Rhinoplasty

Rhinoplasty is considered among the most difficult operations to master and achieve consistently high standard outcomes.

This is because when we operate on the nose, we are changing the bony and cartilaginous framework by various methods, such as cutting and suturing. We then try to move the framework to a new position and get it to stabilize there. However, after the surgery and during the healing phase, which can take many months, the nose is subject to different forces which can distort the shape. These include smiling, eating, kissing, sleeping on it, and accidental trauma. To counteract these pulling and pushing forces surgeons have developed over the years “structural techniques” which use the patient’s own cartilage (usually from the nasal septum) as graft material to stabilise the framework. These techniques help to improve the stability of the nose and therefore give greater predictability and longevity to the outcomes. I use variations of these structural techniques.

Most of my patients undergoing Rhinoplasty need two weeks downtime to get over the initial surgery but the overall healing phase including swelling and refinement can take one year or more. Most patients have very little pain and not much bruising and are happy with the shape and breathing after the two weeks. I follow patients up for at least one year postop. Patients are encouraged to help with the healing process with nasal taping at night and massaging which limits swelling and helps the skin adapt to the new underlying framework. If the nose stays stable and the breathing is good after a year, then the nose is unlikely to change significantly after that due to the structural integrity of the new framework.

I am often travelling to and giving lectures at conferences around Australia and overseas and am familiar with many of the world’s best surgeons and the latest techniques. I am a member of the “International Rhinoplasty Research Society” a small group of elite rhinoplasty surgeons from around the world who meet regularly to discuss and develop new methods of nasal surgery.

It takes great experience, knowledge and attention to detail to achieve consistent great outcomes in rhinoplasty. Five particular aspects of my Rhinoplasty Practice which I feel help me to do the best for my patients are described below:

Ultrasonic bone work:

Most surgeons around the world use chisels and osteotomes to modify the bony framework. These can cause excessive bruising and damage to the bone as well as being coarse and inaccurate.
I have been using a machine called the “piezotome” which utilises high frequency ultrasound to cut and shape the nasal bones since 2015. (In fact, I am the first person in Australia to use this method). The ultrasound is way more accurate and precise and much gentler on the bones and soft tissues including the skin.

Projectometer:

Most surgeons guess or judge the new shape of the nose including the final tip position, rotation and projection and the amount of bump reduction.
The projectometer is a device which is used to measure certain points on the nose including the dorsum and the tip. Measurements are taken at the start of the case and can be rechecked at various times during the surgery. This gives greater accuracy to the final shape.

Dorsal Preservation:

Nasal “Preservation Surgery” includes a series of techniques which have become popular over the last few years aimed at causing less destruction of the nasal tissues and improving healing. In fact, these were developed and modified by very close friends of mine from the “International Rhinoplasty Research Society”.
Again, I was the first person to introduce these techniques to Australia and have been using “Dorsal Preservation” techniques since 2018 to reshape the bony and cartilaginous bridge of the nose.

Structual Tip Refinement:

Many rhinoplasty surgeons can achieve a satisfactory profile but struggle to achieve good tip refinement on the front view.
I have been developing and modifying advanced “structural tip” manoeuvres over the past few years with the aim of achieving good tip refinement and preserving or improving nasal breathing. I and my colleagues in Sydney, especially Professor Richard Harvey, are involved in ongoing research in this area and have already published several scientific papers in reputable journals.

Research and Nasal Airway Assessment:

Most surgeons do not make any measurements of nasal breathing.
In my Practice most patients undergo several breathing tests prior to surgery to measure Nasal Airflow, Resistance and Cross-sectional areas. These help to plan the surgery procedure. The tests are usually repeated at 6-12 months post op to assess the efficacy of the nasal surgery. This data is then used for ongoing research.

Expectations and Complications:

Rhinoplasty surgery aims to improve breathing and change the shape of the nose.
It can be a source of great reward to the patient and the surgeon when outcomes are good.
However, it carries considerable risks and can cause harm when not performed well.

Complications include nasal obstruction, septal perforation, deformity, bleeding, infection, scarring and pain. All my surgical techniques, risks and expectations are explained in great detail during your consultation, so you have a very good understanding of the rhinoplasty process.