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    Day Of Surgery

    Pre-Operative Marking  

    Prior to your surgery, you will have the opportunity to speak with Dr Motykie about any part of your surgical procedure and/or recovery process. You will be asked to change into a surgical gown and Dr Motykie will place surgical markings on your nose. Lastly, wear loose fitting clothing the day of your surgery that is easy to get in and out of such as sweat pants and a shirt that zippers in the front.

    Anesthesia and Operating Facility

    For almost all rhinoplasty techniques you most likely receive general anesthesia (you are asleep) for your own personal comfort, safety and surgical ease.  It is Dr Motykie’s opinion that the most effective way to perform rhinoplasty surgery is under general anesthesia because it allows for focused surgeon concentration and superior patient safety and comfort. In addition, general anesthesia allows for injection of less local anesthetic (numbing solution) which has the potential of obscuring the fine detail work that is needed to perform a detail-oriented artistically-based rhinoplasty surgery.

    Dr. Motykie uses only Board Certified Anesthesiologists to administer anesthesia and monitor your safety during your surgery. You may be given medication before reaching the operating room so you will feel relaxed before surgery. The surgery takes approximately three to four hours to perform in its entirety. Every surgery is performed in a fully accredited, state of the art (AAAASF) surgical facility where your safety, comfort and privacy are of the utmost importance.   Deep vein thrombosis (blood clots) precautions are taken with every patient and include a minimum of anti-embolic stockings and sequential compression devices (SCDs) on the lower extremities during the entire length of your procedure.


    In general there are only two major techniques used to perform a rhinoplasty by most plastic surgeons today: a closed rhinoplasty and an open rhinoplasty. Dr Motykie is able to perform your rhinoplasty using either technique and he can therefore customize your surgery by choosing the best technique to perform in your own, unique individual case.

    In the open approach to rhinoplasty, an incision is made on the outside of your nose along the base of the columella (the hanging lower, middle portion of your nose that separates the nostrils). The skin of the nose is then raised and the underlying supportive framework of bone and cartilage is reshaped in order to achieve the desired contour of the nose. Once the nose has been sculpted to its final shape, the skin is re-draped over the new framework. When the surgery is complete, a splint will be applied to help the nose maintain its new shape during the healing process.

    Dr Motykie prefers to perform his rhinoplasty surgeries utilizing the more advanced closed technique since it delivers superior results, no visible scarring on the nose and quicker overall healing. In the closed approach to rhinoplasty, all of the incisions used to perform the surgery are confined to the inside of the nose. This is often referred to as the “invisible” approach to rhinoplasty because it results in no visible scarring on the nose. During this technique the skin of the nose is also separated from its supporting framework of bone and cartilage in order to sculpt it into its final desired shape. At the end of the surgery the skin is gently laid over the new nasal framework since it was never entirely lifted in the first place. This is important because an experienced plastic surgeon realizes that it is better to not destroy and/or distort as much of the natural architecture of the nose as possible so that there is less room for swelling, scarring and complications after surgery. In addition, there is less interruption of the nerves and blood vessels of the nose that allows for a safer procedure, quicker healing and a faster return of normal sensation to the nose.  The predictability of the surgical result also increases significantly since there is less room for error and less post-operatives swelling that can potentially lead to warping, deformities, asymmetries and crookedness of the final nose during the healing process.

    A successful rhinoplasty procedure depends on the surgeon’s artistic ability to achieve the correct shape, balance and proportion of the nose which is the essence of the closed approach rather than the open approach that focuses on the internal anatomy of the nose and not its overall natural beauty and aesthetics. The nose does not need to be “broken” in every case but it is typically done in order to narrow the width of the nose or straighten a crooked nose.   Since the nose is shaped like a pyramid, it may also need to be broken when a large bump is removed in order to make sure the bridge of the nose does not “flatten out” or become too wide after surgery. The nasal passages and breathing are evaluated in every case. If any surgery to improve breathing is necessary, Dr Motykie will perform it prior to finishing the aesthetic work on the nose.  When the procedure calls for the narrowing of flared nostrils, small incisions are placed at the base of the nose that fade away with time and are typically not visible after they are completely healed. After the surgery is complete, a splint will be applied to the outside of the nose to help maintain its shape during the first week of healing after surgery. Rarely packing will be placed inside of the nostrils (only in the case where major breathing work was performed).

    Recovery Room  

    After surgery you will be brought to the recovery area where you will be allowed to rest and completely recover from anesthesia. Nurses will be on staff by your bedside to make sure you are recovering properly as well as being able to provide you with pain medications and small amounts of water and/or ice chips while you are becoming more awake and alert. After you have fully recovered from anesthesia, you may be released to home with a responsible adult or you may choose to stay overnight in an outpatient recovery retreat where there are nurses on staff 24hrs to assist you with post-operative care and medications.

    The most comfortable position to recover in after surgery is a reclining chair with your head elevated.  Over the first night you will most likely find yourself having to use the bathroom frequently. This is normal and is due to the intravenous fluids you received during your surgical procedure. Leave all dressings intact until the next morning when you will return to Dr Motykie’s office to have your dressings changed and receive further instruction for the rest of the week. The night following your surgery, you may experience some pain and discomfort that can be controlled with your prescribed pain medication. The majority of the sutures used during your surgery will be dissolvable and they will be covered by surgical tape that should be left in place for the first week after your surgery.

    To find out more about nose surgery please contact us at 310-246-2355

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