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DONALD J. CAPUANO, M.D.
Plastic Surgeon


You are interested in information about the surgical procedure for correction of a nasal problem. This may involve breathing problems, (internal) reconstructive or cosmetic problems, (external), or a combination of internal and external problems. The corrective procedures are called septalplasty and nasalplasty (or rhinoplasty - to use the Greek word origin).

CONSULTATION


 Dr. Capuano will discuss the goals of surgery with you.  You will be asked what you see and what you do not like and he will give his opinion about your condition. This way a mutually agreeable plan for obtaining your goals can be developed.

Cosmetic surgery is not usually covered by insurance companies unless it is a result of an accident or injury with supporting documentation such as X-ray, emergency room visits etc.. You should check with your particular insurance carrier regarding what they want as documentation as many plans differ. We will work with you.

If you have problems such as airway obstruction, post nasal drip, headaches, etc., you may have a deviated septum. Dr. Capuano will look into your nose with a very thin scope to determine if this is the case. Most insurance companies will cover septal breathing obstruction) surgery if medically indicated, meaning if you have symptoms and the cause is not allergies, polyps, etc..

ANESTHESIA FOR SURGERY

For patients having septal surgery, general anesthesia is usually used as most septal deviations are deep in the nose. You will have the opportunity to talk with the physician giving you anesthesia before your surgery. If you are having cosmetic surgery, many people have intravenous sedation and local anesthesia. This means you will be given medications to relax you through an IV. and then Dr. Capuano will use "Novacaine" to numb the area. Most patients having surgery this way do not remember their procedure. Dr. Capuano will discuss anesthesia options with you.

Incisions for nasal surgery are made on the inside of the nose, except in cases where the base of the nose is to be made smaller. Dr. Capuano will discuss possible external incisions.

If you are having a septalplasty (internal correction), you should be aware that conditions may occur which may require less than total correction of symptoms (a limited resection). The Doctor must use his best judgment at the time of surgery. Rather than resect a greater amount of tissue and cause possible harm, the Doctor will do a lesser correction. He will discuss this with you before your surgery if this applies to you. You will need someone to drive you home and stay with you for at least twenty-four hours following surgery.

BEFORE SURGERY CARE

We ask that you refrain from taking any products containing compounds that are causes of bleeding for at least two weeks prior to your surgery.  We will give you a list of these at the time of your office visit and evaluation.

You must not eat or drink anything from midnight the night before your surgery. The evening prior to your surgery, and the morning of your surgery, please clean the inside of your nose gently with Q-tips. You should shower the night before and/or the morning of your surgery. Dial soap is most grequently used. Oral hygiene is important. We remind you to brush your teeth and use a mouth rinse the evening before and the morning of surgery. Do not wear contact lenses the day of surgery or immediately following surgery. You may resume wearing contact lenses by using them for short periods of time at first. Gradually increase the time over a number of days. Please remove ALL makeup and make sure your face is clean and free of creams, lotions and powders before your surgical procedure, especially eyeliner.


AFTER SURGERY CARE

You will have a splint on your nose, which should be kept clean, dry and on. You will also have a gauze pad under your nose for drainage. This can be replaced as needed. No showers are advisable until you are seen in the office. Tub baths are fine.

Following internal nasal surgery, you will have packing in your nose. This should be left in place. If the gauze starts to come out, use a Q-tip to gently push it back into place. If this is not effective, snip off the excess gauze with a clean pair of scissors. Patients tell us this feels like you have a head cold. The packing is important. Studies have indicated that it helps nature heal the inside of the nose and keep the septum straight allowing for better breathing results.

Most patients do not have significant discomfort after surgery. Tylenol usually takes care of the pain. 


MEDICATIONS AFTER SURGERY

You will be given medications for swelling, discomfort and to prevent infection. Please take these medicines as directed, and finish all prescriptions unless advised otherwise. If you have a problem with any medication, please call the office.


ACTIVITY FOLLOWING SURGERY

Unless you have a 'desk job' we do not advise working while your splint and/or packing are in place.

The estimated time away from work depends to a large extent upon the nature of your job. Under usual circumstances, you may return to work anywhere from one to three weeks following your surgery. If you work in a dusty environment, or are required to do heavy lifting, you may have to stay out of work even longer. Please discuss your job with the Doctor so you may obtain a better estimate of time away from work.

CAUTION: If you are a body builder, weightlifter, exercise seriously, or if your job requires heavy lifting, you must be aware that after surgery you should not  lift heavy objects, strain or do significant facial grimacing for at least three months,after surgery. The length of the restriction depends upon the complexity and extensiveness of your surgery.  If this pertains to you, you should notify the Doctor BEFORE YOUR SURGERY and discuss your particular situation. Swimming and vigorous exercise should be avoided until Dr. Capuano gives the OK. Cigarette smoking and contact with harsh chemicals should be avoided.

 At the time of your first office visit following surgery the dressing will be removed. You should now be able to shower, and it is advised that you do so, allowing the water vapor to help clean the inside of the nose. You may gently wipe the lower inside of your nose with Q-tips. Do not blow your nose until advised otherwise. It is important not to hit or bump your nose, as it is still in the healing stages. Do not put anything (except Q-tips in the lower inner nostril area) in your nose. Doing so could change the eventual result of surgery.  Packing, if used, will be removed. 

HEALING AFTER SURGERY

Following surgery, you may feel or notice small irregularities in the nose. In many instances, after swelling decreases these irregularities will change markedly. These irregularities are not unusual, and are usually associated with the fracture of the nasal bones. In many cases bones do not uniformly fracture, resulting in irregularities which may be noticed. Usually these are felt and not seen. Be aware that if the height of the nose is decreased, this widens the nose, either in actuality or visually.

No person has a face that is completely symmetric. This includes the nose. You may notice from pictures taken at different angles that there are slight differences in noses. Many people have one profile they prefer over the other. You may have asymmetry of the nose following surgery. This is usually not noted except upon extremely close inspection, and we mention this so you will be aware if this happens in your particular case.

Photographs will be taken before, possibly during and after your surgery. 

More information re nasal surgery

INFORMATION SHEET FOR NASAL SURGERY

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