I have a passion for rhinoplasty and have performed over 700 cosmetic rhinoplasties in the last 7 years.
Patient assessment
Patient assessment is probably the most important part of the rhinoplasty process. This is when I assess that the suitability for surgery, assess patient expectations and concerns and formulate an operative plan for that individual. Getting this right comes with experience and it is an area of continuing learning for any rhinoplasty surgeon. If the assessment is wrong, the outcome will be compromised, no matter how good the later surgery is from a technical point of view. I always see patients on two separate occasions before a cosmetic rhinoplasty. The reasons for this are: (1) it gives me the benefit of assessment and planning twice to check for consistency; (2) it gives me the chance to check that expectations from surgery are realistic and that patients understand the surgery fully; (3) it gives patients the chance to ask questions on the second occasion that they may have forgotten to ask on the first.I encourage patients to bring a partner/spouse/relative or friend with them.
Types of rhinoplasty
There are various different terms that can be confusing to patients-open/closed, rhinoplasty versus septorhinoplasty etc.
Open and closed approach
A closed approach is when incisions are inside the nose entirely. An open approach is when there is an incision across the skin of the columella (between the nostrils at the base of the nose) and then the incision becomes internalised. The open approach allows the surgeon to lift the skin off the nasal cartridges and bones to see this area in more detail. I use the open approach when there are issues to address with the intrinsic features of the nasal tip (using sutures, removing cartridge and/or grafting); if I need to put in a graft to strengthen the nose, help straighten the nose or increase tip projection; and often for revision surgery (where there has been a previous rhinoplasty operation). Generally, about 30% of rhinoplasties I do open; 70% closed.With the open approach, there is a scar but this is, in the vast majority of cases, this is almost invisible and is very rarely the source of any concern. There tends to be more swelling in the first 2-3 post-operative weeks compared to closed approach. There is also more of tip numbness and feeling of tip “rigidity” after an open approach- but these do resolve with time.
Rhinoplasty/septorhinoplasty
A septorhinoplasty basically refers to a rhinoplasty that involves straightening of the nasal septum (the cartilage and bone that separates the two sides of the inside of the nose- and which also forms the bridge of the nose in the mid-third of the nose). This may be necessary for nasal obstruction and/or cosmesis (i.e. if the nose is twisted).If the nose is twisted, particularly in the mid-third, this can be quite difficult to get entirely straight and sometimes grafts (using cartilage from inside the nose usually) are necessary.
Philosophy
It is vital that patients understand the limitations of rhinoplasty. My approach is that a nose after surgery should:
- Look natural
- Have no compromise in structure or function (i.e. no nasal obstruction)
- Fit with the patient’s facial structure and general appearance (height/build)
Most problems that can occur after rhinoplasty result from over-zealous surgery or inappropriate surgery. I make it clear that, for these reasons, it is prudent always to err on the side of caution and be conservative.When assessing patients, I aim to be open and honest with respect to realistic outcome and limitations. A rhinoplasty essentially involves making a patient’s nose as near to the ideal as possible. There are constraints, however, that will determine just how much improvement is possible. For example, a common problem relates to the thickness of skin around the tip of the nose in patients with bulbous tips. A tip may appear bulbous because of excessive width of the tip cartridges and/or because of skin thickness. The former is straightforward to deal with but the latter is not.
Process
Operations are carried out at the Alexandra Hospital, Cheadle. After the operation, patients will have a splint on the nose, and nasal packs inside the nose. Patients stay in hospital overnight and the internal packs are removed the following day before discharge.Patients return to see me in clinic after 6-7 days for removal of the splint (with stitches if open approach used). I then see patients after a further 6-7 weeks and then again in 6-12 months.I recommend patients use arneca tablets before the operation (1 week) and after (1-2 weeks). This reduces swelling/bruising and speeds up recovery.
Costs
Initial assessment costs £100. My secretary will give an overall price that is inclusive-surgery, consultations, anaesthetist fees and hospital fees, so that this is transparent.
Further information
Further information about rhinoplasty can be found at: http://www.entuk.org/patient_info/facial/cosmetic_