Rhinoplasty (Nose Job) in Brisbane

Rhinoplasty surgery is surgery that changes the external shape of the nose.

Rhinoplasty surgery can address breathing difficulties (known as functional rhinoplasty) or alter the appearance of the nose (cosmetic rhinoplasty) or both.

My practice is focused on all aspects of nose surgery, and I perform both functional and cosmetic rhinoplasty procedures as well as revision rhinoplasty.

During rhinoplasty:

• The nose can be straightened, made smaller or bigger, and bumps may be removed.
• The shape of the tip of the nose can be changed (nasal reshaping, nasal enhancement).
• The angle between the nose and upper lip can be changed.
• Pieces of cartilage or bone may be removed from or added to the nose to help change its shape.

When planning rhinoplasty I look at the whole picture, and I consider your other facial features, the skin on your nose and what you would like to change.

Frequently the internal wall (nasal septum) that separates the nose cavities is twisted. This may need to be corrected at the same time (Septoplasty). The combined operation is called a septorhinoplasty.

There are limits to how much a nose can be altered. The final result will depend on the size of your nose, the condition of your skin, your age and how well it heals after surgery.

There are several different types of rhinoplasty surgery, however in most of the rhinoplasty surgery I perform, the operation involves a combination of both cosmetic and functional rhinoplasty.

The aim is that a cosmetic rhinoplasty does not come at the cost of breathing, and equally that a functional rhinoplasty improves the shape of the nose at the same time.

Cosmetic rhinoplasty:
The aim during cosmetic rhinoplasty is to change or refine the shape of the nose.

• The nose can be straightened, made smaller or bigger, and bumps may be removed.
• The tip of the nose can be changed (nasal reshaping, nasal enhancement).
• The angle between the nose and upper lip (also known as rotation) can be changed.

Functional Rhinoplasty:

• To improve functional concerns such as nasal obstruction.
• This is commonly performed in conjunction with a septoplasty
• Functional rhinoplasty is often performed to improve nasal valve collapse where the side of the nose tends to collapse inwards.
• As there is an intricate relationship between the function and shape of the nose, the aim is to improve both the function and the shape of the nose at the same time.

Augmentation Rhinoplasty:

• This type of rhinoplasty aims to increase the size of the nose.
• It is often performed during revision rhinoplasty where too much of the nose had been removed during the previous surgery.
• Augmentation rhinoplasty frequently requires grafts from other parts of the body such as cartilage from the rib or ear.

Reduction Rhinoplasty:

• The most common form of reduction rhinoplasty is reducing a dorsal hump / bump.
• The overall size of the nose can be reduced simultaneously.
• This can include reducing the size of the nostrils as well.

Revision rhinoplasty:

• In some instances, following rhinoplasty surgery issues may arise following the procedure.
• This can include dissatisfaction with the cosmetic appearance of the nose or functional issues that develop as a result of the surgery.
• Revision rhinoplasty aims to address these concerns.

The duration of surgery is linked to the extent and complexity of the surgery. It can vary from just over an hour for minor refinements to over 3 hours for more complex, revision rhinoplasty procedures.

Plan on 10 days to two weeks off work after surgery. In practice the nose looks normal to other people long before it is finished changing. There will however be ongoing changes in the appearance of the nose for about twelve months following surgery, and longer at the tip.

During those recovery months, there are things patients might be best to avoid, such as playing contact sports or sunbathing, as the skin and nose structure are more sensitive.

Yes. Quite often the main aim of rhinoplasty is to improve breathing and nasal function. This is called functional rhinoplasty. As a specialist nose surgeon my aim is to improve the functional and breathing outcome for my patients regardless of the type of rhinoplasty.

I perform rhinoplasty under a full general anaesthetic.

I ask you not to wear glasses, including sunglasses, for six to eight weeks after rhinoplasty. This is to limit pressure on the bridge of your nose which can interfere with the final result of your operation. There are a number of solutions available including cheek pads that lift the glasses off your nose so that there is no pressure placed over the bridge.

• After rhinoplasty surgery there is quite commonly some swelling and bruising under the eyes and around the nose. This should be at its worst between two to three days after your procedure. Swelling and bruising can be reduced by sleeping with your head in an elevated position and using ice packs regularly for the first few days after surgery.
• The nose can be quite congested and stuffy for the first few days and you will be encouraged to use a nasal wash to clear any dissolvable dressings that may have been used during the operation.
• There will be some pain and discomfort as well however, the majority of patients rate their pain between a 0 to 4 out of ten the day after surgery. I will give you pain medication to take after going home, and tell you which medicines to avoid, including ibuprofen and aspirin.
• There will be an external splint on the nose. This is to help reduce swelling and keep everything in a favourable position during the initial stages of healing. The splint comes off at your review, between seven and ten days after surgery. Stitches are usually dissolvable; the only ones that need removing are after an alar base reduction (alarplasty). It is important to keep the splint dry and avoid touching it to make sure it doesn’t move.
• Certain activities should be limited during the initial recovery period. These include strenuous activities such as exercise.
• You will be provided with a detailed instruction and information brochure following surgery to inform you how to look after your nose after the procedure. It is important to follow these instructions.

The cost of rhinoplasty surgery is different for each individual, reflecting the complexity of the surgery required.
Costs will include my fee, and separate fees for the anaesthetist and the hospital.

If surgery is for aesthetic reasons only, Medicare and private health funds will not cover these costs. A Medicare rebate applies only where the criteria are met (a NOSE Scale score above 45, or a significant acquired, congenital or developmental deformity), and your fund may then pay part if your cover is adequate.

You will be given a written quote setting out my fee and the anaesthetist’s and hospital fees, with expected rebates and out of pocket costs, before you decide whether to proceed.

Please contact my rooms if you have an enquiry regarding fees.

Yes. Rhinoplasty is one of the more technically demanding operations in facial surgery, and every patient accepts a degree of surgical risk. Understanding that risk properly is part of deciding whether to proceed.

It helps to separate two different things: the effects that are part of normal healing and happen to almost everyone, and the complications that are uncommon but can occur.

What to expect during normal healing

These are not complications. They are the expected course after surgery.

Swelling and bruising. Swelling around the nose and eyes is greatest in the first few days. Most visible swelling settles over the first six to eight weeks, but residual swelling continues to resolve for twelve months or longer, particularly at the tip. Patients with thicker skin take longer. This is why the photographs in my gallery state how long after surgery each was taken, and why a nose at six weeks does not look like the same nose at twelve months.

Nasal congestion. Internal swelling makes breathing through the nose difficult for the first one to two weeks. This is temporary and does not indicate that the surgery has failed.

Numbness. Reduced sensation in the nasal skin and tip is common and usually settles over several months.

Discomfort. Most patients describe the pain as moderate and manageable with simple analgesia. Pain that worsens after the first week should be reported rather than tolerated.

Complications

Bleeding. Minor bleeding in the first days is common. Significant bleeding is uncommon but occasionally requires treatment.

Infection. Uncommon after rhinoplasty. Where it occurs it is usually treated with antibiotics, and rarely requires further surgery.

Residual irregularity or asymmetry. This is the most common reason patients are dissatisfied. The nose is a three-dimensional structure and small changes in one area affect others in ways that are not entirely predictable. Published revision rates for cosmetic rhinoplasty sit between about 5 and 15 per cent, and single surgeon series commonly report around 10 per cent. Those figures are likely to understate it, because a patient who goes elsewhere for their revision does not appear in their first surgeon's results.

Breathing changes. Rhinoplasty alters the internal structure of the nose as well as its appearance. Breathing can be improved, but it can also be made worse, particularly where the nasal valve is narrowed. This is one reason functional assessment is part of every consultation rather than an optional extra.

Changes to smell. A temporary reduction in the sense of smell is common while the nose is congested. Persistent change is rare.

Septal perforation. A hole in the septum, which can cause whistling, crusting or bleeding. Uncommon, and more likely where septal surgery has been performed previously.

Scarring. In open rhinoplasty there is a small scar across the columella, between the nostrils. In most patients this fades to become difficult to see. Poor scarring is uncommon but possible.

Anaesthetic risk. Serious complications of general anaesthesia are rare, and your anaesthetist will discuss your individual risk before surgery.

The result may not be what you hoped

This is not the same as a complication. Surgery can go technically well and still not produce the outcome you imagined. The final shape of the nose depends on your skin thickness, your underlying anatomy and how you heal, none of which are fully controllable. This is why I discuss what is realistically achievable before surgery, and why I will decline to operate where I do not believe surgery can deliver a worthwhile improvement.

What reduces risk

Choosing a surgeon with specialist qualifications and experience in nasal surgery specifically. Giving a full account of your medical history, medications and smoking. Following post-operative instructions, particularly around avoiding trauma to the nose. Attending your follow-up appointments, so that anything developing is identified early.

When to contact my rooms

Contact my rooms rather than waiting if you develop worsening pain after the first week, fever, bleeding that does not settle, increasing redness or swelling of the nasal skin, or any sudden change in vision. These are uncommon, but they need to be assessed rather than monitored at home.

Some facial cosmetic procedures are temporary and require touch ups every so often. Surgical rhinoplasty changes the structure of the nose, so the change is permanent rather than temporary. It is however important to realise that rhinoplasty surgery cannot stop the nose from ageing naturally.

Rhinoplasty surgery is a complex and technically challenging procedure that can alter both the appearance and function of the nose. It is essential to have realistic expectations of what can be achieved with rhinoplasty surgery. During the pre-surgery consultation process I discuss the extent of the procedure, the risks, the anticipated recovery and the limitations of surgery at length.

I will tell you where those limits fall for your nose. There are limitations to what can be achieved with rhinoplasty surgery.

Some of these factors include:

• The underlying anatomy and structure of the nose (nasal cartilage and bone).
• The thickness of the skin – some individuals have thicker skin which limits the degree of definition that is achievable after surgery.
• Rhinoplasty surgery cannot change the entire appearance of the face. It is however vital to take the other facial proportions into account when planning rhinoplasty surgery so that the final result is balanced and looks natural.
• It is possible that there may be minor areas of asymmetry or minor imperfections once the swelling following surgery has fully subsided.
• Rhinoplasty surgery cannot stop the process of ageing. Following surgery, over time, the nose will continue to age at the same rate as the rest of the facial features.

Yes, Rhinoplasty is often combined with:

• Septoplasty surgery – to straighten the midline partition of the nose, this is known as a septorhinoplasty.
• Turbinoplasty / Turbinate reduction – to reduce the size and bulk of the turbinates (bulges on the inside of the nose to improve airflow through the nose.
• Sinus Surgery – to relieve symptoms associated with chronic sinus disease.

There will be some pain and discomfort following surgery, however most patients rate their pain between a 0 – 4 out of ten the day after surgery. I will give you pain medication, including anti-inflammatory medication, to take after going home.

That is the aim. I plan the operation around your other facial proportions and features, so that the nose fits the rest of the face rather than drawing attention to itself. How closely that is achieved depends on your underlying anatomy, your skin thickness and how you heal.

• The first step towards rhinoplasty surgery is to schedule a consultation with the surgeon of your choice. During the consultation they will discuss the concerns you have regarding your nose and explore your expectations and goals for surgery.
• It is important to inform your surgeon of your full medical history including all medications, allergies and previous surgeries and other procedures on your nose. This is particularly important with regards to previous filler injections or threads in your nose.
• If you smoke this would be an opportune time to stop. Smoking adversely affects healing and increases the risk of complications. It is also important not to restart after surgery especially during the initial healing phase.
• Avoid alcohol in the days leading up to surgery.
• Avoid sun exposure and topical creams to the skin of the nose.
• Following the procedure and general anaesthetic you will not be able to drive. You will need to arrange for someone to drive you home. It is also important to arrange for someone dependable to stay with you for the first night after surgery.
• Make sure that you have everything you need when you come home after surgery – this includes comfortable extra pillows, ice packs etc.
• In the lead-up to surgery, it is important to stop taking certain medications if safe to do so. These medications include but are not limited to:
• Blood thinners
• Anti-inflammatory medication (Aspirin, Ibuprofen etc.)
• Certain vitamins and herbal remedies.

After rhinoplasty it is advisable to sleep with your head in an elevated position. This will help to minimise swelling during the recovery period. Sleep on your back with your head raised on two pillows for at least six weeks. Sleeping on your side or stomach causes uneven swelling.

Rhinoplasty surgery is widely considered to be one of the most technically challenging procedures to perform. Selecting the right surgeon is therefore of the utmost importance. Some of the things to look out for include:

• Qualifications: Rhinoplasty surgery should only be performed by fully qualified specialist surgeons. It is commonly performed by both Otolaryngologists (ENT surgeons) and Plastic surgeons. Check that your surgeon is a Fellow of the Royal Australasian College of Surgeons (FRACS) – this means that the surgeon is a fully qualified and certified specialist surgeon in Australia.
• Experience: There is a significant learning curve associated with Rhinoplasty surgery and getting consistently good results after surgery takes a lot of experience. Don’t be afraid to ask your surgeon about their experience level.
• Previous results: Most surgeons can extensively demonstrate their previous results with before and after photos of previous cases. This often includes photos at different stages of the healing process to demonstrate how the swelling gradually subside over the course of 12 months after surgery.
• Communication Skills: Look for a surgeon who is easy to talk to and understands your concerns and expectations. It is important that they take time to explain the procedure as well as the possible risks in a manner that you can understand and that you feel comfortable with
• Consider a second opinion: Seeking a second opinion often helps to put your mind at ease regarding the procedure. It can also help to make sure that you are happy and confident with your decision to have surgery and your choice of surgeon.

“Nose job” is a broad term that is commonly used in everyday language to refer to surgery on the nose. The two main surgeries often referred to as a “nose job” includes septoplasty, which focuses on straightening the internal partition between the nostrils, and rhinoplasty, which aims to change the external appearance of the nose.

Septoplasty surgery does not alter the external shape or appearance of the nose and is most commonly performed to improve the function of the nose. Septoplasty and rhinoplasty are often combined in one operation, called a septorhinoplasty. The difference between rhinoplasty and septoplasty is set out in more detail separately.

After rhinoplasty surgery it is best to avoid the following:

Exercise and strenuous activities:
You will be encouraged to walk and stay active, but gently at first: gentle walking only in the first two weeks, then brisk walking, and light cycling or elliptical work from about the third week. Nothing that raises your heart rate significantly, and no weights, until I clear you. Swimming, spas and hot tubs are out for at least six weeks, and contact sport waits for about six months and my clearance. The week-by-week schedule is on the recovery page.

Nose blowing:
It is natural to want to blow your nose after rhinoplasty surgery as it will feel congested. It is vital however not to do so for the first three weeks after surgery. After that, blow gently, one nostril at a time. Use the nasal wash provided, three to four times a day for three weeks, instead of blowing your nose to relieve the congestion and to help dissolve the soft packing that is used during surgery. Avoid crowded areas, people that are unwell with a cold or flu and wash your hands regularly to try and avoid getting sick during the first few weeks of recovery.

Getting the splint wet:
After surgery a splint is applied to the outside of the nose. This helps limit the amount of swelling and helps to keep everything in position. If the splint gets wet, it will come off too early which can in turn affect your final result.

Wearing glasses:
I ask you not to wear glasses, including sunglasses, for six to eight weeks after rhinoplasty. This is to limit pressure on the bridge of your nose which can interfere with the result of your operation. There are several solutions available including cheek pads that lift the glasses off your nose so that there is no pressure placed over the bridge.

Sun exposure:
Protect the nose from sun for six to twelve months after surgery, because ultraviolet light can permanently darken the small scar between the nostrils. The skin can be quite sensitive and excessive sun exposure, can increase the risk of complications. Use a high index (50+) sunscreen and wide brim hat to keep your new nose cool.

Smoking and alcohol:
Smoking reduces blood flow and interferes with wound healing. If you are a smoker, it is best to consider deferring surgery until you have been able to stop smoking. Drinking alcohol can interfere with other prescribed medications following the procedure and excessive amounts can impair your balance and may put your new nose at risk. Avoid alcohol for at least the first two weeks, and avoid smoking throughout your recovery.

Touching your nose:
Following surgery, the nose can be quite itchy and there are often areas of scabbing and crusting along the incision sites, both inside the nose and on the outside between the nostrils where the incision is. The natural tendency is to try and clear this away to alleviate the irritation.

The hands and fingers are, however, full of bacteria that live on your skin. It is quite possible to transfer these into the wound which can lead to a wound infection. Even though infection is relatively uncommon after rhinoplasty surgery it can affect the end results when it does occur and is best avoided.