Meet Dr. Ary Krau, Expert Plastic Surgeon in Miami

What do I need to do to get ready for a surgery like that? Whenever we operate on anyone for an elective procedure, they need to be medically optimal. There should be no medical problems. If there are medical issues, like diabetes or hypertension, those all need to be under control, so they need to be medically cleared. We like them to be at a healthy weight and not morbidly obese; anyone with a BMI of over 40, we really shy away from operating on. That's from the medical point of view. Otherwise, we want to stay away from any blood thinners, such as aspirin or nonsteroidals like Voltaren, Aleve or Naprosyn. We try to avoid too much vitamin E, and no alcohol for at least a week before surgery. Obviously, no illicit drugs. They should be off all of those, and then they're ready to go.

What can we expect after a nose procedure? Like any procedure, it takes a while for the results to show themselves and for the post-operative changes to settle down. As a general rule, 48 hours after surgery is the maximum amount of time where swelling shows itself, and then the swelling starts to resolve. In rhinoplasty there's a lot of swelling the first week, and it peaks at two days. It's hard to see because almost all the time there's a splint on the nose that we usually take off a week later. When we take that splint off, you get the impression of what the nose will ultimately look like. The swelling is going to set back in a little bit, so that second week may not look as good as when you first took the splint off, but beginning two weeks later, as the swelling dissipates, you start to see the form of the new nose. As a general rule, at one month you're about 80% there, but nose changes, particularly in the tip, can take six months or sometimes up to a year. If any touch-ups need to be done after surgery, because there's always a possibility of revision, that should not be done until at least a year, when we can see the final results. As far as work: rhinoplasty is not really an uncomfortable operation, but it is a little bothersome because there's a lot of congestion. The patient will have a splint on the nose for the first week, and there may be a little black and blue under the eyes. One can go back to work or school in that first week, but that's a personal choice; I don't think a lot of patients want to go back to school with bandages on their face. At one week, everything pretty much comes off. There are signs that recent surgery was performed, but most patients go back to work at one week. As far as activity goes, we don't want patients to over-exert themselves for the first three weeks after surgery, because the more the blood flows, the more swelling is produced, so we recommend taking it easy. Patients also have to be a little careful in the first three weeks because when we move the bones of the nose, they are sticky but not fully healed for at least three weeks. A significant amount of pressure on the nose can displace those bones, and that's a problem because it isn't easy to fix right away. We have to wait until everything heals, and then we go back for a revision.

What is the perfect candidate for a rhinoplasty, or nose job? Almost any patient is a candidate for rhinoplasty if they want a particular characteristic of their nose changed. Of course, let's exclude patients with body dysmorphic syndrome, who are obsessed with a minor flaw that gets in the way of their life. But most patients have a certain look that they're trying to achieve with their nose. If they're good candidates, meaning there are no medical issues and they're candidates for surgery, certainly we can proceed with the rhinoplasty. Now, there are some limitations as to how much change can be achieved. Ideally, we want patients with skin that's not too thick and not too thin. When skin is too thick, it has its own memory, and there's not much change we can achieve, although some can be achieved. If the skin is very thin, that's not that bad, but it will show any kind of scarring underneath the skin. So the ideal patient is one who has an obvious deformity or characteristic of the nose they want to change, with moderate thickness in their skin.