With nearly two decades of experience in rhinoplasty, Umang Mehta, M.D. is an internationally recognized expert in this surgery. Over 95% of his surgical cases are rhinoplasties, and he currently performs between 175 and 200 per year. A leader in the field, Dr. Mehta has been invited to lecture on his rhinoplasty techniques at numerous international conferences as well.
Rhinoplasty refers to surgery to change or correct the shape of the nose, both internally and externally. Internal changes often include a septoplasty (straightening of a deviated septum) or nasal vestibular stenosis repair (widening the internal/external nasal valves), to improve the ability to breathe through one’s nose. Reduction of the inferior turbinates (submucous resection) can also help to improve the nasal airway. Often, insurance coverage will offset a significant portion of the cost of the surgery when patients have difficulty breathing, a deviated septum, a septal perforation, or a prior broken nose. Because of his large volume of rhinoplasty and the frequent need for functional nasal surgery, Dr. Mehta is in-network with a wide range of insurance plans.
Dr. Mehta is very talented at both primary (first-time) and revision rhinoplasty. He predominantly uses the open rhinoplasty approach, but also has extensive experience in the closed (endonasal approach) and uses this when appropriate. He is also an expert in septal perforation repair and uses the latest in technological advances, such as an absorbable PDS plate, to perform this surgery.
Because of his expertise and volume of rhinoplasty, Dr. Mehta was chosen to be an instructor in an American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) fellowship. He was one of a handful of surgeons nationwide to publish a chapter (Nasal Analysis) in Master Techniques in Rhinoplasty and Nasal Reconstruction. Additionally, Dr. Mehta has lectured numerous times to fellows, residents, medical students, and premedical students on the topic of rhinoplasty, at USC Medical Center, Saint Louis University Hospital, Stanford University, and UCSF. At USC and UCSF, he was also given the privilege of teaching the technique to several future head and neck surgeons in the operating room. He has also published his research on nasal obstruction and nasal surgery in well respected peer-reviewed medical journals, while also having been invited to present his techniques at international facial plastic surgery and otolaryngology meetings. During his training, he learned from numerous talented rhinoplasty surgeons all over the United States and Canada.
Most surgeons would agree that rhinoplasty is the most challenging plastic surgical procedure, given the careful consideration of both aesthetics and function. This surgery should be performed by specialists with extensive training and a profound understanding of both the nasal airway as well as the anatomy of the nose.
Nonsurgical Rhinoplasty
For certain patients, nonsurgical rhinoplasty, also called liquid rhinoplasty, is an excellent option. This procedure involves the injection of fillers such as Restylane Lyft, Restylane, or Voluma in the nose. The procedure takes just a few minutes to perform in the office and can be an alternative to surgical rhinoplasty for patients with small irregularities or indentations. Injection of filler above and below a hump can help camouflage it. Filler can also help lift and refine the tip and make the nose appear straighter. Dr. Mehta is adept and experienced at nonsurgical rhinoplasty and can advise you if this is an option for your nose.
The Consultation
Your visit for a rhinoplasty consultation with Dr. Mehta typically lasts approximately one hour. He will begin with an extensive discussion of what exactly bothers you about your nose. This communication of the desires, aesthetic, and expectations of the patient is truly the most critical component of the entire rhinoplasty process.
Dr. Mehta will obtain a careful history, including medical conditions which may affect your ability to undergo and recover from surgery. Any history of adverse reactions to anesthesia or medications commonly given before, during, and after surgery is also determined. Any history of difficulty breathing, nasal trauma, or prior nasal surgery is particularly relevant.
This discussion is followed by a thorough examination of both the inside and outside of the nose. Dr. Mehta will carefully palpate the outside of the nose, to feel the thickness of the skin and assess the underlying nasal bones and cartilages. The inside of the nose is painlessly examined with a nasal speculum. The nasal septum, the wall which divides the nose into a right and left half, is inspected as well, to determine the degree of deviation and status of the cartilage.
Dr. Mehta or our Medical Assistant, Kelli, will photograph your nose from several different angles. The images are displayed on his computer, enabling both Dr. Mehta and you to inspect your nose in detail. Dr. Mehta then utilizes software to “morph” your nose, to give you an idea of the appearance of your nose after surgery. This computer imaging is a very important process, as it gives you the ability to communicate your aesthetic desires to Dr. Mehta and better understand the surgical goals. During this discussion, Dr. Mehta will begin to formulate his plan and explain to you all of the steps of the operation. These “morphed” images of your nose are stored and used during your surgery as a guide or template. While not a guarantee of results, this imaging process is invaluable in making sure that you and Dr. Mehta are on the same page going into surgery.
Preoperative Visit
After this initial consultation, most patients return for a preoperative visit approximately three weeks before surgery. At this time, Dr. Mehta will again review your images with you in detail, allowing you to communicate any new thoughts or questions since your first visit.
Dr. Mehta and Shannon will also go over your list of medications and supplements, as it is usually necessary at this time to discontinue any products that can increase the risk of bleeding during or after the surgery. These include, but are not limited to, aspirin, ibuprofen, heparin, warfarin (Coumadin), Plavix, vitamin E, fish oil and numerous other supplements. The decision to stop any of these prescription or over-the-counter products is made in conjunction with your primary physician. Medical clearance and other tests may need to be obtained, depending on your age.
At this visit, we typically give you prescriptions for pain medication and antibiotics. This allows you to pick up these important medications prior to your surgery, so that postoperatively, you and your caretakers can rest and concentrate on your recovery. Dr. Mehta will advise you to pick up Arnica Montana and Bromelain, two homeopathic products which reduce bruising after surgery. These are taken as directed, beginning immediately after surgery. You will be given detailed preoperative and postoperative instructions by Shannon. It is important to avoid alcohol for three days before and one week after your surgery.
Lastly, you will have the opportunity to spend time with Jill, our office coordinator, to answer any logistical questions related to your surgery. Your final surgical fees are settled at this visit as well.
Surgery
On the day of surgery, you will arrive at the surgical center with a friend or family member who will drive you home and care for you after your surgery. It is imperative to come in on an empty stomach, not eating or drinking anything for at least 8 hours prior to your surgery. This includes water and chewing gum. You should wear loose and comfortable clothing, including a shirt which buttons in the front to avoid having to pull anything over your head after surgery.
The operating room nurse will meet with you first to go over your instructions in detail. You will then meet your anesthesiologist, who will have carefully reviewed your medical and surgical history. You will have the opportunity to ask the anesthesiologist any questions you may have at this time. Finally, Dr. Mehta will meet you and your friends/family to answer any last minute questions as well.
Dr. Mehta works with top notch anesthesiologists from Medical Anesthesia Consultants (MAC). These anesthesiologists are all board-certified MDs who practice at a number of area hospitals and surgery centers. Because of the numerous cases Dr. Mehta has done with MAC, there is a mutual familiarity and comfort level and patients are truly in the best of hands.
After surgery, you will wake up in the recovery room, where your vital signs are carefully monitored by the anesthesiologist and recovery room nurse. You will have a rigid splint on the outside of your nose with tape underlying it.
After Surgery
After approximately one to two hours in the recovery room, you will be discharged home, in the care of a responsible adult for the first night. Your caretaker will be instructed to assist you with icing your nose and the area around your eyes for the first 24 hours after surgery. Warm compresses are then applied 3-4 times a day until the bruising clears. You will sleep with your head elevated on two pillows. At this time, you will begin taking your prescribed medications as well as the Arnica Montana and bromelain. Eating fruits such as pineapple and papaya are encouraged as well, as they are thought to help minimize bruising.
Over the next 1-2 days, most patients develop bruising around the eyes and cheeks, while pain and discomfort are usually moderate at this point. We recommend taking extra strength Tylenol (500 mg) every 3-4 hours on schedule and supplementing with the pain medication Dr. Mehta prescribes. Often patients will feel fine to work from home as early as 2-3 days after the procedure. You are encouraged to undertake light activity, like walking, as early as the day after surgery.
Your diet should be mild in flavor for the first day after surgery, to minimize nausea. A lower salt diet is advisable for the first few days after surgery, as this may help to reduce swelling. You should avoid any vigorous activity or heavy lifting for 10-14 days after surgery.
Your next visit will be 5-7 days after surgery, at which time your splint is removed. In open rhinoplasty cases, the few, tiny sutures placed on the columella (between the nostrils) are removed at this time. Your nose will be somewhat swollen when the splint is removed, though the majority of the swelling disappears over the subsequent few days. On average, patients return to work or school around 8-12 days after surgery though this certainly varies depending on one’s degree of bruising/swelling and comfort level. Taping the nose at night can help the swelling clear more quickly.
The next visit will be at two to six weeks after surgery, at which time, Dr. Mehta will consider injecting your nose with steroids if there is a need. You will then be seen at 3 months, at which time the first set of “after” photographs are often taken. Your subsequent visits will be about every 3 months until the 12-18 month mark, by which time the miniscule bit of residual swelling will typically have resolved.
Conclusion
Rhinoplasty is a delicate surgical procedure which, when performed by an expert surgeon, yields excellent results for the vast majority of patients. The surgery is well tolerated by most people with a brief recovery period afterwards. The surgery can have a profound effect on both your ability to breathe as well as the shape of your nose.
If you have any additional questions or would like to schedule a consultation, please contact our office.
Dr. Mehta is a featured Rhinoplasty expert on Realself.com — See Dr. Mehta’s answers to actual patient questions.
