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RHINOPLASTY SYDNEY

The nose is a complex three-dimensional structure with critical structural and functional roles, which, by virtue of its position, serves as the central component of the face. Its relationship to surrounding structures is in part responsible for a harmonious, pleasing visage as a whole. 

Functionally, the nose provides an airway and acts to warm, filter and humidify air passing through it. Noses that deviate from ideal structural proportions – whether subtle variations of normal or more dramatic post-traumatic or neoplastic deformities – have motivated rhinoplasty surgeons since ancient India 800 B.C.E.

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A SIMPLE WAY TO THINK OF THE NOSE


A simple way to understand the nose is to think of it as a tent. This tent is divided into three parts. The upper third, the middle third and the lower third. It is pitched and given structural support by bone in the upper third, bone and cartilage in the middle third and cartilage only in the lower third. 

The lining of the nose is modified hair bearing skin at the nostrils and transitions to mucosa superior early. The purpose of this part of the mucosa is to humidify the air destined for the lungs. The lung alveoli need humidified warm air before they can extract oxygen. The increased surface area afforded by the protrusions into the nose increases the nose’s ability to humidify this air. At the root of the nose where inside only a thin plate of bone separates the brain from the outside world projections from the olfactory nerve into the nose gives specialised mucosa which confers our sense of smell. This is vital for our sense of taste and of course can be affected by any surgery to the septum of the nose or trauma to the face. 

The lower third of the nose and tip are supported by the cartilaginous septum and are shaped by their lower lateral cartilages. Simply spoken this part of the nose gives the tip of the nose its definition and shape. The middle third is defined by the cartilaginous septum which often gives the shape of the dorsal hump and the upper lateral cartilages which define part of the width of the nose in this section. The upper third is defined by the nasal bones. These are some of the thinnest bones in the body. As such are easily prone to fracture by trauma or controlled force. Their problems can define the width of the nose, the angle of the nose and its roots with the upper face and of course nasal prominence in this region. 

Any rhinoplasty surgery or nose job involves appropriate manipulation, resection, reshaping and re-draping of these structures. The overlying skin has unique characteristics in different patient population. In general, the upper third is the thinnest skin the middle third is of medium thickness and oiliness and the lower third some of the thickest and oilier skin in the body. This has impact on the final result of surgery. In people with very thin skin any console irregularity is likely to be seen and felt. Equally, those with thicker skin, any manipulation or resection is more likely to be camouflaged by the overlying draped thick skin. 

RHINOPLASTY

SYDNEY

GET INCREDIBLE RESULTS WITH 

YOUR NOSE JOB SURGERY

GETTING RHINOPLASTY SURGERY

WITH OUR CLINIC

Often referred to as a ‘nose job’, a rhinoplasty is a procedure that seeks to fix any structural, shape, size and functional shortcomings of the nose. As an integral feature of the face, the nose plays a huge part in determining what someone looks like. Because of this, reshaping the nose is often considered one of the most challenging facial aesthetic procedures. 

Unlike other aesthetic or reconstructive procedures, in rhinoplasty the shape and appearance of the nose continues to evolve long after the original surgery is complete. This is mainly because it involves manipulation of nasal cartilages, which are relatively elastic, and also because of the surrounding forces transmitted from the skin envelope and facial muscles.

In simplistic terms, the nose can be thought of as an organ divided into three anatomical topographical sites: the skin, the skeletal support (bone and cartilage) and the mucosa (inside lining). Topographical division is into upper, middle and lower thirds, based on the underlying skeletal support. The ideal nose is determined as much by personal preferences and aesthetic standards as by cultural norms. 

There is no standard appearance and each procedure has to be tailored to the individual patient’s needs. Any facial cosmetic surgery should ideally seek to preserve essence and character, while enhancing aesthetic form and the nature of the subject. It is vital that both surgeon and patient understand and agree with each other on what needs to be addressed. 

Some patients seek advice to address previous nasal trauma, others are concerned about the width, profile appearance or asymmetric central location of the nose in their face. A drooping, thickened tip or excessive flaring of nostrils may be other reasons for seeking advice. 

WHAT TO EXPECT BEFORE AND

AFTER RHINOPLASTY SURGERY

Dr Farhadieh will then discuss your aesthetic concerns, as well as any functional issues that may worry you. After examination of your nose and facial features, a set of medical record photographs will be taken and all options will be discussed with you. 

Major complications are not common in rhinoplasty and all possible risks will be discussed with you at length during your consultation. Smokers are advised to stop smoking for at least 3–6 weeks both before and after surgery. You will need to stop taking any blood-thinning medications or alternative dietary supplements for at least 2 weeks prior to surgery. 

Rhinoplasty is performed either as an outpatient surgery or in the hospital with overnight admission. It’s important to note that you will need someone to drive you home afterwards. Prior to surgery, Dr Farhadieh will mark your nose and face and address any remaining questions with you. The surgery involves internal incisions and often a small external incision (open rhinoplasty), which heals well and is not noticeable. Nose job surgery usually takes between 1 and 2 hours, but can sometimes be longer, especially in cases where it is a revision rhinoplasty or more extensive work is carried out. Depending on the aim, your nose may be built up in areas using your own nasal cartilage, the bridge may be narrowed, the septum straightened and nostrils adjusted if needs be. 

BEFORE SURGERY:


During the initial consultation, Dr. Farhadieh will go over your previous medical history by asking for information on the following things:

  • High blood pressure 
  • Blood clotting disorders 
  • Thyroid disease 
  • All previous surgeries 
  • Smoking history 
  • Allergies and hay fever 
  • Current medications 

Dr Farhadieh will then discuss your aesthetic concerns, as well as any functional issues that may worry you. After examination of your nose and facial features, a set of medical record photographs will be taken and all options will be discussed with you. 

Major complications are not common in rhinoplasty and all possible risks will be discussed with you at length during your consultation. Smokers are advised to stop smoking for at least 3–6 weeks both before and after surgery. You will need to stop taking any blood-thinning medications or alternative dietary supplements for at least 2 weeks prior to surgery. 

Rhinoplasty is performed either as an outpatient surgery or in the hospital with overnight admission. It’s important to note that you will need someone to drive you home afterwards. Prior to surgery, Dr Farhadieh will mark your nose and face and address any remaining questions with you. The surgery involves internal incisions and often a small external incision (open rhinoplasty), which heals well and is not noticeable. Nose job surgery usually takes between 1 and 2 hours, but can sometimes be longer, especially in cases where it is a revision rhinoplasty or more extensive work is carried out. Depending on the aim, your nose may be built up in areas using your own nasal cartilage, the bridge may be narrowed, the septum straightened and nostrils adjusted if needs be. 

AFTER SURGERY:


When you wake up in recovery, there will be a thermoplastic plaster on your nose. You will need to wear this for up to 2 weeks post-surgery. Pain relief will be provided to make you comfortable, as your nose will feel blocked and breathing may seem arduous at first. However, most patients adapt to mouth breathing quickly. If you have been admitted overnight, you will be discharged in the morning after removal of nasal packs. 

POTENTIAL COMPLICATIONS

After the rhinoplasty, the normal postoperative course has some expected inconveniences that you will be made aware of preoperatively and should not be considered as complications. Pain, bruising and postoperative swelling are to be expected. If the swelling is excessive or prolonged, postoperative oral steroids may help to speed resolution. However, excessive postoperative bleeding is rare (o.9% of cases). Taping the nose may be helpful in decreasing swelling and may be continued by the patient on a nightly basis even weeks after surgery

IN THE INTERMEDIATE POSTOPERATIVE PERIOD (2 WEEKS – 2 MONTHS), COMPLICATIONS MAY INCLUDE:

  • Prolonged swelling; 
  • Delayed healing; 
  • Patient concern/dissatisfaction; 
  • Synechiae (where the iris adheres to        either the cornea or lens; 
  • Osseous overgrowth (consists of/or has        turned into bone); 
  • Septal perforation; 
  • Anosmia (loss of sense of smell); and 
  • Late presentation of a cerebrospinal fluid (CSF) leak.

LATE COMPLICATIONS FROM RHINOPLASTY INCLUDE:

  • Nasal airway obstruction; 
  • Various irregularities and deformities; 
  • Implant exposure; 
  • Extrusion or migration; 
  • Scarring; 
  • Silent sinus syndrome; 
  • Enophthalmos (posterior displacement of the eyeball); and 
  • Mucocele (cyst) formation. 

IN THE IMMEDIATE POSTOPERATIVE PERIOD, COMPLICATIONS MAY INCLUDE:

  • Bleeding; 
  • Erythema (redness of the skin) related to vascular congestion; 
  • Infection; 
  • Skin loss or necrosis; and 
  • Early patient dissatisfaction.

HAVE YOU HAD A PRIOR RHINOPLASTY

PROCEDURE AND NEED REVISION?

It is not uncommon for the rhinoplasty surgeon to be presented with a patient that has had a prior rhinoplasty. It is estimated that between 2 and 30% of rhinoplasties result in secondary rhinoplasty. The preoperative assessment described above for primary rhinoplasty, for the most part, applies in revision rhinoplasty. Of particular importance is the patient’s previous surgical history, the nature of their concerns or dissatisfaction, the patient’s social history and psychiatric history and, of course, a thorough objective evaluation of the patient’s anatomy.

EVALUATION:

OPERATIVE HISTORY
It is important to provide your surgeon with the operative record of any and all previous nasal surgeries as part of the preoperative evaluation of a patient presenting for revision rhinoplasty.

PATIENT-REPORTED ISSUES
The surgeon needs to have a very clear and specific understanding of the source of your dissatisfaction. Perhaps even more than with the primary rhinoplasty, realistic expectations must be established. If your expectations are judged to be unrealistic, it should be made clear and documented whether the surgeon believes that your desired results are attainable.

OBJECTIVE ISSUES
A full examination and facial analysis should be performed. The height, width and symmetry of your nose should be asserted.

SKIN
If you have had a previous rhinoplasty, skin examination is important as it can be thinned or scarred from previous surgery.

STRUCTURAL SUPPORT
The full nasal exam and analysis as described above will provide insight about the structural support remaining in the previously operated nose.

GET THE BEST QUALITY 

CARE AVAILABLE

Dr Farhadieh is a strong believer that a good patient–surgeon relationship is the building block of any successful outcome. Commitment to patient care and good communication is the philosophy of our clinic. 

We will follow you up again in our clinic routinely and will always be available for any issues that may require addressing. Get in touch with either our Sydney or Canberra clinics today to enquire about making an initial consultation with our professional team of medical experts.

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7 THINGS YOU NEED TO KNOW ABOUT RHINOPLASTY

5

EARLY POST-OPERATIVE PERIOD

In the early post-operative period it is not at all unusual to find ongoing spotting from the nose or old blood discharging from the nasopharyngeal passages. This will take some time to settle down.

1

THE IMPORTANCE OF PROVIDING ALL THE INFORMATION ABOUT YOUR NOSE

So in deciding on surgery it is vital that if there are any functional disturbances in your nasal passage that they are taken into consideration.

2

THE IMPORTANCE OF THE GOOD SURGEON

The choice of your surgeon. Both ENT and plastic surgeons perform rhinoseptoplasty surgery. What’s important is that you feel comfortable with the surgical options your surgeon discusses with you. That you are comfortable with the amount of information provided and the complication profile of the surgery

4

SENSATIONAL RETURNING OF SENSE 

Your nose will feel numb during the post-operative period. By definition, especially in an open rhinoplasty the skin is disconnected from its main cutaneous nerve supply. Most people report sensation returning to almost normal within 12 months.

3

BE PATIENT

Your nose will take some time to settle down and find its final shape. There is generally more swelling associated with an open rhinoplasty technique than a close technique. However, an open rhinoplasty technique offers more control and visibility of all the components of the nose allowing a more optimal and predictable outcome.

6

LATE POST-OPERATIVE PERIOD

Breathing as well as sense of smell may be affected in the early post-operative period. These usually take some time to settle down. Usually, significant improvements will have been noted by eight weeks after surgery. 

7

GENERALLY, THE VAST MAJORITY OF THE SWELLING HAS SETTLED DOWN BY THREE MONTHS

Oedema and swelling effects the shape of the nose. In the early post-operative period this is a constant and consistent theme. As this swelling and oedema settles down, this becomes intermittent with most people noticing the shape and swelling of their nose different at various times of the day. Generally, the vast majority of the swelling has settled down by three months. The final result however, remains a work in progress and is best judged at 12 months. Good luck on your journey! 

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