CONSULTATIONS

The first consultation

It lasts one hour.
It starts with a medical quiz looking for:
  • - general medical history: allergy, asthma, diabetes, high blood pressure…
  • - ORL case history: nasal trauma, operations on the nose, nasal septum, sinuses and their after-effects on breathing.

  • Some photos are taken: full-face, profiles ( right and left, upper and lower views )

Clinic examination

It will assess:
- skin texture: its thickness, its elasticity.
A thin and clear skin will show the slightest blemish.

A thick skin will tend to mask the details of the nose cartilaginous architecture and make its volume reductions more difficult for the skin retraction capacities are more limited.

As for a nose formerly operated on, the fibrous cicatricial tissue also alters this retraction capacity. The result will then be harder and longer to obtain.
- The consistency of the' cartilages at the tip of the nose: their resistance to pressure.
leur résistance à la pression.
- The proper bones of the nose: differences in incline, after-effects of fractures.

Nasal endoscopy

It is of paramount importance:
Such an examination will enable us to explore the nasal fossae entrance painlessly and detect a nasal septum curvature, turbinate bones hypertrophy or a nasal vestibule chronic infection, which the patient often did not know about.

In certain cases, a scan will be asked and carried out in order to know the sinus after-effect of those pathologies to contemplate an associate gesture if necessary:
Nasal septum surgery ( septoplasty ) and / or, sinis surgery ( meatotomy, ethmoidectomy )

Therefore it is only after such a full examination that the surgeon can determine whether the operation to plan is strictly cosmetic or both functional and cosmetic.

Analysis of the photographs and computer morphing

Computer morphing is carried out with the patient's help.

The very sophisticated used software enables to create a draft in profile but also a full-face one ( more difficult to make )


Caution: the images we get are virtual images made with a computer mouse; the results of the operation cannot be superposed onto the computer morphing results in every respect.

Once the photo draft has been materialized, two situations can appear.


Surgical Rhinoplasty

It is what is usually meant by rhinoplasty, i.e. a surgical operation carried out at the clinic under anaesthetic.
We will be able to act on all the parts of the nose (bones, cartilages and sometimes thickness of the skin), change them, reduce them or increase them thanks to cartilaginous grafts(taken from the cartilage of the nasal septum or the ear). The results are final.
A description is made of the nose anatomy and techniques specifically chosen for your project.
The potential operating risks and best ways to avoid them are also mentioned.
You will be given a summary document as well as an enlightened consent form.
An estimate is made out with all the details about the expenses inherent to this surgery:
The surgeon's fees
The anaesthetist's fees
The clinic expenses
A two weeks' time to think will of course be allowed.
Cosmetic surgery of the nose does not entitle to any reimbursement by the mutual insurance company or the health insurance.


Medical Rhinoplasty

The recent appearance of injectable filling products (fillers) which are hyaluronic acid-based and botulinic toxin-based enables to change temporarily the morphology of certain parts of the nose after mere local anaesthesia (by cream or injection). It is performed at the medical office.
A sloping tip can thus be slightly uplifted by increasing its definition (hyaluronic acid) and weakening the muscle depressor of the nasal septum (botulinic toxin); the visibility of a hump can be attenuated by slightly filling the over and subjacent parts.
Considering the life span of hyaluronic acids, a new injection will have to be done every other 12 or 18 months; as for the botulinic toxin, a new injection will have to be repeated every other 4 to 6 months.
Medical rhinoplasty is therefore reserved for patients with small distortions or who do not dare to go to surgery. It enables only limited changes.
In the long term, owing to the increase of the number of injection sessions, it is more expensive than surgery.
It can fit within the framework of a fuller face harmonization:
- filling of nasogenous furrows that are too pronounced
- reshaping of the cheekbones
- increasing in volume of too thin lips
- redefinition of the oval of the face
- removal of the lion wrinkles and bitterness wrinkles
- repositioning of the eyebrows height
There again, a document mentioning possible risks and complications will be handed as well as an estimate.
Medical rhinoplasty does not entitle you whatsoever to an undertaking to reimburse medical expenses by the State Health Insurance Office or the mutual insurance company.


THE SECOND CONSULTATION

The hospital file is filled in and the appointment for the anaesthesia consultation is made at St François Clinic.

Surgical Rhinoplasty:

It takes place fifteen days after the first consultation and lasts half an hour. The patient has already been informed on the risks inherent to such a surgery and possible complications published in medical literature. We go back over each one of them in detail and on the way to avoid them. The enlightened consent form is then filled in and signed.
The morphing photos are validated and become the final project.
The hospital file is filled in and the appointment with the anaesthetist is made at St François Clinic. The latter must take place 48 hours before the operation at the latest. The pre-operative blood check-up will be carried out during this consultation.
No antiaggregating platelet medicine (aspirin, Plavix Ticlid) nor anticoagulant one (Sintron, Coumadine, Préviscan) should be taken within the 10 days preceding the operation.
Let us remind you that it is necessary to be on an empty stomach (no drinking, no eating, no smoking) during the 6 hours preceding the operation.
The estimate is to be accepted, signed in triplicate (patient, doctor, clinic).

Medical rhinoplasty
During the second consultation, should the estimate be accepted, the medical treatment is carried out at the surgery after skin disinfection prior to it.
The cosmetic result is almost immediate with hyaluronic acid whereas it takes a few days for botulinic toxin. Other parts of the face can be treated simultaneously.
Pieces of advice should be given (areas to be massaged or on the contrary respected).
A third consultation will be necessary in the distance (a fortnight) to judge the result and make corrections, if necessary.