1. WHAT IS RHINOPLASTY

Plastic surgery of the nose. This surgery can have multiple different types of forms. revision (second or third time around) purely cosmetic is when there is no medical condition to consider or fix. mini rhinoplasty is when there is a small bone asymmetry that can be fixed with a minimally invasive procedures. Can also have chin implants as well.

Mini rhinoplasty is when there is a small bone asymmetry that can be fixed with a minimally invasive procedures. 

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2. ABOUT DR. ESMAIL

Dr. Ali Esmail is Winnipeg’s first and only fellowship trained Facial Plastic Surgeon. Unlike a ‘general plastic surgeon’, Dr. Esmail has 6 years of specialized training that focused on procedures from the neck up. Facial plastic surgery requires extreme attention to detail, an eye for symmetry and a drive for perfection.

When it comes to someone’s face there is no room for error, and at Visage, this is the very work ethic that drives our entire team. It is those attributes that originally attracted Dr. Esmail to the field of facial plastic surgery. His obsessive attention to detail and keen eye for aesthetic symmetry is what makes him one of the most exciting and top young surgeons in the field.

3. TIMELINE

Surgery

We have three options for surgery.  For those cases where there is a medical component, the operation can be done under general anesthesia at the Victoria General Hosptial.  For purely cosmetic cases the surgery can be done under general anesthesia at the Western Surgical center across the street from our clinic or under deep sedation inside our state of the art operating theatre.

The Consult

We start with a consult where Dr. Esmail or his assistant will take detailed medical history and a complete nasal exam often including an endoscopic exam of the nose.  We will discuss what you don’t like or want to change about your nose, and any breathing issues.

Photos: We take a set of 3D VECTRA photos as well as high definition 2D photos.  Using the latest technology we are able to take precise measurements and analysis of your nose and provide morphing to show you what an expected outcome may look like.

POST-OP

We see you post-op on visits at 1 week, 1 month, 3 months, 6 months and 1 year.  At each visit we will take photos and will monitor your progress at the 1 month visit we can discuss any concerns and can start injections of steroids to help reduce scar tissue and swelling in areas that need more definition.

4. BENEFITS

Most patients who choose to undergo rhinoplasty do so because they feel embarrassed or inhibited by the size, shape, or projection of the nose. As it is the central feature of the face, there is no hiding a flaw, whether it is a hump on the bridge, droopy, large, or bulbous tip, or an aesthetic problem related to overlarge, wide nostrils, or a flat bridge or asymmetrical shape. 

5. TYPES OF PROCEDURES

1. Primary Rhinoplasty

If this is your first surgery, you fit under primary rhinoplasty.  Depending on what is required, what type of anesthesia is chosen and if any of the procedure is covered by insurance, the price will vary.

2. Ethnic Rhinoplasty

In the past ethnic rhinoplasty was done to give patients a more Western-looking nose, but today the surgery is performed in a way that enhances the appearance of the nose while maintaining ethnic features. You are able to change the way your nose looks to become more attractive according to your standards without losing any ethnic distinction. 

3. Revision Rhinoplasty

Revision rhinoplasty is a difficult surgery to master and unfortunately it is often performed with poor results by surgeons who are not rhinoplasty specialists. If you have previously undergone a rhinoplasty and are unhappy with your results, revision rhinoplasty is the procedure for you to consider.

4. Micro Rhinoplasty

Often we see patients who have a small bump or imperfection they would like fixed. This includes some revision cases with ridges or bumps or that may require narrowing of the nostrils. We can perform these procedures often with freezing and no anesthetic at all. Some patients prefer to take a short acting oral sedative as well.

5. Alar Revision

Alar reduction is a component of Rhinoplasty; a specific technique that addresses the width of the nostrils only. The Alar is the area of the nose that extends from the tip of the nose and rounds outwards towards the cheek. An incision is made on either the exterior or interior of the Alar region in order to remove excess tissue. 

6. RISKS

As with any procedure   There are risks associated with rhinoplasty.   Given the unpredictability of the way the nose heals a change of a few mm can create an undesirable result.  Because of this given in the most experienced hands rate of revision rhinoplasty is 10-15%.

Any patient undergoing a rhinoplasty should be mentally prepared to have to require 2nd most often much smaller procedure to correct any irregularities. Other risks include prolonged bleeding, infection, and prolonged stuffiness.  Most of these are minor and resolve with time.

7. RECOVERY

Patients generally wear a splint for the first week.  There will be bruising and swelling under the eyes and nose that will be there for a few days - a few weeks following surgery. Should avoid strenuous activity for 2-3 weeks. 

8. WHAT TO EXPECT

Post-Op :  Most patients only need pain killers for the 1st 48 hours.  It is not a terribly painful surgery. Get some rest.

Week 1 :  At the end of this week your splints  come off and you get the first glimpse of your nose.   The profile will look great but the tip will look fat and the nose will look wide.  This will continue to improve over the coming months. If there is bruising the majority of it should have  resolved by 10-14 days. Dr. Esmail is unique in that he uses only dissolvable sutures during rhinoplasty. No suture removal is required at this appointment.

Month 1 : after 1 month 80% of the swelling has come down. The tip starts to show more refinement.  Breathing starts to significantly improve around this time. Think if this time frame with the analogy of loose fitting clothing. The initial swelling has resolved and  the nasal skin is sitting loosely over the structure created below. Over the next 11 months the skin well shrink wrap over this structure to reveal the work of your rhinoplasty.

 1 year :  It takes approximately 1 year with a final shape of the nose to reveal itself.  Rhinoplasty requires patience and trust in your surgeon.

9. CHOOSING A SURGEON

The most important thing you could do to insure a good outcome for  your rhinoplasty is to choose the right surgeon. Rhinoplasty is widely considered 1 of the most difficult cosmetic procedures to perform well.  This is why you want to choose a surgeon that does a lot of rhinoplasty and specializes in the procedure. Dr. Esmail is Winnipeg’s only fellowship trained facial plastic surgeon.  This means he focuses only on the face. Rhinoplasty is the most common procedure performed by Dr. Esmail. 

10. COST:  Starting at $8000 +   Pricing includes facility fee and anesthetic  fee.

10. FAQs

Is rhinoplasty painful?

Will I have black eyes?

How long before can wear makeup?

How long before I can exercise?

Will my breathing be improved after surgery?

Will Manitoba Health or private insurance cover  my surgery?

What type of anesthesia is used? Will I be completely asleep?