Frequently asked question

The aim of the first consultation is to make a correct diagnosis of your external and internal nose as well as to evaluate your past medical history. Specific nose-related symptoms will be evaluated by taking a thorough history, a nasendoscopy, and performing morphological analysis of the external nose. Finally, I will take professional quality photographs of your face and nose for detailed analysis.

The first consultation is not aimed to sell a product. It cannot be free of charge as it is a very specialized consultation lasting 30’-45’ by an international rhinoplasty expert using high tech-tools in a modern, comfortable and well equipped medical office.

As each case is different, a standard cost cannot apply. Costs are related to the extent of surgery and the duration of the operation. Within the first 48-72 hours of the first consultation, a detailed quotation will be emailed to you.

As your surgeon, I will adapt my technique to match your specific anatomical findings and with respect to your wish list of desirable changes. Due to my decades of dedicated rhinoplasty surgery, I can call upon a vast array of techniques in order to safely cope with the myriad variants of nasal anatomy.
I prefer closed (endonasal) rhinoplasty for most of my patients in order to be respectful of nasal anatomy and avoid unnecessary surgical aggressiveness. In more complex cases, I use an “hybrid” closed approach that allows me to utilize techniques commonly used in the open approach (sutures, grafts) but without opening the nose. I opt for the open approach in severe malformations or in specific revision cases.

The nose is a complex structure in which form and function are intimately connected. Almost always, rhinoplasty is a septo-rhinoplasty because the septum not only plays a functional role, but also contributes to common problems of the external nose. Examples include: crooked nose, hump, drooping tip, excessive nasal length, over-projection of the nasal tip, just to name a few of the common deformities seen in my practice.
Inferior turbinates are probably the commonest cause of nasal obstruction, and their treatment is commonly associated with septo-rhinoplasty or rhinoplasty. Modern, minimally invasive endoscopic techniques allow the surgeon to manage these important structures precisely and conservatively.
Therefore, it is absolutely indispensable that your rhinoplasty surgeon possesses specialist training and substantial experience in treating problems of the internal nose.

Nasal polyposis has a highly variable presentation. Some nasal polyps require medical treatment, while others are best treated with surgery. A CT scan of the paranasal sinuses is mandatory in cases requiring surgery. Sometimes other laboratory tests like nasal cytology are also desirable. When indicated, it is technically possible to combine rhino-septoplasty and endoscopic surgery of paranasal sinuses (ESS, FESS).

Yes, I do them systematically in each single patient who has been booked for surgery. The aim of my simulations is not to sell the surgery, but to understand patient’s wishes and openly discuss with him/her the possibilities and limitations of the proposed simulation(s). At my office we don’t use trivial photo-manipulation softwares. We use a custom-made software developed with specialist engineers in the biomedical field. Our simulations represent the end product of a thorough computer analysis including relevant landmarks analyzed on professional pictures taken by myself. It is a highly specialized task requesting an assistant working closely with me. It takes between 30’ and 45’ to create the simulations for each patient.

A second specific consultation in my office is then scheduled to discuss the simulations face-to-face with the patient. Simulations are never to be considered as a guarantee of results. Simulations provide a backdrop for a frank and honest discussion about the  expected benefits and the chances of a less-than-ideal outcome.

This meticulous pre-operative planning allows me to create a “tailor-made” surgical plan where the minutest details regarding the approach, techniques and sequence of surgical steps are highlighted. Each surgical plan is individually planned, and different from patient to patient. Every rhinoplasty is a YOUnique RhinoplastyTM.

This aspect is managed by my very experienced anesthetist colleague. Prior to the operation, patients are interviewed by my anesthetist regarding their general health, past medical history, medications, and allergies. The results of certain investigations have to be communicated to the anesthetist several weeks in advance. If necessary, our clinic provides an efficient service for this purpose, at reasonable rates, 2-3 days before surgery.

I operate in the private hospital “La Madonnina”. The clinic features very high standards in technology and accommodation facilities. I prefer to perform the operation supported by an experienced anesthetist in a top-ranking clinic, equipped with high level technology, qualified personnel, and excellent accommodation. A 24-hour emergency unit also provides a safe environment that makes my international patients feel secure.
Casa di Cura “La Madonnina” is located in the city center and easily reachable by public transportation (the stop “Crocetta” on the metro line # 3 – yellow line – is less than 5 minute walking distance from the clinic).

Generally I perform rhinoplasty under general anesthesia. The patients stay overnight in the clinic. At my practice, patient’s safety is my main concern.
At times, I use local anesthesia for day-case surgery, for relatively simple “touch-ip” procedures.

The vast majority of my patients leave the clinic without nasal packing. In the rare cases where nasal packing is to be used, they are generally removed 48 hours after surgery.

Modern-day nasal packing are made by a very natural soft-material (cellulose) and they are coated by a very thin layer of soft special plastic material that makes removal minimally painful.

Many patients experience no pain or minimal discomfort, however, pain can be present in the first few days. This is generally well controlled by Paracetamol (1 to 3 grams daily). The management of the post-operative period is managed by the specialist anesthetist.

The result is already visible at the time of the removal of the external dressing, after 7 days. Of course, the nose is still swollen, and some areas will be more swollen than others. The healing process is gradual, will take time and demonstrates significant individual variations. The nose will take its final form after months, and up to one year in patients with thick, sebaceous skin with poor elasticity.

No human activity, including surgery, can ever be predicted to be 100% successful at all times. The level of success depends on the starting point, i.e. the degree of the severity to be corrected. Expert and dedicated rhinoplasty surgeons are able to deliver a high rate of success in the vast majority of their patients. However, in a modest percentage of cases, some residual defect may be visible after surgery. In some of these cases a minimal “touch-up” surgery can be indicated, at variable distance from surgery depending from the problem, in a range variable from 2 to 12 months.
Before surgery, in my case just at the time of the first consultation, every patient is systematically and repeatedly informed about the possible occurrence of adverse effects that might require further “touch-up” surgery, which is almost always, minor surgery.

Rhinoplasty can be executed in throughout the year. The prognosis is not affected by the season of the operation.

Most of the patients return home after being discharged from the clinic. They have to return to my office after 5-8 days for the first post-op control which consists of removing the external splint and a meticulous check of the internal and external nose. In certain case, it may be prudent to remain in Milano (hotel, B&B, Airbnb) for additional 24-48 hours.
Regarding flying, it is generally advisable to avoid flying for 8-10 days after surgery, but this rule is not an universal one as the decision is taken case per case depending on the typology of surgery that was performed.

Milano offers a wide range of accommodation options. Whatever location in/around the city center is adequate as public transportation is efficient. A location close to the yellow metro line would be easier (both the office and “La Madonnina” are on the metro yellow line). On the Internet there are different accommodation options according to individual budgets.

The first post-operative consultation will take place in my office 5-8 days after the operation, depending on the individual case. Further post-op visits are generally scheduled after 1, 3, 6 and 12 months, but their planning is quite flexible.

In the rare cases where a “touch-up” is deemed necessary, you will be required to only pay the clinic costs. This will be much cheaper if the surgery is performed under local anesthesia as a day-case operation inside the same clinic. No fees payable to the medical staff (surgeon, anesthetist, assistant surgeon).

Certainly yes. However, please keep in mind the photos sent via Internet do not substitute the personal pre-operative consultation that remain the cornerstone for a correct diagnosis and establish a healthy doctor-patient relationship. This is especially relevant in revision rhinoplasty as it demands a high level of technical expertise and has a significant emotional impact.

The are simple rules that each patient will find in a fact-sheet that I systematically provide to each patient, including telephone numbers for emergencies.
They are especially detailed regarding the timing of returning back to work, use of glasses, sun exposure and physical activity including sports.

Pietro PALMA Chirurgo Rinoplastica

Pietro Palma