All of us are anxious to see results. Whether it is cosmetic surgery or building a home, we like to see the work done and sometimes become inappropriately impatient.
I often have to remind patients that with any operation, it takes nature 100 days to do the basic repair work and absorb most of the swelling. Whether that is an artificial hip replacement, a hernia repair, a breast reduction or rhinoplasty or septoplasty, rhinoplasty with turbinate resection (which not only improves appearance but also improves the airway and prevents sinus problems) — it takes time for ole Mother Nature to do its job.
We can’t rush nature; we can’t push the clock. We have to understand that this is what it takes to finish the job. You know the old saying, “Rome wasn’t built in a day.” Great noses are built in day. But, it takes weeks or months for all the swelling to go down.
Now, this does not mean that the nose looks hideous or is unattractive. Typically within seven to 10 days, the nose looks very good. But it continues to get better. It ripens like wine. Swelling goes down. Refinement sets in. The nose becomes thinner and more delicate, less bulbous. But all this takes place a tiny bit each day.
Patients, while told ahead of time that it takes weeks and up to a couple months for the appearance to optimize, often become impatient and ask, “What’s wrong? Why is my nose still swollen?” or “What can be done to make the swelling go away?” We have to be frank and say to them that we cannot push nature beyond its speed any more than human beings can run faster than the fastest runner can run, or make corn grow six feet in one week. There are certain limitations that nature imposes on all things human.
However, if the cosmetic plastic surgeon reminds the patient that the outcome will be better than it appears at a week or a month or two months or three months, then hopefully, the patient — and family – will accept that.
Just this week, one of our cosmetic nasal plastic surgery (rhinoplasty) patients came in. Prior to surgery, she was an otherwise attractive young lady but had a crooked nose that was bulbous, had a bump. Too big for her delicate face. Further, it was turned down such that every time she smiled, her nose almost hit her lip. The crookedness implied internal blockage and indeed she had trouble breathing because of a deviated septum and enlarged turbinates. To make matters generally worse, she had some facial asymmetries, which were also mirrored in the nose. That was another reason why it looked crooked. Not the simplest of cases, right?
Nonetheless, the prospects for success were very good when we took on the case in June of 2009.
The case went very well. “Mission accomplished.” We straightened the nose, corrected the asymmetry, took off the bump, narrowed the tip. We raised the tip from the lip and prevented the nose from plunging with every smile. But the nose was swollen in the first week or two — perhaps a bit more than the average — but that reflected how much work was done. But after the second week, things got better and three weeks later, she was looking quite decent and could now appreciate the improvement.
Unfortunately, the patient and her parents were a bit anxious and somewhat unrealistic about what it would take nature to deliver the final result. I kept assuring them that everything was on course, that things were getting better and not worse, and that nature would finish the job by adding additional refinements as the swelling was reduced. At six months, the nose looked terrific, but I knew it would look better even after a longer period of time. Now in this case, understand that because the patient has thick skin and such extensive surgery, the complete healing period was somewhat prolonged.
When she came in this week, it was 13 months after the surgery. She looked fantastic. Extremely happy. Now, a beautiful woman. Since the last visit, the nose had improved significantly over a period of months as predicted. Yes, it took nearly a year which is not typical (usually it is three to six months for optimization), but that’s what it took for this particular young lady’s nose. We had no control over nature. But, we had trust.
The important thing is to remember that once the result was in, this teenager has it for the rest of her life. Yes, it takes some patience and fortitude to ride out the reduction of swelling and the further improvement. But when you think while it took longer than usual, one year, compare that to the lifetime of pleasure that now follows. Maybe that wait wasn’t quite so long.
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