Rhinoplasty

Rhinoplasty or Septo-rhinoplasty is an operation designed to re-shape the nose and / or improve the function of nasal respiration.

Rhinoplasty is considered one of the most technically demanding plastic surgery operations as it is such a delicate yet important structure. It is also one of my favorite operations as it’s the perfect blend of technical and artistic goals and can produce very gratifying results for patients. I routinely perform both reconstructive and cosmetic rhinoplasty in paediatric (most cleft lip and palate) and adult patients.

Common questions during consultation are:

1. Your symptoms and area of concern.

   We will extensively discuss your symptoms related to the nose or cosmetic concerns regarding the appearance of the nose. This will then guide our discussion regarding potential surgical solutions.

2. What scars will there be?

   The surgery is most often performed through an ‘open approach'. I find this technique to give by far the best exposure for performing both cosmetic and reconstructive rhinoplasty, which ranges in difficulty from simple alterations to major total nasal reconstruction in certain circumstances. There is a small incision on the columella (the strip of skin that joins the tip of the nose to the upper lip), with the rest of the incisions being placed inside the nose itself. The scars are usually extremetly difficult to see and this approach provides the exposure which is required for precise and accurate surgical alterations to the nasal framework (bone and cartilage).

   In some cases we may also need a rib cartilage graft or temporal fascia graft to get the best result, particularly if you’ve had previous surgery or very thin nasal skin.

3. Expectation of results.

   During the consultation we will spend a significant amount of time discussing the exact requirements of surgery and what you nasal shape you hope to achieve. It is essential for me to understand precisely what you wish to alter and in what way so we can achieve the best surgical result.

   I will show you a number of my pre- and post-operative results that are similar to your situation so you have a realistic expectation of what can be achieved with surgery. We do also sometimes use computer morphing to aid our discussion in terms of you would like to achieve with surgery. This can be very useful to make sure we are both “on the same page”, although actual patient results are generally more realistic.

4. Cost of surgery.

   If your nasal problem is functional, then it is likely that your medical insurance will cover the cost of surgery.

   If your nasal problem is functional and as a result of previous injury, then the total cost of any surgical treatment may be covered by ACC. You will need to have this ACC claim lodged by your GP. It can be done retrospectively if relating to an old injury. In some circumstances, ACC may also cover the cost of revision surgery if there was a problem following your initial surgery.

What to expect from Surgery

The surgery can be performed as a daycase procedure or you may prefer an overnight stay. It will usually be performed under a general anaesthetic. There will be a splint placed on the nose at the end of the operation which will be in place for one week. The sutures are generally all dissolving.

Rhinoplasty is not a painful operation and most patients are surprised at how little actual pain there is. You will however feel quite ‘stuffy' and may get some swelling and bruising around the eyes. Most of this will settle in seven to ten days.

You may anticipate returning to work in 10 to 14 days. The nose however will be delicate for 3 months and will take this time to reach maximum strength. For this reason contact sport should be avoided. Exercise may be commenced at about 2 weeks at a gentle pace, gradually building up to full activity in 6 weeks.

Summary

Rhinoplasty is a common aesthetic and reconstructive procedure and has a very high patient satisfaction rate. However it is also one of the most difficult to perform well and even amongst plastic surgeon, only a subset would routinely do this procedure. For this reason, it is essential that you do your research as to who you would like to have perform the surgery for you. The most important part of the procedure is the preoperative consultation so a precise understanding of the patient's wishes and limitations of surgery can be communicated.