Frequently Asked Questions


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Q: What do the terms rhinoplasty, septoplasty and septorhinoplasty mean?

A: Rhinoplasty is an operation designed to reshape the bones and cartilages of the nose in order to improve nasal appearance. Frequently, the operation involves the straightening of a deviated nasal septum (the partition between the right and left nasal passages) in order to improve breathing. This operation is known as septoplasty.
In many cases, patients require both septoplasty and rhinoplasty. In these cases, the procedure is known as septorhinoplasty.

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Q: If I have trouble breathing, will provincial health insurance pay for my rhinoplasty?

A: Unfortunately, it takes as long to perform a septorhinoplasty as it does to perform septoplasty and rhinoplasty sequentially. While fees may be submitted to provincial health insurance plans to cover the costs associated with the correction of nasal airway obstruction, these fees do not offset those required from the patient in order to cover the cost of associated cosmetic work.

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Q: Am I entitled to sick leave benefits after rhinoplasty?

A: Most employment plans will not cover sick leave associated with cosmetic surgery when performed as a stand-alone procedure. If you are undergoing a septorhinoplasty procedure, however, you would be entitled to the same duration of sick benefits (usually 2 weeks) as if you had undergone septoplasty alone. In other words, your decision to have additional cosmetic work performed concurrently with septoplasty does not restrict or reduce your right to claim insurance benefits.

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Q: Who performs septorhinoplasty?

A: Septorhinoplasty can be performed by any qualified facial plastic surgeon (either general plastic surgery or otolaryngology, head and neck / facial plastic surgery).

The Royal College of Surgeons of Canada is the only recognized credentialing body and governing organization for surgeons in this country and your surgeon should have the FRCSC designation which is only available to those surgeons that have completed the requisite training and passed certification examinations. While some surgeons will try to use other voluntary organizations or boards to give the appearance of extra qualifications, credentials or training, we suggest caution when interpreting these other designations.

Unfortunately, rhinoplasty is probably performed more inconsistently and poorly than any other plastic procedure. It requires a degree of expertise and experience that is typically found only in surgeons who make this the focus of their surgical careers. Surgeons who perform only occasional rhinoplasties tend to have less desirable and less predictable results. Unfortunately, once cartilage has been altered or removed, subsequent correction (revision rhinoplasty) can be quite difficult. At the Toronto Rhinoplasty Clinic, we have devoted ourselves to perfecting the art of rhinoplasty.

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Q: Do I need to worry about anything other than the way my nose looks?

A: Yes. Many surgeons try to sell their patients on the benefits of enhancing their nasal appearance. The nose, however, is a physiologically important component of the upper respiratory tract. In addition to providing an unobstructed conduit for the passage of oxygen, the nose both humidifies air and filters its particles and pollutants. At the Toronto Rhinoplasty Clinic, we believe that any surgeon offering septorhinoplasty should be skilled in preserving nasal function (in addition to improving nasal appearance). Unfortunately, this is not always the case.

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Q: Are there different ways in which rhinoplasty is performed?

A: Most of the Toronto Rhinoplasty Clinic's patients undergo 'endonasal' or 'closed' procedures meaning that no cuts are made on the nasal skin and that there are no visible scars.

Very rarely, an 'open' or'external approach' rhinoplasty is required - usually in association with complex revision cases. This procedure involves making a small zig-zag cut on the skin between the nostrils at the base of the nose which leaves a nearly invisible scar.

Regardless of the approach used, cuts are made in the nasal bones and cartilages to give the desired cosmetic appearance.

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Q: Why does the Toronto Rhinoplasty Clinic preferred 'closed rhinoplasty'?

A: While most patients are focused on the scar that results from open rhinoplasty, this incision usually heals nearly invisibly. We prefer to avoid external rhinoplasty, however, because the excessive soft tissue dissection required in these cases can result in greater variability in the healing process which can lead to an increase in the need for touch-up (revision) procedures.

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Q: What is a 'revision rate'?

A: Occasionally, noses do not heal in the intended fashion. For example, there might be a small, palpable bump where bone cuts are made or the tip may settle a millimeter or two back from the desired level. In these cases, a revision procedure is required and will usually be performed no earlier than one year from the initial operation. The percentage of cases that a surgeon needs to revise is their 'revision rate'. Revision rates vary from surgeon to surgeon - anywhere from a few percent to forty percent. As no surgeon can completely control how human tissues heal, any surgeon that says they don't revise noses is clearly willing to accept suboptimal results in some of their patients.

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Q: What is your revision rate?

A: At the Toronto Rhinoplasty Clinic, our revision rate is between 1 and 4% on a yearly basis. Touch-up procedures are generally done for very minor variations in healing. While we will never charge you for a revision procedure, you will have to wait at least one year from the initial procedure in order for healing to be complete.

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Q: What type of anesthetic is used?

A: Most of the Toronto Rhinoplasty Clinic's patients have their procedure performed under a light general anesthetic. The case is performed as day-surgery, meaning that you arrive and go home on the same day as your operation.

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Q: Why is it important for my surgeon to have expertise and long-term experience in rhinoplasty?

A: In general, one wants their surgeon to be experienced in any procedure that they are providing. This is particularly true, however, in rhinoplasty. As you age, your nose changes with time. Most children have tiny, turned-up noses and most seniors have ptotic (down-turned) nasal tips. This occurs because the nasal cartilage loses strength and elasticity with age. Some surgeons utilize aggressive cartilage-removing procedures to get quick, dramatic results. These "quick fixes" can lead to problems down the road when weakened cartilages can no longer support the nasal tip and airway collapse results in severe nasal obstruction. At the Toronto Rhinoplasty Clinic, we are experts in nasal airway physiology and will not compromise long-term results for short-term gain.

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Q: How long will it take me to recover from rhinoplasty?

A: Most patients have light gauze packing in their nose for one to two days following surgery. Packing serves to minimize bleeding and also acts to hold structures in place during the initial healing period. Many patients will also have silastic (surgical grade plastic) stents placed in the nose. These act like an internal cast and are removed eight days postoperatively. The nose is quite stuffy for two weeks after surgery, until most of the internal swelling has subsided. Nasal discomfort is usually mild and is present for two to three days. Strong pain-killers are prescribed for all patients. Externally, patients wear a cast for eight days. Nasal swelling and bruising around the eyes are present for up to two weeks but bruising can typically be camouflaged by makeup after about a week. While some patients will return to school or work within three to four days, many patients take two weeks to recover. At that point, most friends and colleagues will not even recognize that a surgical procedure has been performed.

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Q: Are there any post-operative restrictions?

A: We generally recommend that patients rest and keep their head elevated for a few days after surgery. Patients should avoid nose blowing until the cast and stents are removed. Light exercise such as walking is acceptable for two weeks and more vigorous exercise can be started at that point. We caution strongly against contact sports for a minimum of two months following surgery so as to prevent any injury to the nose while in a weakened state. While some surgeons caution against wearing glasses following surgery, we have not experienced any real problems from patients wearing corrective lenses when needed. If possible, avoid wearing such things as heavy, over-sized sunglasses that may place excessive pressure on the nasal bridge.

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Q: Where will the surgery be performed?

A: Most surgery is performed in an acute care general hospital as this is the safest place in which to have any type of surgical procedure. Since many septorhinoplasty procedures are partly covered by government insurance for the airway component, it is also less expensive for the patient to have their procedure performed in a general hospital. If the procedure is strictly cosmetic or, if the patient desires, surgery can be performed in a private operating room.

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Q: How do you ensure confidentiality?

A: All medical records are strictly confidential and are treated with the utmost respect. They can only be accessed by you or others with your written consent.

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Q: Can I see before and after photos of your other patients?

A: While we do take before and after photos of all of our patients, we do not share these photos with other, prospective patients. Photo-sharing constitutes a gross breach of physician-patient confidentiality which is the cornerstone of medical ethics and taught on the very first day of medical school.

Can you imagine asking a cancer surgeon to open the files of their patients so that you could review those results?

It simply would not be permitted. At the Toronto Rhinoplasty Clinic, we treat cosmetic surgery with that same degree of respect and discretion. Accordingly, your pre / post photos will NEVER be shown to another patient and will NEVER be used for advertising or on this website. To that end, we do have a number of very high profile patients that come to us, in part, because of our privacy policy.

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Q: If I can't see before and after photos, how can I tell if a surgeon's results are good?

A: Viewing photos of a surgeon's work really only provides a very false sense of security. Those surgeons that choose to show these photos are usually not showing all of their work - rather, only the best results and from the most flattering of angles. At most, a patient could ascertain that such a surgeon has had some good results (assuming that the images had not been digitally altered) but not the proportion of good results nor the longevity of those outcomes (which are, by far, the more important parameters of success). The Toronto Rhinoplasty Clinic goes further to caution patients about seeking treatment from any physician that is willing to overlook fundamental principles of medical ethics (confidentiality) in favour of their own marketing initiatives (in this case, photo-sharing).

The best way to find out if a surgeon is right for you is to talk to them.
Find out: How long have they been doing this work? How many cases do they perform? Do they specialize in rhinoplasty? What is their revision rate? Do they understand what it takes to make you both breathe well and look good? What do they recommend for your nose and why?

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Q: Can you put my picture on a computer and show what my nose will look like?

A: The use of 'morphing software', as it is called, is generally viewed as unethical. These programs are nothing more than marketing tools designed to convince patients to book surgery based on the promise of a perceived outcome. Unfortunately, these programs often lead to very unrealistic expectations and patients are frequently unhappy that their actual results don't match those shown in the images.

At the Toronto Rhinoplasty Clinic, we are not trying to sell you on an operation. Rather, we have a realistic discussion that includes such elements as your own particular nasal anatomy, the goals of rhinoplasty and the techniques to be utilized. We would rather that you not book an operation with us than be unhappy that we did not deliver a promised result.

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Q: How much does rhinoplasty cost?

A: In most cases, primary rhinoplasty (that is, first time surgery) costs $5699.00. If you have had failed surgery by another surgeon, the price is $6599.00 as these cases usually demand significantly more time and have less predictable outcomes. We accept all forms of payment.

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Q: Do you charge for the consultation?

A: We do charge $140 for our consultations as these appointments take about an hour and include pre-operative imaging. This is not an additional fee, however. Rather, it is deducted from our standard surgical fees on booking of the procedure.

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Q: Are there any hidden fees?

A: No. Our price is inclusive of all consultation, surgical, anaesthesia, hospital facility and follow-up appointment fees. Other small costs may include such things as prescriptions for pain medicine, gauze dressings, etc.

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Q: Are monthly payment plans available?

A: Financing is available through one of two cosmetic medical financing companies - Medicard and Credit Medical. While these companies offer exceedingly simple application procedures and approve the vast majority of applicants within a couple of days, we generally discourage our patients from financing cosmetic surgical procedures, particularly if doing so will impose any financial hardship.

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Q: Are there any risks?

A: There is no such thing as a risk-free operation anywhere on the body (for that matter, even driving to the hospital that day carries with it some degree of risk). Fortunately, the risks of rhinoplasty are quite low as this operation is typically performed electively and on young and healthy individuals.

When surgeons discuss any type of surgery with patients, they are obligated legally and ethically to disclose two types of risks: common risks and serious risks.

The only common risk of rhinoplasty is that you may be unhappy with either the aesthetic or functional outcome. While we certainly won't let patients leave the operating room until we are 100% satisfied with the results, we cannot entirely control for the way that human tissues will heal. It is this variability in the healing process that leads to the need for revision or touch-up procedures. Usually, issues that need to be revised are quite minor and, even prior to revision, patients are quite happy with the results of the initial procedure. Rest assured that our surgeons' expertise and experience minimize these risks and that their devotion to their patients and their specialty is second to none.

Serious risks are exceedingly rare and include things like severe nasal bleeding, nasal scars, loss of smell, chronic nasal pain and septal perforation.

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Q: What are grafts and how are they used?

A: Grafts are strips of cartilage, bone or foreign material (e.g. Gortex) that are placed in order to help contour the nose or aid in supporting the nasal skeleton. Cartilage (the most commonly used material) is usually harvested from within the nose as part of the already planned operation and no additional cuts are necessary. It is occasionally necessary, however, to look elsewhere for more cartilage (typically, in revision surgery). In these cases, cartilage can be taken from the ear through an incision made on the back side (this does not disfigure or scar the ear). At the Toronto Rhinoplasty Clinic, we do not favour the use of foreign materials as these have a propensity for infection and extrusion. Foreign materials will never be used unless you consent to their use ahead of time.

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Q: How long will it take for me to see the results?

A: Patients will see 80-90% of the final result two weeks after surgery. More subtle changes, such as those involving the nasal tip, however, can take up to a year to be fully evident. In patients with very thick skin, nasal refinement can occur even more slowly. Also remember that the nose is a dynamic organ which changes throughout your entire life. The changes incurred in rhinoplasty surgery will affect the appearance of your nose at every stage of life.

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Q: How old do I have to be in order to have a rhinoplasty procedure?

A: At the Toronto Rhinoplasty Clinic, we will not consider rhinoplasty on anyone under 16 years of age except in exceptional circumstances such as in cases of trauma or severe nasal airway obstruction. While there is no medical or surgical contra-indication to performing rhinoplasty procedures at a younger age, we do believe that these procedures require some degree of emotional maturity and that the decision to have a cosmetic surgical procedure requires a well defined sense of body image that is usually lacking in younger patients. In patients under 17, we do require parental support in most cases.

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Q: How long does it take to get an appointment for consultation?

A: We always strive to offer patients an appointment for consultation within a week. If that means staying late and seeing patients in the evening, we'll do it. At the Toronto Rhinoplasty Clinic, we recognize that your giving us the opportunity to address your nasal concerns is our greatest privilege and we will work diligently to earn your trust

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Q: How long does it take to schedule surgery?

A: The answer to this question is a little more difficult because operating room availability is a finite resource and the demand for our services does have some seasonal variation. In general, our surgical waiting list runs at about three months but, in almost all cases, we can accommodate patients within a few weeks should they have more pressing time constraints.

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Q: I am and American citizen and live in the United States. Can I come to Toronto for my rhinoplasty?

A: Unfortunately, insurance regulations prohibit Canadian surgeons from performing anything but emergency surgery on non-Canadian citizens or residents. Canadian citizens living in the United States and abroad, however, would still be eligible to have their procedure done here.

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Q: I live in another province. How do I arrange to come to Toronto for my rhinoplasty?

A: We do have a number of patients that come to us from out of province and there are a couple of options for those patients.

The first option is to fly in to Toronto for a detailed consultation and to return at a later date for surgery.

The second option is to book a surgical date in advance with the consultation to be performed on the day before surgery. While this option eliminates the need for a second flight, a $500 non-refundable booking deposit is required in order to secure the operating room. If either the surgeon or patient were to be uncomfortable in proceeding to surgery based on that consultation, the deposit would be forfeited as there would be insufficient time to book another patient into that operating room time slot. To date, however, no patient has ever forfeited their deposit to the Toronto Rhinoplasty Clinic in this fashion.

While it is safe to fly after this procedure, we generally recommend that patients stay in Toronto for about a week following surgery or until the cast is removed.

Our staff would be happy in assisting out of town patients in arranging appropriate accommodations and transportation. Just let us know.

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Q: Do you offer concierge service?

A: Yes. For an additional fee, we will arrange limousine service, hotel accommodations and just about anything else you need to make your experience more pleasant. We'll even come to your home or hotel room to remove your nasal packing and dressings. No request is too big or too small. Please contact one of our offices for details.

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