.  The surgeon can see everything that needs to be modified.  Also, the basic philosophical difference is that in an "open" rhinoplasty the surgeon usually removes less cartilage and generally adds structure to the nasal tip that strengthens the underlying architecture and prevents twisting and other adverse changes as you age.  Most commonly the surgeon uses your own septal cartilage for these shaping and strengthening cartilage grafts.

In most cases, Dr. Bentkover favors the "open" approach.  If he needs to make a small modification to an operated nose in a minor revision, he may use a "closed" approach to file the bones down a bit more or perhaps add a small piece of cartilage to fill a small post operative depression.  The reality of revision rhinoplasty, however, is that most often it requires an "open" approach to replace large amounts of cartilage removed during the first procedure.  Examples of such a situation are show in the Before and After pictures in the Revision Rhinoplasty section of this website.      

Surgery performed under local anesthesia may be performed in our office operating room in our suite at Worcester Medical Center, Worcester, MA or in our office in Stoneham, MA, whichever is more convenient for you. Procedures requiring intravenous sedation or general anesthesia are usually performed in the Day Surgery Unit at Saint Vincent Hospital in Worcester Medical Center, Worcester, MA, or the Massachusetts Eye and Ear Infirmary.  We are confident you will find all of these facilities to be state-of-the-art, comfortable and very patient friendly

Recovery: What to Expect

The recovery takes one to two weeks. Most people resume most of their normal activities and return to work within 10 days. Following surgery, a lightweight splint is applied to maintain the new shape of the nose. The splint is removed in a week. Soft silicone plastic splints may be inserted on either side of the nasal septum at the time of surgery to protect the septum. These are also removed in a week. There is always some stuffiness of the nose for a week or two, especially when work has been done on the nasal septum. Pain is generally moderate and is usually well controlled with medication. Bruising occurs around the eyes, but begins to fade within a few days. Discoloration usually disappears within 10 days to two weeks.

For the convenience of our patients, we have included our Post Operative Instructions below:

Post Operative Instructions

TO AVOID BLEEDING

• Do not pick your nose.
• Do not blow your nose. Dab the nostrils with facial tissues.
• If you must sneeze, do so with your mouth open.
• To keep your nasal linings moist and clean: A. Three times daily dab inside the nostrils with a solution of ½ water and ½ hydrogen peroxide and then apply Bacitracin to the same area with a Q-tip in a circular manner. B. Spray saline nose spray, 3 puffs in each nostril at least 5 - 6 times a day.
• NO SMOKING for 1 month. Basically, give it up.
• No bending, stooping or straining.
• Do not strain while having a bowel movement. No alcohol for 7 days.
• Avoid hot temperature drinks or hot foods.
• Rest and sleep with your head propped up on 2 - 3 pillows.
• No aspirin or aspirin related products such as Advil, Nuprin, Motrin, Aleve or ibuprofen should be used for pain relief for 7 days. Use an aspirin substitute, such as Extra-Strength Tylenol or medications prescribed by your physician. Also avoid high doses of vitamin E, gingko biloba, ginseng, garlic tablets and St. John's wart.
  

AVOID TRAUMA 

After surgery, the nasal structures may be weaker than before, temporarily in most cases and permanently in some cases. A nasal injury at this time may severely damage your nose.

• AVOID ACTIVITIES DURING WHICH YOU MAY BUMP YOUR NOSE No active swimming or diving for 6 weeks. You may wade, but watch out for other people's heads and elbows.
• If you bump your nose, please call us at (508) 363-6500.
• No contact sports for at least 5 - 6 months.
• Avoid vigorous indoor activities for 10 days.
• IMPORTANT: You may have a small pack or sheet of plastic in your nose for a period of time. If it should fall out or be bothersome, please call us at (508) 363-6500