1.EXCLUDE POSSIBLE CONTRAINDICATIONS
Contraindications due to acute or chronic diseases:
– Cardiovascular diseases: coronary heart disease, heart failure and arterial hypertension (surgery is not contraindicated with stable blood pressure numbers, controlled by taking antihypertensive medications);
– Pregnancy and lactation;
– atrophic rhinitis;
– Chronic liver and kidney disease;
– diabetes mellitus;
– diseases accompanied by blood clotting disorders;
– folliculitis in the area of the planned surgical intervention;
– Acne in the area of the planned surgical intervention;
– oncological diseases;
– mental diseases;
– Hepatitis B, C;
– HIV;
– Acute viral diseases.
Age contraindications:
– Age under 17 years old;
– Age over 65 years old (due to an increased risk of complications, as well as delayed tissue healing due to weakened regenerative processes).
Contraindications due to the psychological aspect:
– If the patient’s expectations initially do not match the planned result of the surgery, the doctor has the right to refuse to perform rhinoplasty.
– Refusal will also follow in the absence of indications for surgery.
– The desire to copy the appearance of stars will not copy their successful lives.
– Rhinoplasty will not make a person successful and famous overnight. It is a kind of transformation, a work on yourself. Be ready for that!
TO MAKE AN APPOINTMENT FOR THE SURGERY IN YEREVAN YOU NEED TO GO THROUGH
— computer tomography
— modeling
2. HAVE A CT SCAN
Computer tomography (CT) of the nose and sinuses is one of the most accurate and fastest methods of diagnosing the condition of the nasal cavity and paranasal sinuses (cavities in the bones of the skull filled with air). CT evaluates all features of the anatomy of the nasal cavity and sinuses, diagnoses pathological processes (inflammations, cysts, polyps, etc.).
The overall CT picture is created from a series of X-rays. The machine takes «X-ray pictures in layers. The most informative thickness of the slice is 0.5-1mm. That is why it is important to have a CT scan not on a dental CT scanner, but on a full-fledged clinical one.
The results of the CT scan and the radiologist’s report must be sent to me. A CT scan without a report will not be considered!
The files with your CT result are given as a CD. These files must be downloaded via «virtual consultant»: https://nose.am/en/#virtual.
This is a link to a video, that simply and clearly shows how to upload CT files:
https://nose.am/en/all-about-tomography
3. SEND PHOTOS FOR MODELING
I can predict the outcome of surgery to 90-95%. This is possible thanks to computer modeling. All you have to do is send your photos. Looking at the picture of “yourself in the future” will make it easier for you to make the right decision.
How do take a photo?
– Selfies for modeling are NOT accepted – ask someone to take a picture of you.
– The photographer should be 1-1.5 meters away while taking the photo.
– The camera must be at nose level while taking pictures.
– Photos should be of good quality, not blurred, in “focus”. Photos must be taken in good light, with no shadows.
– The background of the photos should be light (ideally white).
– No closed-eye modelling is performed!
– The size of the photos should be at least 500 kb.
Nose modeling will require:
– One full face photo
– Two photos in profile (on both sides)
– Two half-profile photos (45 degrees on both sides)
– One photo – view from below
The result of the modeling is usually sent within 7 days.
If you don’t receive the modeling within a week, email me at info@nose.am
CTs and photos for modeling should ONLY be sent through the virtual assistant on the website: https://nose.am/en/#virtual
If you don’t like modeling…
Of course, I always consider your wishes for your future nose! However, modeling a nose is not “painting” it. It is a virtual operation, which I perform, guided by your individual features, the anatomy of your nose and face. The goal is to create the most harmonious profile and nose that will give aesthetics to the face and healthy nasal breathing to the body.
Nose modeling is absolutely free. It is done only once and is not subject to correction. If you are not satisfied with the result of modeling, the surgery will not take place.
I am a doctor – I am for the patient’s health!
4. CHOOSE A DATE AND MAKE A PREPAYMENT
How to make an appointment
— After the examinations, modeling and tests, you choose a date for your rhinoplasty. To find out which day is the next appointment, go to: nose.am/en/#date.
— You write me a letter and tell me your preferred date.
— I will write back and tell you whether you can book that date.
— When we have already decided on the exact date of your operation, you make the prepayment to the clinic’s account.
— Take a picture or scan the payment receipt and send it to me.
— After you confirm receipt of your payment from the clinic’s accounting department, you will receive a letter with the exact date and time of your surgery and further instructions.
Prepayment
In order to make an appointment for a specific day of the surgery schedule, a prepayment of 10% of the surgery fee is required.
If everything goes «as planned» — you pay 10% less for the surgery.
You may reschedule your surgery only once and at least two weeks in advance. If you reschedule your surgery more than once or less than 2 weeks prior to surgery, the prepayment is converted into a fine and withheld by the clinic. You will need to pay again to reschedule.
Price of various surgeries
— Tip rhinoplasty — AMD 800 000
— Primary rhinoplasty¹ — AMD 1 000 000
— Primary rhinoseptoplasty¹ — AMD 1 200 000
— Secondary rhinoplasty² — from AMD 2 000 000
¹ If this is the first time you have had surgery on your nose, it is called primary surgery.
² If you have had surgery on your nose or septum in the past, it is called secondary surgery (even if you have had several). The cost of secondary surgery is higher and depends on the complexity and extent of the surgery.
The exact cost of surgery is determined only after reviewing the CT scan files, the conclusion of the CT specialist, and photographs for modeling. Note that you can send all of this data through a «virtual consultant»: https://nose.am/en/#virtual
Please note, the cost in dollars and euros is given on the basis of the current exchange rates of those currencies to the Armenian dram and is approximate.
You may pay only in cash and only in Armenian drams in two steps:
— On the day of tests — you pay the cost of pre-operative examination (included in the cost of surgery);
— On the day of surgery — the balance minus the examination and prepayment.
What is included in the price?
— Face-to-face consultation with a surgeon prior to surgery;
— Preoperative examination: ECG, chest X-ray, coagulogram, biochemical blood analysis, general blood and urine tests, blood group and Rh factor tests, blood tests for HIV, syphilis, and hepatitis B and C;
— Examination by an anesthesiologist;
— Surgery under general anesthesia (anesthesia)
— One day of stay at the clinic (individual two-room VIP ward, free Wi-Fi and cable TV, dietary meals for the patient). One attending person may stay with the patient in the ward;
— Dressing a week after surgery.
— Checkups 6 months and 1 year after surgery via videocall.
Medicines that will be needed during the recovery period at home, after discharge, are bought by the patients themselves.
5. FOLLOW ALL RECOMMENDATIONS AFTER RHINOPLASTY
— The day before surgery from 8 pm eat nothing, from 12 pm drink nothing.
— You should not eat or drink anything in the morning before the surgery!
— Do not wear makeup the day before surgery.
— Remove nail polish from the thumb nail on your left hand.
— Leave all jewelry at home.
— Do not take any medicines or dietary supplements a week before surgery.
— Do not smoke 3 days before and within a month after the surgery — smoking slows the healing process and keeps swelling.
— Completely exclude alcohol a week before the operation and within 1 month after the operation!
— Prepare a comfortable change of clothes for changing before the surgery. Buttoned or locked, so as not to disturb your nose when changing clothes after the surgery.
Comply with all recommendations after rhinoplasty
Postsurgery period
After the operation: ice packs will be put on the eyelid area and replaced by a new one every 20-30 minutes to minimize bruising and swelling (5 times in total). The patient stays in the clinic for one day and is discharged the next day.
Nutrition after the operation
— It is allowed to drink not earlier than one hour after the operation, at first little by little and in small sips. Then unlimited, not less than 2 liters of pure non-carbonated water a day.
— Three to four hours after surgery you can have a light, soft and not hot food.
Hot dishes and drinks, spicy and salty foods and products are excluded. This rule applies for at least 1 week after surgery.
— Bed rest is observed only during the first day after surgery. The next day it is canceled.
— Sleep only lying on your back for two weeks.
— An elevated position of the head will minimize swelling and puffiness of the face.
You can eat anything you like and in large quantities — your body needs the strength and energy for a quick recovery. Note that the food should not be hot, as well as salty and sweet. Salty and sweet foods retain fluid in the body and do not allow the swelling that has already formed to go down quickly.
Postoperative regimen
For the next two weeks, imagine yourself as an English queen: do all movements slowly, calmly with dignity, with your nose looking up. Minimize physical exertion and sudden movements.
Phone, book, or tablet — all with your nose looking up. When you put your nose down, gravity causes swelling to build up in the tissues of your nose.
Your body must not be dehydrated in order to restore proper mucous membrane function. Therefore, drink pure non-carbonated water as much as possible. At least 2 liters of regular water should be drunk every day.
Important!
Over the next 1-2 weeks, your temperature will be elevated. Usually, it will be higher in the evenings and a little lower in the mornings. This is a normal body response to trauma. You don’t need to do anything up to 38 degrees. If the temperature rises above 38 degrees, you drink any antipyretic (such as aspirin, paracetamol or ibuprofen).
Pain after surgery is not felt at all or very little. However, if you have a very low pain threshold, silence and patience is not necessary. It is enough to take a painkiller (such as Catafast or Nimesil).
The bandage under your nose, which was renewed before you were discharged, you take off when you get home. For a week or two after rhinoplasty, a small amount of mucus will come out of your nose along with blood. Do not be alarmed — this is normal. It is enough to blot the nose with sterile gauze tissues, carefully not to damage the sutures.
Care
1. At home, after discharge from the clinic, use two medicines in tablets — Augmentin and Fluconazole. This is an antibiotic and antifungal. You take Augmentin (625mg) 1 tablet 3 times a day for 5 days. Fluconazole (150mg) you drink so you don’t have bowel problems. Tonight you take one capsule. Five days later, after the last antibiotic pill, take another capsule. Regardless of the meal.
2. The day after discharge from the clinic, 2 additional items are added to the medication: peroxide cleansing and Lioton gel.
a)
The peroxide cleanse is done once a day, in the morning. You take 3% hydrogen peroxide and an ear wand. You dip the stick into a jar of peroxide for half a minute (so that the absorbent cotton had time to soak in the peroxide) and very quickly (just 2-3 seconds) cleanse the stitches from dried blood. Do not treat the skin with peroxide for a long time — you will get a chemical burn. If after cleaning with peroxide you notice swelling and redness — do not use peroxide and chopsticks again. When you come back in a week for a dressing, we will clean everything ourselves.
b)
Lioton 1000 gel (used only if you see bruises) works for 12 hours, so we use it in the morning at 10 and in the evening at 10. We apply a thin layer only on bruises. Careful not to get the gel in the eyes (otherwise for about a month you will have a vampire bloodshot view). Gel dries on the skin in the form of a shiny film with a yellowish cast. Before the next application of the gel rinse the film with a cotton pad soaked in warm water and squeezed, and then be sure to dry the skin. The gel is most effective on clean and dry skin. Use the gel until the bruises completely disappear.
3. Exactly one week after surgery, at 10:00 come to the dressing. It takes 5-10 minutes, after which you can go anywhere and on anything you want.
4. After dressing one week after surgery:
— Do not touch your nose for 24 hours to avoid introducing an infection through the newly removed stitches.
— You can touch your nose, bathe, and wash the day after the dressing.
— Bathe quickly and without very hot water. You should not steam your nose in the next month after surgery, as most of the swelling subsides in the first month after surgery.
— Inside the nose, on the septum, we purposely leave a few stitches that are absolutely safe and are not felt by the patient (except when the patient does not listen to the recommendations of his doctor and continues to pick his nose with the help of chopsticks, napkins or other improvised means). All stitches used inside the nose are resorbable. Time of resorption: 3-6 months. Observe these stitches, touch them, rub them, pull them out, cut them, etc — FORBIDDEN!
If you properly care for your nose from the first days after surgery, the postoperative period, which lasts a year, will pass practically unnoticed.
5. The next day after bandaging (a week after surgery) we start nasal irrigation 2-4 times a day with Aqualor Active-Soft. It contains solution of sea water. It can be used indefinitely without side effects and addiction.
Nose wash is done in an upright position (sitting or standing). The head should be slightly tilted forward. Make sure that during the rinse your head is not tilted back. Press on the nozzle and hold for a few seconds. Then remove any remaining flushing fluid by cupping using the «Pinocchio method».
«Pinocchio method»:
— Cover the right nostril with the thumb of your right hand from below so that no air can pass through it. Do not press from the side, so as not to deform the tip of the nose, just from below.
— With the other nostril, slowly and weakly, blow your nose. Do the same on the left side — with the thumb of your left hand we close the left nostril and blow our nose by the Pinocchio method.
— Slowly and softly — the main principles of the Pinocchio method. Strong and abrupt blowing, as some men do, clearing the nose, for 3-4 meters, is not necessary.
— After properly clearing your nose, you should not have fresh traces of blood and even more nasal congestion. This means that you are putting too much effort. Next time, try a few times weaker.
The only proper way to clean your nose for the next 1 year after surgery is with Aqualor and the Pinocchio method. Forget about all other ways!
The last drug in the prescription is Vibrocil (nasal drops). This is a reserve medication.
It should only be used if you have a stuffy nose. If there is no congestion, leave the drug in reserve and use it only if you have a cold or runny nose. We put it in lying down (the package includes a dropper) in each nostril exactly 3 drops 3 times a day for only 1 week.
Special Directions. Vibrocil should not be put on the septum. On the contrary, after putting it into the right nostril, turn your head to the right and raise it slightly so that the drug spreads over the right side of the nose. Put it in the left nostril — turn your head to the left and slightly upwards.
List of drugs to buy at the pharmacy:
— Augmentin, 625mg, 15 tablets
— Fluconazole, 150mg, 2 capsules
— Aqualor Active-Soft.
— Vibrocil, nasal drops
— Lioton 1000
— Hydrogen peroxide 3%
— Ear wands
— Sterile gauze wipes, at least 3-4 packs
Hygiene and cosmetics
— A quick shower with not very hot water is possible on the second day after surgery, but the bandage on the nose must remain dry.
— You can wash your hair from day 3, with your head tilted back, like in a barbershop.
— Cosmetics can be used 7 days after surgery.
— Cosmetic procedures (peeling, photorejuvenation, etc.) can be performed at least 6 months after rhinoplasty.
Warnings and restrictions
— Try to protect your nose from different traumas after rhinoplasty.— Avoid excessive activity, strain and bending of the body, as this can cause swelling, especially in the first week after the surgery.
— Sports and vigorous exercise can be resumed only after 2 months.
— Exclude hot baths, baths, saunas, do not go to countries with a hot climate for 2 months.
— Do not sunbathe or visit a tanning salon for 2 months.
— Under no circumstances should you take alcohol for a month — it interferes with healing and causes very severe swelling.
— Do not wear glasses for 6 months after rhinoplasty.
— Women are not recommended to get pregnant for 6 months after rhinoplasty.