UNDERSTANDING RHINOPLASTY Every year, thousands of people who are interested in improving the appearance of their noses seek consultation with facial plastic surgeons.  Some are unhappy with the noses they were born with, and some with the way aging has changed their nose. For others, an injury may have distorted the nose, or the goal may be improved breathing. But one thing is clear: nothing has a greater impact on how a person looks than the size and shape of the nose. Because the nose is the most defining characteristic of the face, a slight alteration can greatly improve one’s appearance. If you have wondered how nose surgery (rhinoplasty) could improve your looks, self-confidence, or health, you need to know how rhinoplasty is performed and what you can expect. No pamphlet can answer all your concerns, but this one can provide answers to many of the questions you may have. Successful facial plastic surgery is a result of good rapport between client and surgeon.  Trust, based on realistic expectations and exacting medical expertise, develops in the consulting stages before surgery. Your surgeon can answer specific questions about your specific needs. IS RHINOPLASTY FOR YOU? As with all facial plastic surgery, good health and realistic expectations are prerequisites.  Understanding nasal surgery is also critical. Since there is no ideal in rhinoplasty, the goal is to improve the nose aesthetically, making it harmonize better with other facial features. Skin type, ethnic background, and age are important factors to be considered in discussions with your surgeon prior to surgery. Before the nose is altered, a young client must reach full growth, usually around age fifteen or sixteen.  Exceptions are cases in which breathing is severely impaired. Before deciding on rhinoplasty, ask your facial plastic surgeon if any additional surgery might be recommended to enhance the appearance of you face. Many clients have chin augmentation in conjunction with rhinoplasty to create a better balance of features. MAKING THE DECISION FOR RHINOPLASTY Whether the surgery is for functional or cosmetic reasons, your choice of a qualified facial plastic surgeon is of paramount importance.  Facial Plastic Surgeons are trained in ear, nose, throat, and facial cosmetic surgery, which provides you, the client, with the highest level of training and ability.  Your surgeon will examine the structure of your nose, both externally and internally, to evaluate what you can expect from rhinoplasty. You are most likely to be pleased with the results of your surgery if you have a realistic idea of what nasal surgery can and cannot do. You can expect a thorough explanation of the surgeon’s expectations and the risks involved in surgery. Following a joint decision by you and your surgeon to proceed with rhinoplasty, the surgeon will take photographs of you and discuss the options available. Your surgeon will explain how the nasal structures, including bone and cartilage, can be sculpted to reshape the nose and indicate how reshaping the chin, for example, could enhance the desired results. After conducting a thorough medical history, your surgeon will offer information regarding anesthesia, and the costs for the procedure. UNDERSTANDING THE SURGERY The definition of rhinoplasty is, shaping the nose.  First, incisions are made and the bone and cartilage support system of the nose is accessed. The majority of incisions are made inside the nose, where they are invisible. In some cases, a small incision is made in the area of skin separating the nostrils. Next, certain amounts of underlying bone and cartilage are removed, added to, or rearranged to provide a newly shaped structure. For example, when the tip of the nose is too large, the surgeon can sculpt the cartilage in this area to reduce it in size. The angle of the nose in relation to the upper lip can be altered for a more youthful look or to correct a distortion. The tissues are then redraped over the new frame and the incisions are closed. A splint is applied to the outside of the nose to help retain the new shape while the nose heals. Soft, absorbents material may be used inside the nose to maintain stability along the dividing wall of the air passages called the septum. Alternatively, soft nasal supports that permit nasal breathing post operatively can be placed. Risk factors in rhinoplasty are generally minor, and your facial plastic surgeon will discuss these prior to surgery. Read in greater detail about what to expect before and after rhinoplasty>> WHAT TO EXPECT AFTER THE SURGERY Immediately after surgery, a small splint will be placed on your nose to protect it and to keep the structure stable for at least ten days.  If packing is placed inside the nose during surgery, it is removed the morning following the surgery. Your face will feel puffy, especially the first day after surgery. Pain medication may be required. Your surgeon will advise you to avoid blowing your nose for seven days after surgery. In the immediate days following surgery, you may experience bruising and minor swelling in the eye area. Cold compresses often reduce the bruising and discomfort. Absorbable sutures that do not need to be removed are usually used. Nasal dressing and splints are usually removed ten days after surgery. It is crucial that you follow your surgeon’s directions, especially instructions to keep your head elevated for a certain period after surgery. Some activities will be prohibited in the weeks after the procedure. Sun exposure, exertion, and risk of injury must be avoided. If you wear glasses, special arrangements must be made to ensure that the glasses do not rest on the bridge of the nose. Tape and other devices are sometimes used to permit wearing glasses without stressing the area where the surgery was performed. Follow up care is vital for this procedure to monitor healing. Obviously, anything unusual should be reported to your surgeon immediately. It is essential that you keep you follow up appointments with your surgeon. Insurance does not generally cover surgery that is purely for cosmetic reasons.

WHAT IS THE ROLE OF COMPUTER SIMULATION (MORPHING) IN RHINOPLASTY? The role of computer simulation in rhinoplasty is multifaceted and serves several important purposes: VISUALIZATION OF POTENTIAL RESULTS Computer simulations enable patients to visualize potential post-operative results. They provide a visual representation of how the nose might appear after surgery, helping patients gain a better understanding of the expected changes. COMMUNICATION TOOL Simulations serve as a valuable communication tool between Dr Sandeep Uppal and his patient’s. They facilitate a shared vision of the desired outcome, ensuring that both parties have a clear understanding of the goals and expectations. REALISTIC EXPECTATION SETTING By offering a glimpse into the future appearance, computer simulations help set realistic expectations. Patients can see what is achievable through surgery and understand the limitations. INFORMED DECISION-MAKING Simulations empower patients to make informed decisions about whether to proceed with rhinoplasty. They can assess whether the anticipated results align with their aesthetic objectives. CUSTOMIZATION Computer simulations can be adjusted and refined to fine-tune the surgical plan. This customization ensures that the patient’s preferences and goals are taken into account. ENHANCED PATIENT-SURGEON COLLABORATION The collaborative approach fostered by simulations encourages open dialogue between Dr Sandeep, his team, and the patient. It allows for the exchange of ideas and ensures that the final surgical plan aligns with the patient’s desires. However, it’s important to note that computer simulations are not a definitive representation of the final outcome. The healing process and individual variations can lead to differences between the simulation and the actual result. Nonetheless, by using this technology, patients and surgeons can work together to achieve the best possible outcome in rhinoplasty.

WHAT IS DR. SANDEEP’S RHINOPLASTY PHILOSPHY? THE PERCEPTION OF BEAUTY The human perception of beauty and aesthetics is deeply rooted in how we interpret the interplay of light and shadow on surfaces. This is especially true for the face, where subtle changes in contour can dramatically alter one’s appearance. The nose, being centrally located on the face, plays a pivotal role in this perception. RHINOPLASTY: AN ART FORM Rhinoplasty, often referred to as a “nose job,” is not just a surgical procedure; it’s an art form. Like a sculptor chiselling away at a block of marble, Dr Sandeep meticulously reshapes the nose, keeping in mind the delicate balance between form and function. The comparison to intricate sculpting is apt because, in both cases, the artist or surgeon is working with a fixed medium, making irreversible changes, and aiming for an outcome that is both aesthetically pleasing and structurally sound. THE SCIENCE OF RHINOPLASTY However, unlike a static sculpture, the nose is a living, breathing structure. It has functional requirements, such as facilitating breathing, that cannot be compromised. This is where the engineering aspect comes into play. Dr Sandeep ensures that while refining the nose’s appearance, its structural integrity and functionality are preserved. This balance between art and engineering is delicate and requires a deep understanding of both anatomy and aesthetics. CRAFTED BY EXPERIENCE, PERFECTED WITH SKILL Experience is a crucial factor in mastering this balance. Just as an artist grows and evolves with each piece they create; Dr Sandeep’s skills and insights have deepened with every procedure he has performed over his long career. Over time, he has developed an intuitive understanding of the nuances involved in shaping the nose, predicting how changes will heal and age over time, and ensuring the results are both beautiful and sustainable. Dr Sandeep understands that rhinoplasty involves a complex interplay of art and science. He combines his artistic vision, technical prowess, and a wealth of experience to achieve outcomes that satisfy both aesthetic desires and functional needs. Here’s a glimpse into his guiding principles: TAILORED APPROACH Dr Sandeep believes that every individual has a unique nose and face. He doesn’t advocate for a generic solution but emphasizes crafting a nose that harmonizes with each person’s distinct facial attributes. PURSUIT OF NATURALNESS For Dr Sandeep, the hallmark of a successful rhinoplasty is subtlety. He strives for outcomes where the nose complements the face without appearing altered. EMBRACING A WORLD OF BEAUTY Dr Sandeep honours the rich tapestry of diverse racial and cultural aesthetics, ensuring personalized care that respects everyone’s heritage. With a wealth of global experience from Europe to Asia and the USA, he brings a nuanced perspective to nasal artistry that celebrates diverse ethnic features. BALANCING BEAUTY AND UTILITY To Dr Sandeep, a nose should be as functional as it is aesthetically pleasing. He ensures that his surgeries enhance both the look and the function of the nose. Dr Sandeep is the rare breed of Otolaryngologists to have completed 2 fellowships which gives him a complete mastery of all problems, cosmetic and functional, related to the nose. One year fellowship of the European Academy of Facial Plastic Surgery with intense training in rhinoplasty under the tutelage of some of the top rhinoplasty surgeons in the world. His fellowship and subsequent experience have helped him develop a deep understanding of rhinoplasty surgery in patients from various ethnicities. One year fellowship of the Royal College of Surgeons of England in advanced rhinology. During the fellowship he obtained advanced training in the diagnosis, and treatment of disorders of the nose and the nasal passages. This includes conditions affecting the sinuses and other related structures. EMPHASIS ON CONSERVATION Dr Sandeep often leans towards a conservative approach, preserving the natural anatomy wherever possible, rather than unnecessary aggressive alterations. He has adapted the principle of preservation and structural rhinoplasty in his practice to give the best possible results for his patients. ETHICAL PRACTICE Dr Sandeep is committed to understanding the motivations behind a patient’s decision for rhinoplasty. He ensures they have grounded expectations and are mentally prepared for the change. AGING GRACEFULLY In Dr Sandeep’s view, the results of rhinoplasty should not only be immediately satisfying but should also evolve elegantly as the patient ages. To this effect Dr Sandeep uses techniques that provide long lasting results for his patients. PATIENT SAFETY ABOVE ALL For Dr Sandeep, patient safety is paramount. He ensures every surgery takes place in a state-of-the-art surgical facility, equipped with advanced anaesthesia and recovery systems, managed by board certified anaesthesiologists, and professional and seasoned nurses, to guarantee the safest and most reliable care available. COMMITMENT TO LEARNING AND TEACHING Dr Sandeep is a firm believer in continuous professional education. He stays updated with the latest in rhinoplasty techniques and research to offer the best to his patients. He attends and contributes at international and national conferences, seminars, workshops, and courses, teaching others and learning from his peers and colleagues. INTEGRATING RHINOPLASTY WITH CHIN CONTOURING In his detailed approach to facial aesthetics, Dr Sandeep firmly believes in considering the harmonious interplay between all facial features. When planning a rhinoplasty, he is not merely focused on the nose in isolation, but also on how modifying its shape will impact the balance of the patient’s face, including the chin. A well-proportioned chin can complement and enhance the results of a nose surgery, sometimes leading to the recommendation of a chin surgery, or genioplasty, as part of the overall treatment plan. This procedure can adjust the chin’s projection and shape, thereby bringing a more balanced and proportionate facial profile. Read more>> CRAFTING HARMONY: DR SANDEEP’S INTEGRATIVE APPROACH TO RHINOPLASTY Dr Sandeep’s philosophy on rhinoplasty is a blend of technical expertise, artistic insight, ethical considerations, and an insightful grasp of human aesthetics. He approaches each surgery with a holistic and patient-centric mindset, ensuring outcomes that resonate with individual desires and needs. Dr Sandeep’s comprehensive perspective ensures that the aesthetic changes are cohesive, accentuating the individual’s natural beauty and achieving

WHAT ARE THE PREVAILING RHINOPLASTY PHILOSOPHIES? In the field of rhinoplasty, two broad surgical philosophies guide surgeons in achieving successful outcomes. These philosophies encompass various principles and considerations to meet the diverse needs and expectations of patients. STRUCTURAL RHINOPLASTY Refers to a surgical approach that focuses on reshaping the underlying framework of the nose to achieve both functional and aesthetic improvements. The term “structural” emphasizes the manipulation of the nose’s foundational elements, such as the bone, cartilage, and soft tissues. The primary goal is to create a strong and stable nasal framework. This is achieved by reshaping or reinforcing the nasal bones and cartilages. Structural rhinoplasty is a comprehensive approach to nasal surgery that addresses both the form and function of the nose. By focusing on the foundational elements of the nose, this procedure can provide lasting and natural-looking results. Functional Improvements: Structural rhinoplasty can address breathing issues caused by a deviated septum, valve collapse, or other internal obstructions. Aesthetic Improvements: By altering the underlying structure, the surgeon can address various cosmetic concerns, such as a hump on the bridge, a drooping tip, or wide nostrils. TECHNIQUES Cartilage grafts: Often, cartilage from the patient’s septum, ear, or rib is used to reinforce or reshape parts of the nose. These grafts can be used to straighten the septum, support the nasal tip, or fill depressions. Osteotomies: Controlled breaks in the nasal bones to narrow the nose or correct a crooked nose. Suture techniques: Used to reshape the nasal cartilages without removing them. PRESERVATION RHINOPLASTY Preservation rhinoplasty offers an alternative approach to traditional nasal surgery, focusing on conserving and repositioning the existing nasal structures. Preservation rhinoplasty is a relatively newer approach to nasal surgery that has gained attention in recent years. It represents a shift from the traditional “reductive” techniques commonly used in rhinoplasty, where cartilage and bone are often removed or significantly altered. Instead, preservation rhinoplasty focuses on conserving and repositioning the existing nasal structures. While it offers several potential advantages, preservation rhinoplasty might not be suitable for all patients or all nasal concerns. Some cases may still require traditional or reductive techniques. It’s essential to consult with Dr Sandeep to determine the best approach for your individual needs and goals. KEY CONCEPTS OF PRESERVATION RHINOPLASTY Conservation: The primary philosophy behind preservation rhinoplasty is to maintain as much of the patient’s native nasal tissues as possible. This can lead to more natural results and potentially a quicker recovery. Dorsal Hump Management: Instead of removing the dorsal hump (the bump on the bridge of the nose), the surgeon repositions the nasal bones or reshapes them, preserving the natural anatomy. Ligament Preservation: By conserving the natural ligaments of the nose, the surgery can result in less post-operative oedema (swelling) and a more predictable healing process. Tip Preservation: Instead of significant cartilage removal or grafting, the natural tip cartilages are repositioned or reshaped to achieve the desired look. Functional Benefits: By preserving the natural structures, there’s often less disruption to the internal nasal valves, which can reduce the risk of post-operative breathing issues. ADVANTAGES OF PRESERVATION RHINOPLASTY Natural Results: By conserving the native structures, the results often appear more natural and less “surgical.” Reduced Swelling: Preservation techniques may lead to less trauma, which can result in reduced post-operative swelling. Quicker Recovery: Some patients may experience a quicker recovery compared to traditional methods.

RHINOPLASTY SURGICAL PROCEDURE Dr Sandeep ensures that each step of the process in your Rhinoplasty journey, from initial consultation to post-operative care, is designed to support informed decision-making and client comfort. INITIAL CONSULTATION Dr Sandeep’s team begins with a detailed consultation to understand the client’s aesthetic goals, examine the nasal structure, skin quality, function and overall health. Detailed examination includes an internal nasal examination before and after nasal decongestion as well as nasal endoscopy to diagnose the specific cause of nasal blockage experienced by the client. PHOTOGRAPHY AND COMPUTER SIMULATION Before the surgery, photographs are captured for record-keeping and to aid in computer-aided simulation that helps in comprehending the client’s expectations. This process facilitates effective communication between Dr Sandeep and the client, ensuring clarity and agreement on the anticipated outcomes and confirming a shared vision for the procedure. INFORMED CONSENT The rhinoplasty procedure, tailored to each individual’s needs, is explained, including potential benefits and risks. A thorough discussion on the specifics of rhinoplasty, including the surgical benefits, risks, alternative treatments, expected downtime, and the necessity for post-operative follow-ups, is part of the informed consent process. PRE-SURGICAL PREPARATION Pre-operative evaluations are conducted to confirm the client’s suitability for rhinoplasty. Clients receive precise instructions on medication management, dietary guidelines, and lifestyle modifications leading up to surgery. An evaluation by the anaesthesiologist is arranged to ensure the client is medically ready for the surgical procedure. DAY OF PROCEDURE Clients are welcomed into a cutting-edge surgical environment. Adherence to stringent hygiene and safety standards is ensured. An experienced anaesthesiologist administers the anaesthesia. SURGICAL APPROACH Incisions are strategically made, often within the nasal structure, to minimize visible scarring. Tiny incisions are sometimes placed at the bottom of the nose or on the sides, if needed. These heal very well with nearly imperceptible scars. Dr Sandeep places particular attention on restoring and improving the function of the nose. Dr Sandeep employs refined techniques to ensure a balanced and natural-looking nose. The surgery may involve reshaping the nasal bones and cartilage to achieve the desired contour. Depending on the pathology the nasal dorsum is augmented or lowered, and the nose straightened. Excess bone or cartilage may be removed or repositioned. The nasal tip is sculpted and refined, and the nostrils may be resized for proportionate results. Careful suturing techniques are used to support the new nasal structure for long term superior results. POST-OPERATIVE CARE Clients are monitored closely as they recover from anaesthesia. The procedure typically involves minimal pain, yet pain management medication is provided to ensure the client’s comfort. Post-operative care instructions, including care for the nasal dressing and activity restrictions, are provided. FOLLOW-UP AND MONITORING Follow-up visits are scheduled to monitor the healing process and to remove any sutures and splint. Nasal toilet is performed for improved comfort and breathing. Dr Sandeep evaluates the results over time and advises on any further care needed. Recovery involves some downtime, with swelling and bruising that diminish over time. Dr Sandeep’s team provides comprehensive support throughout the healing process to ensure the best possible outcome and client satisfaction. Read more about why instructions for your Rhinoplasty>> Learn how you can enhance and quicken the recovery after your Rhinoplasty>> ADVANTAGES OF RHINOPLASTY WITH DR SANDEEP Clients undergoing rhinoplasty with Dr Sandeep benefit from his extensive experience, a client-focused approach, and a commitment to achieving the most harmonious and satisfying outcomes. Tailored results that enhance facial symmetry and nasal functionality. Improved breathing due to careful consideration of internal nasal structures. Long-lasting results that maintain the integrity of the nasal form. Minimally visible scarring thanks to precise incision techniques. Read more about why you should trust Dr Sandeep with your Rhinoplasty>> CONSIDERATIONS IN RHINOPLASTY Although relatively rare, similar to any surgical procedure, rhinoplasty comes with inherent risks, which can include anaesthesia reactions, bleeding, infection, and the need for revision surgery. Clients are fully informed about rhinoplasty’s challenges, including the need for a thorough recovery period, the potential for revision surgery, and the importance of setting realistic expectations. Dr Sandeep’s methodical approach is designed to mitigate these risks, ensuring a safe and effective transformation. Read more about Potential risks of Rhinoplasty here>> DR SANDEEP’S RHINOPLASTY: ENSURING EXCELLENCE AND SAFETY In Dr Sandeep’s hands, rhinoplasty is performed with a focus on safety and outstanding results. His expertise minimizes risks, and his attentive aftercare ensures a smooth recovery. Trust in his commitment to your well-being for a successful rhinoplasty experience. Read more about why you should trust Dr Sandeep with your Rhinoplasty>>

WHERE IS MATERIAL NEEDED FOR RHINOPLASTY OBTAINED FROM? In rhinoplasty, grafts and implants are used to augment, reshape, or provide structural support to the nose. They can be sourced from the patient’s own body (autologous) or be synthetic. Here’s a detailed overview of the various grafts and implants used in rhinoplasty: AUTOLOGOUS GRAFTS These are derived from the patient’s own tissues, reducing the risk of allergic reactions or rejection. SEPTAL CARTILAGE This is the most commonly used graft material in primary rhinoplasty. It’s harvested from the nasal septum and is ideal due to its strength, flexibility, and versatility. EAR CARTILAGE Typically sourced from the conchal bowl of the ear, it’s softer than septal cartilage and is often used for subtle refinements, especially in the nasal tip. RIB CARTILAGE Used in cases requiring significant augmentation or when other sources of autologous cartilage are depleted. It provides a large volume and is robust, but there’s a risk of warping over time. TEMPORALIS FASCIA This is soft tissue harvested from the lining of the temporalis muscle in temple region and can be used to wrap other grafts or as a soft tissue filler in the nose. RECTUS ABDOMINIS FASCIA This is soft tissue harvested from the covering of the rectus abdominis muscle in the abdominal/chest region and can be used to wrap other grafts or as a soft tissue filler in the nose. BONE Occasionally, bone grafts (often from the skull or rib) might be used, especially in cases of significant dorsal augmentation. SEPTAL CARTILAGE Septal cartilage is one of the most commonly used graft materials in rhinoplasty. It’s harvested from the nasal septum, the structure that divides the two nostrils. Here’s a detailed look at the use of septal cartilage grafts in rhinoplasty: ADVANTAGES OF SEPTAL CARTILAGE GRAFTS BIOCOMPATIBILITY Since septal cartilage is harvested from the patient’s own body, it is biocompatible. This means that the body recognizes it as its own tissue, reducing the risk of complications such as graft rejection or allergic reactions. STRUCTURAL INTEGRITY Septal cartilage possesses a combination of rigidity and flexibility, making it an ideal material for structural support and reshaping in rhinoplasty. It maintains its shape over time, ensuring the longevity of the surgical outcome. IDEAL CONSISTENCY Septal cartilage has a firm yet flexible consistency, making it suitable for various modifications in rhinoplasty. READILY AVAILABLE For most patients, especially those undergoing primary rhinoplasty, septal cartilage is available and can be harvested without creating a visible external scar. Septal cartilage is Dr Sandeep’s first port of call for cartilage graft harvest in rhinoplasty. LOW RESORPTION RATE Septal cartilage grafts tend to maintain their shape and volume over time, with a lower rate of resorption compared to some other graft materials. APPLICATIONS OF SEPTAL CARTILAGE GRAFTS IN RHINOPLASTY DORSAL ONLAY GRAFTS These grafts are used to correct a saddle nose deformity or to augment a flat nasal bridge. The graft is carved to the desired shape and placed along the nasal dorsum. Based on the current scientific evidence Dr Sandeep prefers to use Diced cartilage with fibrin glue for dorsal augmentation as this technique leads to long lasting natural looking results without the risk of cartilage graft warping. TIP GRAFTS meticulously carved and placed in the tip region to achieve the desired aesthetic. SPREADERS GRAFTS These are thin, rectangular grafts placed between the septum and the upper lateral cartilages. They play a crucial role in: Rectifying internal valve collapse, which can cause breathing difficulties. Straightening a crooked nose. Preventing an “inverted V” deformity post-surgery. COLUMELLAR STRUT GRAFTS This graft provides support to the columella, ensuring that the nasal tip remains elevated and doesn’t droop post-surgery. It’s a foundational graft that can influence the rotation and projection of the nasal tip. ALAR BATTEN GRAFTS Positioned in the soft tissue of the nostrils, these grafts combat external nasal valve collapse, a common cause of nasal obstruction. RIM GRAFTS Positioned in the soft tissue of the nostrils, along the alar rim, these grafts combat external nasal valve collapse, a common cause of nasal obstruction. SHIELD GRAFTS Shaped like a shield, these grafts are placed over the nasal tip, providing definition, projection, and a slight upward tilt. HARVESTING CONSIDERATIONS When extracting septal cartilage, Dr Sandeep ensures that enough cartilage remains to maintain the structural integrity of the septum. This careful approach minimizes potential complications like a deviated septum, saddle nose or a septal perforation. POST-SURGICAL EVOLUTION Over time, the septal cartilage graft integrates with the surrounding tissues, becoming a part of the nasal structure. While there’s a minor risk of graft warping or resorption, in most cases, the graft remains stable, ensuring the longevity of the rhinoplasty results. CONSIDERATIONS AND LIMITATIONS LIMITED QUANTITY There’s a finite amount of septal cartilage available. In revision rhinoplasty cases or after previous septoplasty, there might be insufficient or no septal cartilage left for grafting. DONOR SITE MORBIDITY Harvesting septal cartilage might lead to complications like septal perforation or nasal septum instability, although these are rare with experienced surgeons. CONCLUSION Septal cartilage is a versatile and preferred graft material in rhinoplasty due to its favourable properties and the ease of harvest. Its use can address a variety of nasal deformities, providing both aesthetic and functional improvements. The decision to use septal cartilage, other autologous materials, or synthetic grafts will depend on the specific needs of the patient, the surgeon’s assessment, and the desired outcome. Proper surgical technique and post-operative care are crucial to optimize results and minimize potential complications. EAR CARTILAGE HARVEST Using ear cartilage in rhinoplasty is a common technique, especially when there’s a need for additional cartilage to achieve the desired nasal shape or to provide structural support. Here’s a more detailed look at its application and considerations: WHY EAR CARTILAGE? AVAILABILITY The ear provides an easily accessible source of cartilage. FLEXIBILITY Ear cartilage is relatively soft and flexible, making it suitable for certain areas of the nose, especially the tip. SHAPE The shape and curvature of the ear cartilage makes it particularly suitable

INSTRUCTIONS FOR YOUR RHINOPLASTY SURGERY TWO WEEKS BEFORE SURGERY Pre-operative assessment will be done in the hospital to make sure that there is no contra-indication to surgery. If needed laboratory tests and ECG will be arranged.  Pre-operative photographs will be taken if they were not taken at the time of your first consultation. You will be provided with clear instructions about your arrival time and reporting place for the day of surgery. Surgery will need to be rescheduled if there is any chance you are pregnant. Do not take any products containing aspirin, ibuprofen, non-steroidal anti-inflammatory medication, or Vitamin E (multivitamins). Please check labels on over-the-counter medications. Many cold, sinus, and pain relievers contain aspirin or ibuprofen. Please do not take any herbal products including Chinese medicines. Refrain from all products including cigarettes, pipe tobacco, chew, or nicotine patch/gum. Nicotine interferes with healthy blood circulation and may affect post-operative healing and consequently the result of your surgery.  It also places you at higher risk for complications when receiving anaesthesia. Start taking 1000mg of vitamin C three times per day. Vitamin C helps with the healing process. ONE WEEK BEFORE SURGERY Do not drink alcohol for 1 week before and after surgery. Please inform us if you are unable to go ahead with your scheduled surgery so that the operating room time may be used to help another patient. THE DAY BEFORE SURGERY If your surgery is in the morning do not eat or drink anything after midnight (this includes water, candy, and gum chewing). If the surgery is planned for later in the day, Dr Sandeep’s team will inform you about the time to stop eating and drinking before surgery. Surgery will be cancelled if this is not followed. A fasting state is needed to go ahead for surgery.  The only exception is medication, which we will instruct you to take with a sip of water on the morning of surgery. DAY OF SURGERY You may shower and shampoo the morning before surgery. Do not wear makeup, hair sprays or gels, or nails polish. You may leave acrylic nails on. Avoid clothing that must be pulled over the head. Please wear loose fitting clothing. Do not wear jewelry, this includes body jewelry. Do not bring any valuables to surgery. Dentures, if worn, should be left in place. Do not wear contact lenses but rather wear your glasses on day of surgery. COMMON INSTRUCTIONS AFTER SURGERY You are encouraged to walk around the hospital/home on the day of the surgery and thereafter. This helps to prevent blood clots from forming in the legs. Move/pump your legs often while lying down. This helps in preventing blood clots from developing. Take deep breaths often when you get home for the first 24 hours after surgery. This helps to expand the base of your lungs. Sleep with your head elevated on 2-3 pillows. This helps to prevent increased swelling. Take all medications for the duration of the prescription and as instructed. Do not drive for 24 hours after surgery or anytime that you are taking pain medications. A responsible adult must provide transportation for you after surgery (public transportation is not permissible because of the risk of injury). Avoid making major decisions or taking part in activities requiring judgment for 24 hours after surgery. Do not drink alcohol for 1 week after surgery to decrease the risk of bleeding and bruising. Avoid bending, lifting, pulling, pushing, straining and aerobic activities for 3 weeks. Keep your dressings dry. You may bathe but not shower until post-operative day five. Avoid direct sunlight to the ears for at least a year. NASAL CARE Keep your cast dry. It will be removed on post-operative day five.  Dr Sandeep will then apply another cast for a further 5 days. Change drip pad under nose as needed. After packing is removed, use nasal saline douche (Flo sinus/Neilmed sinus rinse) three times a day for 3 weeks. This prevents dryness and crusting on the inside of the nose and helps to clear secretions and blood clots. Clean the incision line with hydrogen peroxide and Q tip (cotton bud) and then apply chloramphenicol eye ointment to the sutures three times a day for 5 days. Sutures are removed on post-operative day five. When the cast is removed, the nose will be quite swollen, and the nasal tip will be turned up slightly. This will settle down over the next 3-4 days, then more gradually thereafter. Nasal exercises will be given to you at the appropriate time. These are to keep the sides of the nose narrow and in proper alignment, along with decreasing scar tissue formation. CARE OF INCISION (FIRST 12 DAYS) In the morning: Apply a thin layer of Dermatix-ultra to the incision area– just so that you can see the shine. Continue this for 12 months. Heliocare SPF 30 every 1 hour if you are outside in the sun. Continue this for 12 months.  Ideally avoid going into the sun, this prevents the scars from darkening. At night: Triluma cream, apply to the incision area late evening after it becomes dark. Continue this for 2 months. Apply a thin layer of Dermatix-ultra to the incision area– just so that you can see the shine. Continue this for 12 months. ACTIVITY – THE FIRST WEEK Limit your activity sharply over the first week following surgery. You are encouraged to walk about the house, but avoid bending over the waist, picking up heavy objects or straining of any kind.  If you exert yourself, bleeding or prolonged swelling may result.  When you rest or sleep, keep your head elevated 2-3 pillows and avoid sleeping on your side. Keep your emotions under control. It is not unusual to feel a bit depressed for a few days after surgery.  This quickly passes as you begin to look and feel better.  Anger, crying or other emotional outbursts will only add to the swelling or increase the likelihood of bleeding.  Drink plenty of fluids and avoid

HOW CAN I ENHANCE AND QUICKEN THE RECOVERY PERIOD AFTER MY RHINOPLASTY? To optimize the healing process post-rhinoplasty, several measures can be instrumental: REST It’s paramount to give your body ample time to heal. Ensure you get plenty of sleep. ELEVATION Keeping your head elevated, even while sleeping, can help reduce swelling. Using multiple pillows or a recliner can be beneficial. ICING Applying cold compresses or ice packs around the surgical area (avoiding direct contact) can significantly reduce inflammation and bruising. This is especially effective in the first 48 hours post-surgery. STAY HYDRATED Drinking plenty of water can aid in flushing out toxins and reducing swelling. AVOID CERTAIN MEDICATIONS Some over-the-counter medications and supplements can increase the risk of bleeding. It’s essential to discuss any medications you’re taking with Dr Sandeep before and after the procedure. AVOID TRAUMA Certainly, avoiding trauma to the nose after rhinoplasty is crucial for optimal healing and to ensure the best possible outcome. The nose is very vulnerable to even minor trauma for the first few weeks after surgery. Here are some instructions to help patients prevent any inadvertent injuries to their newly operated nose: PROTECT YOUR NOSE Be extra cautious around children, pets, or in crowded places where accidental bumps might occur. SLEEPING POSITION Sleep on your back with your head elevated for the first few weeks. This not only helps reduce swelling but also prevents any unintentional pressure on the nose. AVOID CONTACT SPORTS Refrain from participating in contact sports or any activities where there’s a risk of a ball or another object hitting your face. If you must return to sports, consider wearing a protective face shield. BE CAREFUL DRESSING When putting on and taking off clothing, especially shirts or tops that go over your head, be gentle and slow to avoid brushing against your nose. GLASSES AND SUNGLASSES If you wear glasses, try to avoid placing them directly on the bridge of your nose for the first few weeks. You can use cheek rests or tape the glasses to your forehead to prevent them from pressing down on your nose. AVOID FORCEFUL NOSE BLOWING Do not blow your nose forcefully for at least a few weeks after surgery. If you need to sneeze, try to keep your mouth open to reduce pressure on the nose. LIMIT FACIAL EXPRESSIONS Minimize extreme facial expressions, like laughing or smiling too broadly, in the initial days post-surgery. TOUCHING AND CLEANING Only touch your nose when necessary, such as during gentle cleaning or applying ointment as instructed. Avoid poking, itching, or rubbing. AVOID DIRECT SUNLIGHT Extended exposure to the sun can lead to increased swelling and potential discoloration of the operated area. If outdoor activities are unavoidable, it’s essential to wear a hat and apply sunscreen. Remember to reapply the sunscreen every hour for continuous protection. GENERAL AVOID HEAVY LIFTING AND STRENUOUS EXERCISE Do not lift heavy objects or bend down, as this can increase facial pressure and risk bumping your nose. Avoid strenuous activities, especially in the initial days following the surgery. STAY AWAY FROM SMOKE Smoking or being around smoke can impair healing. Also, avoid smoky environments as they can irritate the nasal passages. LIMIT ALCOHOL CONSUMPTION Alcohol can increase swelling and the risk of bleeding. FOLLOW POSTOPERATIVE INSTRUCTIONS Adhering to the guidelines provided in our Rhinoplasty Postoperative Instruction Sheet is crucial. This document offers specific recommendations tailored to ensure a smooth and efficient recovery. Always follow the specific post-operative instructions provided by Dr Sandeep. If you experience any significant trauma to your nose or have concerns about healing, contact your medical team immediately. Remember, while these steps can aid in speeding up the recovery, it’s essential to be patient and allow your body the time it needs to heal fully. Always consult with Dr Sandeep or the medical team if you have concerns or questions during your recovery.

WHAT ARE THE POTENTIAL RISKS OF RHINOPLASTY SURGERY? Rhinoplasty, like any surgical procedure, carries potential risks. While many of these risks are rare, especially when the surgery is performed by a qualified and experienced surgeon, it’s essential for patients to be aware of them. Here are the potential risks associated with rhinoplasty: BLEEDING Some post-operative bleeding is expected, but excessive bleeding can be of concern and may require readmission. INFECTION As with any surgical procedure, there’s a risk of infection. However, when post-operative care instructions are followed and prescribed antibiotics taken as instructed, this risk is minimal. SCARRING While incisions for rhinoplasty are usually made inside the nose to avoid visible scars, there can still be scarring, especially with an open rhinoplasty where an external incision is made on the columella. The risk of noticeable scarring is minimal in Dr Sandeep’ hands. BREATHING DIFFICULTIES Some patients may have trouble breathing through their nose after surgery, especially if the procedure involves narrowing the nostrils or if there’s post-operative swelling. UNSATISFACTORY COSMETIC RESULTS There’s always a risk that the patient might not be satisfied with the appearance of their nose after surgery. This could be due to asymmetry, a nose shape that doesn’t match the patient’s expectations, or other aesthetic concerns. NEED FOR REVISION SURGERY In some cases, a secondary or revision surgery might be required to correct issues from the initial surgery or to achieve the desired results. ANESTHESIA RISKS As with any surgery that requires anaesthesia, there’s a risk of complications such as allergic reactions or breathing difficulties, rarely more serious complications may occur. NUMBNESS Some patients might experience numbness or a loss of sensation in the nasal area, especially the nasal tip, which usually resolves over time. Sometimes there may be numbness of the upper central incisor teeth. PERSISTENT SWELLING While swelling is expected after surgery, in rare cases, it might persist for an extended period. SKIN DISCOLORATION Some patients might experience skin discoloration or prolonged redness in the surgical area. SKIN IRREGULARITIES Very rarely the skin over the nose might appear wavy or have irregularities. SEPTAL PERFORATION In rare cases, there might be a hole in the septum, which can cause breathing difficulties, bleeding, whistling sounds and crusting. This may require corrective action if the patient is symptomatic. NASAL SEPTAL HEMATOMA This refers to a collection of blood within the septum, which can lead to complications if not treated promptly. ADVERSE REACTION TO SUTURES OR MATERIALS Rarely some patients might have allergic reactions to sutures or other materials used during the surgery. COMPLICATIONS FROM EAR CARTILAGE HARVEST Harvesting ear cartilage is a common procedure in reconstructive surgeries, especially in rhinoplasty, to provide additional structural support or to reshape certain areas. While the procedure is generally safe when performed by experienced surgeons like Dr Sandeep and the scars are well hidden, there are potential risks like scarring and change in shape of the ear.