Rhinoplasty and Nasal Reconstruction


The nose is the central focal point of the human face. It is a complex three dimensional structure that intricately combines shape, contour and space to allow unencumbered breathing and an harmonious facial aesthetic. Surgery on the nose for reconstructive purposes following cancer or trauma, or for cosmetic reasons, is something that requires a considered approach. No other surgery typifies the principles of plastic surgery more in terms of form and function.

I developed my specific interest in nose surgery after seeing Dr Frederick J. Menick MD talk at a Melbourne conference. Dr Menick is recognised as one of the world experts on nasal reconstruction.

I was also always intrigued by the time devoted to discussion at meetings about cosmetic rhinoplasty and the amount of detail and subtlety involved in this surgery. Many surgeons avoid this operation due to the difficulty of the surgery and the sometimes unreliable long term results.

This inspired me to pursue a fellowship in rhinoplasty and brought me to the doorstep of Professor Wolfgang Gubisch in Stuttgart, Germany.  Professor Gubisch holds both ENT and Plastic Surgery Fellowships and is recognised on the world stage for his techniques in rhinoplasty as well as the outstanding results that he achieves for his patients. He runs a rhinoplasty course in Stuttgart that, through a combination of anatomical dissection workshops, lectures and live surgery, imparts an understanding of the nose and surgery for it that is unparalleled. I had the opportunity to participate in this course and to then spend 3 months working with Professor Gubisch. During this time, we did over 60 rhinoplasties for cosmetic, traumatic and reconstructive reasons.

I also had the opportunity to see complicated total nose reconstructions done by his colleague Dr Helmut Fischer who, like Dr Menick, was able to create remarkable results for his patients. The culmination of my fellowship was assisting Professor Gubisch edit his book on secondary rhinoplasty.

I then took my rhinoplasty interest to Vancouver where I spent time with Dr Richard Warren, a Plastic Surgeon who also has a passion for rhinoplasty and shares similar techniques and philosophies with Professor Gubisch.

Back home in Australia, I now have the confidence to offer my patients the most current techniques and understanding in rhinoplasty and nasal reconstruction. Whilst I will still refer purely functional and sinus problems to my ENT colleagues, I am comfortable managing the nasal airway in the setting of reconstruction and rhinoplasty.


Procedures I offer:

Open Rhinoplasty

  • cosmetic
  • traumatic

Nasal Reconstruction

  • skin cancer
  • soft tissue tumors
  • trauma

Rhinoplasty


About The Procedure

Rhinoplasty is surgery for reshaping the nose. It is probably the most intricate, and finely balanced plastic surgical procedure done and the subtlety and balance of a good result belies the complexity of the underlying process. No other operation epitomizes the principles of balancing form and function more.

Rhinoplasty is generally done using what is called an open technique.  This approach allows direct visualisation of the underlying anatomy of the cartilage and bone structure of the nose. As a result, deviations and deformities can be accurately diagnosed and corrected.

Vectra XT 3D Imaging

3D image manipulation is probably the best way to ensure that you understand what we are trying to achieve with surgery. Changes to your nose, the defining central feature of your face and identity, can significantly affect your appearance.

Changes in facial profile.

Improvements to profile, size, shape and length can all be demonstrated and manipulated with the Vectra XT 3D technology until we reach an understanding of what we are aiming for. Being able to see what that might mean on a 3D image of your own face provides reassurance for both me as the surgeon and you as the patient that the goals we have in mind match the tools we have to achieve them. Whilst the actual surgical outcome will not be exactly the same as a computer image, it does provide a realistic comparison.

Will I see a scar?

The only external scar is on the columella which is the small bridge of skin between the nostrils. This heals well and is generally very difficult, if not impossible to see. The other access incisions are internal and concealed within the nose.

Does my nose bone need to be broken?

Often osteotomies (controlled fracturing of the bone) are required to reposition the nasal bones to straighten the nose and preserve the contour of the back. Significant hump reduction will always need osteotomies performed.

The Surgery

The procedure is performed under general anaesthetic in an accredited hospital. The operation can take from 3 to 5 hours depending on the complexity of the presenting problem. There is no fixed time, and provided it is safe to undergo general anaesthesia, surgery stops once the desired result is achieved.

Recovery

Rhinoplasty can be done as a day procedure, but it is preferable to stay overnight to ensure that you are comfortable and there are no bleeding problems.

You need to allow about 2 weeks for recovery in terms of work and social commitments, however, this does vary from patient to patient.

The amount of bruising and swelling will depend on whether the bone needs to be fractured or not but should settle over a 2 week period.

Complications

Bleeding, infections, wound healing problems and scars are potential complications of any procedure. General anaesthesia itself also carries a small risk.

Breathing can be affected if the internal dimensions of the airway are changed.

Shape asymmetries, bony edges and visible cartilages under the skin can result.

Further Information

In making a decision to have Rhinoplasty, it is important to ensure that you see a qualified specialist plastic surgeon to discuss your options and suitability. We look forward to meeting you to do this and to answer any questions that you may have.