Dr Timothy Cooper is a specialist plastic surgeon with a particular interest in Rhinoplasty. We asked Dr Cooper to answer our burning rhinoplasty questions:
A patients biggest fear is not getting the nose shape they thought. How do you realise the patient’s goals and how do you communicate that?
Communication is the key to achieving a good outcome in Rhinoplasty. It is important to work out what the patients ideals are. This is facilitated with the use of a computerised imaging software. It enables a consensus to be reached with the patient as to what can and can”t be corrected. ie. realistic goals must be established. It also enables a rapport to be established with the prospective patient.I find patients who come with photos of someone else (often famous), wishing to copy that look, are often unrealistic. If a patient can’t articulate what they don’t like about their nose it does raise a red flag.
What is my planning process? To what extent is the patient involved in the planning process?
At the initial consultation I find out what the patient hopes to achieve. If this is technically possible then I will make notes as to how I will do this. This process is aided with the use of standardised anatomic diagrams. Some surgeons will routinely measure things. Others will use artistic judgement in making operative decisions. I prefer the latter method. Preoperative images displayed on the computer screen during the procedure are an aid.
Who is a good rhinoplasty candidate?
A patient who can articulate what they want corrected is often a good start. They must be psychologically stable and understand that the operation is not going to dramatically change their life or how people perceive them. They must have realistic expectations as to what the surgery can achieve
Who is a bad rhinoplasty candidate?
The inability to articulate what they don’t like about their nose is problematic. Conversely, patients who present with architectural design drawings are also likely to be poor candidates. Anyone undergoing a concurrent life stress such as a divorce should be advised to defer any decision to undergo such a procedure.
If the degree of deformity is out of proportion to the patients concern then that is also a red flag.
What about function in rhinoplasty?
Breathing is often compromised in rhinoplasty patients and should be assessed preoperatively. CT scans may be ordered preoperatively to assess the internal airway. Sometimes it is necessary to correct a crooked septum or bulky turbinates at the time of the procedure. Breathing may be compromised in the early post op phase but should improve within weeks.
How does a patient choose a rhinoplasty surgeon?
Peter Callan articulates this well in his video presentation on PSF - view here. It is worth doing your homework when choosing a surgeon. Look closely at their experience and qualifications. They should be an FRACS in either Plastic or ENT Surgery. Rhinoplasty surgeons tend to advertise their special interest. Online reviews may help. Don’t hesitate to seek a second opinion, especially if you can’t establish a rapport with the Doctor.
Can any Plastic or ENT Surgeon do rhinoplasties?
The short answer is no. Many choose not to do rhinoplasties because it takes considerable extra training to perform well. If the problem is more functional than aesthetic then patients may be better served by seeing an ENT surgeon. I don’t hesitate to cross refer to an ENT colleague if the airway compromise is difficult.
What to expect after surgery?
Prior to discharge nasal packs are often removed as they are uncomfortable and interfere with breathing. Splints are usually removed at 5 days, along with sutures. There may be some bruising around the eyes following osteotomies. This settles rapidly. Breathing may be compromised for some weeks. Once the splints/ tape are removed the final shape will become apparent but I advise patients to not be too critical initially as the swelling takes ages to settle. I sometimes tape the nose for an extended period to control swelling.
What happens to the nose long term?
The nose swelling subsides over many months. The shape becomes better defined although shape anomalies may become more evident over time eg. inverted V deformity of bridge.
How long after Rhinoplasty should a revision be considered?
I tell all my patients that a revision may be necessary as minor shape issues are very common postoperatively. Even experienced surgeons have revision rates of at least 10%. If a revision becomes necessary then it can be done at anytime. Conventional wisdom is to wait at least a year to do a revision but I don’t subscribe to this philosophy. It is important to discuss with your surgeon who pays if a revision becomes necessary prior to undertaking the original surgery.
What about closed vs open rhinoplasty?
Most surgeons will use an open approach in the majority of cases. It is more predictable in outcome as exposure of the anatomy is excellent.
What’s a Septoplasty?
The septum is the central cartilage pillar of the nose. It can often be crooked following trauma and this can interfere with the airway. It can be straightened during the operation and often cartilage is harvested for internal grafting.
What about fillers in the nose?
I use fillers in the nose for minor tip or dorsal defects. These are Hyaluronic Acid products which are proven to be safe if injected in the correct plane. I don’t use any permanent fillers. HA products often last a lot longer in the nose than the rest of the face.
PSF would like to thank Dr Timothy Cooper, specialist Plastic and Reconstructive surgeon for his input into this post.