What’s the typical recovery time from Rhinoplasty? Usually Rhinoplasty patients have black eyes, particularly if you need to move the nasal bones inward which happens in most cases. So I would say you can expect some black and blue or yellowing around the eyes for a week to 10 days afterwards. The initial recovery is uncomfortable not because of pain, as I said before, but because there’s packing frequently in the nose. There’s a splint on the outside which pushes the bones and tissues in and there’s packing on the inside which pushes the bones and tissues out. And this way I can keep things immobilized, sort of like a cast. The packing comes out at 3 days, the splint on the outside usually comes off at 7-8 days. Usually by 9-10 days they are able to go out to parties and look good with a little cover up makeup on the bruised eye lids. So one really couldn’t tell a 2 weeks, 3 weeks, 4 weeks out that one maybe even had Rhinoplasty done on themselves? I can tell you that the second patient I showed you was 3 months out from surgery. The first patient I showed you is only 6 weeks after. Very impressive.
How long does this procedure typically take? Well one somebody who’s never had anything done to their nose before I would say it could say it could take maybe as short as an hour and a half to maybe two and a half if there’s lots of cartilage additions I need to do. If it’s somebody who’s had 1, 2, 3 Rhinoplasty procedures elsewhere and they’re coming because they would like things that they’re not happy with corrected that can take 2 and a half to 3 hours. It makes it a much more difficult procedure. Can it affect your breathing? Well certainly. I mean the nose has two functions I guess. The most important being breathing. However that’s the one we tend to overlook when we discuss Rhinoplasty surgery because everyone’s concerned with the appearance. And I think it’s key. It’s absolutely key to improve form and function together.
Many times when I do a Rhinoplasty I’ll straighten out a septum or correct some out pouchings inside the nose called turbinates that typically humidify air as they go inside into your lungs. However they can become overexuberant and get really large and obstruct air flow, particularly in an area like Washington D.C. with lots of pollen and lots of allergens.
Please begin by telling us what kind of problems people with large breasts experience? Rocko it’s amazing. Women with large breasts experience pain in their back, their shoulders. Their bra straps will actually groove in and you can get an indentation.
And as far as who’s a typically candidate, who would you say? Rocko I would say that any woman whose large breasts are causing her symptoms of back pain, neck pain, shoulder pain, is a candidate for breast reduction, provided they’re in good health. What about men as well? Actually it’s funny that you say that. Male breast reduction is actually the 5th most common cosmetic procedure for men. However the procedure is very different for men than women. For men most of the time it’s just liposuction and removal of the extra fat and glandular tissue and allowing their skin to shrink back so the chest is flat. For women as we’ll see it’s a much more involved procedure.
Is there any discomfort involved in this procedure? Remarkably you’d think it would be painful and in fact I heard one of the female technicians saying oh that looks like it must be painful. In fact it’s not. There is very little pain and discomfort with this after the first 48 hours. Maybe they’ll take some narcotic pain pills initially, but within 48 hours almost all my patients are just taking Tylenol. The breast tissue itself doesn’t have much nerves, and the skin is healed, it’s sealed, it’s sewn together so there’s no real exposed nerve endings. It just is not that painful.
A Tummy Tuck is a common name for improving the shape of your abdomen and torso. Entails removing some skin and fat usually from the abdomen. Sometimes the muscles are tightened. Sometimes liposuction is done of the waist and in the area above the buttocks to really give that nice hour glass type figure. So it basically corrects problems that one has within the abdominal area but not just limited to the frontal side but basically all within that area. All the way around. You want an integrated look. It really depends on what the patient needs, what the patient wants, and what their body allows me to do.
Please tell us what are some of the most common problems that many of us experience with our eyelids. Rocko I think the eyelids break down to three common problems. One there can excess skin hanging on the upper eyelids. Two there can bagginess and puffiness and loose skin of the lower eyelids and three you can get hollows underneath the lower eyelids that make you look even more tired than having just bags alone. And what are the newest advances that can affectively correct those problems? I can’t tell that there are new advances, in other words, there is not a brand new technique that’s different however our way of looking at these problems has changed a lot over the last five to ten years. And the way we approach these problems, I think, is radically different from most plastic surgeons hands.
So what would be some areas as to how one would correct these eyelid problems? The upper lid is really straightforward. There is an incision in the upper eyelid crease a conservative amount of extra upper eyelid skin is removed, you don’t want the eyelid too tight, and a small amount of upper eyelid fat is removed. You don’t want a hollowed out appearance, so it’s just a conservative amount. With the lower eyelid it’s much more complex. There are many more variables. The lower eyelid can be loose. In other words it can cause you dry-eye problems, you can get redness and inflammation of the lower lid because the lower eyelid has lost its attachment really to the bone of the corner of the eye. That’s corrected by tightening that ligament right back to the bone. The fat pads of the lower eyelids used to be taken out all the time. That turned out to be the exact wrong choice. It gives a hollowed out appearance, it gives an aged appearance and we’ve found out that to be youthful you need to retain fat in your face. Very interesting. Now can these procedures be done comfortably say under local anesthesia? Some can be done under local anesthesia and some cannot. The simple ones just taking extra skin from the upper or lower eyelids, maybe tightening up the corner of the eyelid that can be done under a local anesthesia comfortably. When I’m actually taking the fat and leaving it attached but flipping it over the bone into the hollows of the cheek you probably want to asleep for that. It doesn’t take very long but it is not comfortable. Best to be under during that procedure. Best to be under during. Afterwards you feel great.
Rocko in our first set of pictures this is strictly laser resurfacing of the lower eyelids. The lower eyelids in the before picture are wrinkly, the skin is irregular maybe from the fat pads underneath but really when I look at this patient the problem I see that the lower eyelid skin has become thin, the callogen has become thin, the elasticity of the lower eyelid has gone. I didn’t even make a single incision. I just vaporized the outer layer of skin delicately with a CO2 laser and that was it. Within about a month, two months, the skin of the lower eyelid turns back to white from its sort of light sunburned pink and the lid becomes smooth. The second picture is obviously an Asian woman who has lower eyelids that have sort of sunken in. They’ve become a little elongated, by elongated I mean their height from lash line down to where the eyelids stop on the cheek has become too long. It’s no longer youthful. In the after picture which is taken only a couple months after surgery you can see she still has a tiny bit of swelling of the lid but the lid height is short again, which is a sign of youth, the loose skin the sunkenness the tiredness is gone. She is much more bright eyed.
What is the typical recovery time that one would be looking at? Well typical recovery time again varies by how extensive the procedure is that I am doing in the first place. I would say that sort of the standard Tummy Tuck with the incision going across the abdomen, the muscles being tightened, some light liposuction maybe of the upper abdomen. Patients walking around, they go home the same day. They’re walking around the next day. They’re not driving perhaps ten days, two weeks. And very strenuous exercise like a pilates class would be six weeks away.
In the beginning, patients need to tell their doctor that if they are having a Tummy Tuck are you on any herbal medication, are you taking any over the counter medications because you don’t want your doctor to get in there and have you bleed and not clot well and have issues related to that. Afterwards it’s just very important to listen to what the limitations are in your instructions. Surprisingly, the patients feel very well by about a week out and they might tend to overdue it. So they just have to be cautious, let everything heal properly, increase the activity slowly as the doctor instructs you and enjoy your new figure.
See firsthand how Dr. Richards has helped patients across Northern Virginia, Maryland, the Washington, D.C. area, and beyond with his advanced cosmetic surgery techniques. View our online video gallery and learn how the transformations happen.
