What will rhinoseptoplasty do to improve my nose?

....AND MORE

HOW DO I KNOW IF MY BLOCKED NOSE IS A PROBLEM?

  • If you feel your blocked nose is lowering your quality of life, it can be improved

We ask the following questions:

  • Do you suffer from nasal congestion or stuffiness?

  • Do you suffer nasal blockage or obstruction

  • Do you have trouble breathing through your nose?

  • Do you have trouble sleeping or snoring?

  • Do you have trouble with exercise because of your nose?

  • If these sound like problems you have, then it is worth beginning treatments to improve your situation.

  • This does not always require surgery.

When is the appearance of my nose a problem?

  • A very big or very bent nose may be obvious to all, and may be a defining feature for the person

  • Other concerns are more subtle, and quite subjective but can cause distress to the patient

  • Before considering rhinoplasty surgery, the specific cosmetic and functional concerns must be very well defined, and understood between your surgeon and you.

  • Changing the appearance of the nose is not to be undertaken lightly.

  • Once you have decided that rhinoplasty is for you, you should be able to agree with your surgeon on a checklist of objective issues that you would like to address.

     FOR EXAMPLE:

  1. Improve left nasal blockage

  2. Make nose smaller

  3. Improve external bend

  4. Improve profile

  5. Refine nasal tip

  • This approach in planning is far more useful than computer modelling, which in most cases does little to help patients understand what they can really expect after surgery.

  • When the surgery addresses the issues on the checklist, the result will be a dramatic improvement in nasal function and appearance, giving a balanced and natural result.

  • Dr Smith has an extensive experience in rhinoplasty surgery, an has operated on almost every conceivable type of nose.

  • He will be able to show you pre and postoperative photos of a case just like yours, so that you know what you can expect.

What is an ideal nose?

  • When we look at people from show business and the world of celebrity, we often see obvious evidence of rhinoplasty.

  • Whilst these people are usually very attractive, it is a mistake to think that it is because of their nose. Despite this, many people would like to achieve a similar nasal appearance.

  • The unnatural, post-surgical nose will often carry a “signature appearance”, being recognisable as the work of a particular surgeon.

  • These “nose-jobs” will go out of fashion as the stars of the moment disappear from the front pages.

  • Some stars and celebrities have had rhinoplasty, which even the most trained eye cannot easily detect.

  • These noses will never go out of fashion.

They are:

               well proportioned

               straight

               symmetrical

               smooth…

                                            and

                                       ...have clear airways

  • These ideal noses are really quite unremarkable, even average in appearance, and what we notice is the person’s eyes.

  • Well-planned and well-performed rhinoplasty will give this result.

What is the assessment process for rhinoplasty?

  • Most patients that we see for these issues will already have a clear idea that they would like a rhinoplasty.

  • In some cases, patients present with mainly breathing concerns. On reflection they may identify things about the nasal appearance they would like to change, whilst improving the airway.

  • It is often possible to improve the nasal airway without out doing anything to the outside of the nose.

  • In the most severe cases of nasal deformity, the external shape must be changed to give a good airway

History

  • Dr Smith will spend time documenting the issues that worry you about your nose in terms of function and appearance

  • A history of other related “sinus”, allergy and ENT symptoms will be gathered.

  • We will identify what treatments have been undertaken to this point, and what effect they have had.

  • We discuss the degree to which you feel your nose impacts your quality of life.

  • A general medical history is taken.

Examination

  • A detailed inspection of the inside outside of the nose.

  • A detailed internal nasal examination including flexible nasal endoscopy.

flexible nasal endoscopy

  • A local anesthetic spray with decongestant is applied to the nose.

  • A fine endoscopic tube, usually with a camera attachment, is used.

  • Sinusitis, and potential causes of blockage at the back of the nose can be diagnosed.

  • The spray (COPHENYLCAINE)has a slightly unpleasant, bitter taste.

  • The mouth and throat are numb for about half an hour.

  • There is usually no other discomfort associated.

PHOTO Documentation         

  • Standard photography is taken from multiple views

  • The views are: Front>profile (left and right)>oblique (left and right)> high basal>low basal

  • Dynamic photos (eg smiling, deep nasal inspiration) are often taken

  • The photos are essential to discuss what we can expect after surgery, and to document changes after surgery has been performed

  • Rather than computer modelling which has little relevance in understanding the probable outcome of surgery, Dr Smith likes to :

  1. make a checklist of the issues we can both see with the nose, and to discuss how these can be corrected

  2. find an example of someone who has previously had rhinoplasty with a similar nose to yours, and show the postoperative results

  • Dr Smith has extensive experience in rhinoseptoplasty, and has operated on virtually every possible kind of nose, so it is likely that we can find archived treatment records of a nose just like yours.

  • We ask our patients for consent to use their photographs for the purpose of educating other patients and/ or for use on our website, and for teaching other health professionals and students.

  • Most patients are very happy for this, but some may elect not to consent. There is no pressure, and consent for use of the photos can be withdrawn at any time

Further investigation

  • Low radiation CT scan is usually undertaken. This allows us to definitively exclude deeper causes of nasal obstruction. It also gives a great aid for explaining structural airway issues, and how they can be addressed.

  • A referral for a blood test for allergy/ hayfever (RAST) is often made.

HOW CAN I ARRANGE RHINOPLASTY SURGERY?

  • This surgery should only be undertaken when you feel that you fully understand the issues and the surgical techniques to correct them.

  • It is unusual to book surgery at the first consultation- we will have a detailed discussion about the relevant issues at that stage.

  • It takes time to digest this information, and there are often further results which we are awaiting (eg CT scan).

  • It is important to reflect and to discuss with close family members (parents/ partners) and friends.

  • Clearly, this is never an urgent operation, and so you should never feel rushed when making a decision to have surgery.

  • When you have decided to go ahead, Dr Smith can give a booking form for a local hospital (Kareena or St George Private Hospital are the main locations).

  • Simone or Nardine (our practice mangers) can give a detailed breakdown of expected costs

Is rhinoplasty covered by my private health fund?

  • Depending on your level of coverage, your health fund is likely to cover hospital expenses, and a proportion of surgical and anaesthetic fees as long as it can be demonstrated that the surgery is largely for functional (breathing) issues, and not primarily cosmetic reasons.

  • Medicare will also contribute a portion of the fees in this circumstance.

  • There will be out of pocket expenses, which can be reliably predicted with the help of our office staff.

  • If the rhinoplasty is primarily cosmetic, the fund will not cover any of the costs, and the entire process including hospital expenses will need to be covered in full by the patient

How much does a rhinoplasty cost?

  • This is a technically challenging operation, usually taking several hours (or more) to ensure the best results.

  • A good result is evident from the earliest postoperative days, and once the patient is recovered they scarcely think about their nose again.

  • A poor result can have devastating consequences for the patient’s physical and emotional wellbeing, and require ongoing treatment, despite which the nose may never be quite right.

  • Our fees reflect Dr Smith’s expertise, and consistently demonstrated good results, whilst trying to remain reasonable for our typical patients.

  • There are many surgeons in Sydney who are much more expensive. Whilst some of them are very skilled, this is not always the case. Often, very high prices are determined by factors other than the expertise of the surgeon or the expected quality of the treatment experience.

  • If you are interested in a quote for rhinoplasty, feel free to contact Simone or Nardine in our office. It is impossible to exactly determine costs without seeing you in person, but it is likely to give a fairly accurate guide

Should I have my rhinoplasty with an ENT surgeon or a plastic surgeon?

  • The most important thing is that your surgeon can demonstrate their rhinoplasty experience and ability to address both function and appearance of the nose, whether they be an ENT or a plastic surgeon.

  • ENT surgeons have core training in functional nasal surgery and treatment of sinusitis. Cosmetic rhinoplasty is very well taught within the ENT subspecialty of facial plastic surgery.

  • Dr Smith has extensive training and experience in functional and cosmetic nasal surgery, and performs rhinoplasty surgery on a frequent basis.

  • He is able to definitively treat your nose, regardless of the contributing factors.

  • Dr Smith also has extensive experience in revision rhinoplasty, improving the nose after unsuccessful surgery by other practitioners.

Can I have my rhinoplasty in the Sutherland Shire, or Kogarah areas?

  • If you live in the Sutherland Shire or St George areas, it is not necessary to leave the area for high quality rhinoplasty, as there are several very accomplished rhinoplasty surgeons locally.

  • Dr Smith is able to see you in a local practice and operate in either Kareena, or St George Private Hospitals.

Surgery and postoperative

  • The surgery is performed under general anaesthetic.

  • Rhinoplasty is usually combined with Inferior Turbinoplasty to get the best possible airway.

  • An overnight stay in hospital is usually necessary.

  • There is a small cut, repaired with very fine sutures of the collumella.

  • There is an external nasal splint for the first 7-10 days (protecting the nose while it heals)

Photo, showing External splint, and stitches

Photo, showing External splint, and stitches

  • There may be some swelling or bruising around the eyes, and this may increase for several days postoperatively. Severe bruising is unusual

  • The nose is completely blocked for a few days after surgery with a dissolving nasal pack (NASOPORE), which is suctioned out usually 3-4 days postoperatively, after spraying local anaesthetic in the nose.

  • At this stage the nose is usually a lot clearer than most patients can remember.

  • The next review is at 7-10 days after surgery, at which point the stitches are removed, and the external splint removed.

  • If all is well (which is usual) the next review is at about 1 month, and then there are reviews at 6 and 12 months

  • All postoperative reviews are either no charge (first 6 weeks), or bulk-billed so there is no further out of pocket expense.

  • Pain is usually not severe, and is well controlled with a combination of

                               PARACETAMOL+IBUPROFEN+/- ENDONE

What are the risks of rhinoplasty?

The risks include:

  • general anaesthetic

  • postoperative bleeding requiring further treatment, and rarely blood transfusion.

  • haematoma or infection

  • unsatisfactory functional or cosmetic result.

  • chronic nasal infection

  • septal perforation (a hole between the two sides of the nose)

  • rare loss of sense of smell

 

  • At the time of booking any surgery, we have a more detailed discussion about risks and benefits

  • I provide appropriate printed information issued by the Royal Australasian College of Surgeons and will answer any questions that you or your family may have

How long will I need off work after rhinoplasty?

  • This depends on the nature of your work.

  • If you have a very physical job, you will need two weeks off work.

  • If your job is sedentary or office based, it is likely that you could be back to work within a week (if you feel well enough, and have the desire).

  • For all patients, I recommend having 2 weeks of leave available for a worse case scenario.

  • If you get back to work prior to 2 weeks, we consider it a bonus.

  • If you are relying on an early return to work, it can cause unnecessary extra stress if there is any delay in recovery

How long until I can play sport after rhinoplasty?

  • I recommend 3 weeks off heavy physical exertion, to reduce the risk of postoperative bleeding.

  • A gradual reintroduction to physical exercise can occur at about the one week mark if you feel well enough.

  • Contact sports should be avoided for 6 weeks postoperatively, as the nose will not be fully stable until that time

How long until I can travel/ fly after rhinoplasty?

  • You should not travel or undertake long flights for 4 weeks after surgery

How long does it take the swelling to go down after rhinoplasty surgery?

  • The nose often looks very swollen when the external splint comes off.

  • Even with this swelling, it should be possible to see a significant improvement in appearance at this stage.

  • The majority of the swelling will go down in the first few weeks, but complete resolution can take 6 months to 2 years.

  • The nose should look slightly swollen or bulky at the beginning of recovery, otherwise it is possible that the nose has been made too small at the time of surgery, or that it hasn’t been adequately reconstructed. This means that the long term result could be skeletal and obviously postsurgical.

What if there is a problem with the result of surgery?

  • It is very unusual to have significant nasal obstruction after well planned, and well performed rhinoplasty surgery

  • Even with well-performed surgery there are occasionally issues with the appearance or function of the nose; fortunately these are usually easy to fix.

  • If necessary, Dr Smith will undertake ongoing treatments without any further surgical out of pocket expenses.

POSTOPERATIVE INSTRUCTIONS AFTER RHINOSEPTOPLASTY AND TURBINOPLASTY

HOSPITAL STAY

  • This procedure will usually require an overnight stay.

RECOVERY

  • There may be significant postoperative swelling and bruising around the eyes.

  • A metallic external nasal splint will be applied at the completion of surgery, and will usually stay in place for the first week.

  • If the splint falls off prior to this, it can be replaced and held in place with a medical tape such as Micropore.

  • Fine stitches under the nose (the collumella) will be removed at about 1 week.

  • The nose will usually feel entirely blocked for several days postoperatively.

  • In most cases, the nose will feel quite clear following the first postoperative review, at which point dissolving packing material and blood clot is suctioned from the nose.

TIME OFF WORK

  • Up to 2 weeks time off MAY be required, and it is best to have an arrangement for this when planning surgery.

  • For people who have a relatively sedentary occupation, earlier return to work may be possible, it they feel well enough and there is minimal bleeding.

  • Heavy physical exertion or travel should not be undertaken for 3 weeks following the day of surgery.

PAIN RELIEF

(1) Regular paracetamol 1g 4X a day

(2) Non steroidal antiinflamatory- eg CELEBREX  200mg 2 Xday

(3) Breakthrough endone (5mg up to every 4 hours) - a script for this will usually be given

  • The nose is swollen, and is usually tender.

  • There may also be headache.

  • Should your pain be poorly controlled with the prescribed medication,  please notify our office.

  • The first step is to ensure that there is nothing out of the ordinary, such as an infection.

  • Following this, the pain regime may be boosted.

SINUS/ NASAL WASH

  • Unless you have been instructed otherwise, vigorous nasal saline irrigation and nose blowing can commence on the first postoperative day.

  • It may be hard to get the wash into the nose at first, but if rinsing is tolerated, it will start to clear the nose, and will make cleaning out the nose a lot more comfortable at the first postoperative visit.

  • Hold off rinsing the nose if it is comfortable, or if there is significant bleeding.

PRODUCTS TO CLEAN THE NOSE

  • SINUS RINSE, FLO or equivalent preparations may be purchased from the pharmacy.

  • If these are too vigorous, gentler preparations include NEILMED NASAMIST, FESS SINUCLEANSE AND STERIMAR.

  • The more salt water rinsing of the nose that is undertaken, the smoother the recovery.

ANTIBIOTICS

  • It is usual to be given a script for antibiotics to be taken for 1-2 weeks postoperatively.

CARE OF THE EXTERNAL NASAL WOUND

  • It is possible to soak this area gently with a clean washer, and warm soapy water to remove crust.

  • While the wound is raw, a healing gel such as SOLUGEL, BANDAID GEL or FIRST AID GEL should be applied twice a day.

  • Once the wound is more established (after 2 weeks) a vitamin E moisturising cream may be applied

POSTOPERATIVE VISITS

  • The first postoperative visit is usually 3-4 days after surgery.

  • At this stage, the nose is suctioned, and it usually feels quite clear.

  • If you are struggling in any way, this can be brought forward in most cases.

  • The second postoperative visit is usually at 7-10 days, at which point the external stitches are removed, and the external splint taken off.

HOW LONG DOES IT TAKE FOR THE SWELLING TO GO DOWN AFTER RHINOPLASTY?

  • The nose will look very swollen, and there will likely be some bruising, even black eyes for the first week.

  • A lot of the swelling will go down between day 7 and day 14 postoperatively, but the nose will still look markedly swollen when the splint comes off at 1 week.

  • More than 90% of the swelling will have gone down by 6 months postoperatively, but it can take up to 2 years to gain the stable, long-term result.