Rhinoplasty (Nose Reshaping) Sydney

Rhinoplasty is a procedure that is performed to reshape the nose.

Dr Moradi uses 3D Vectra software to help simulate the results patients may get.

What Is A Rhinoplasty?

Rhinoplasty is one of the most common plastic surgical procedures. However, it's also one that requires considerable training and planning to get right.

The procedure aims to increase or decrease the overall size of the nose, alter the shape of the bridge or tip, narrow the span of the nostrils, or change the angle between the upper lip and the nose. The surgery can alter the shape and amount of both cartilage and bone. Many patients have a rhinoplasty to improve breathing through the nose. While other patients choose to have rhinoplasty for cosmetic reasons.

The key to an excellent rhinoplasty is to achieve a natural and sustainable look.

How long before I see the final shape after rhinoplasty.

The upper half of the nose takes around 1 - 2 months. However, the tip of the nose can take around 12 - 18 months before you get the final result. So be patient and massage and tape the nose as long as possible post-op.

Can I have a combined procedure?

Yes, many patients who have a cosmetic rhinoplasty also suffer from sinus and breathing issues. In those cases, it's best to combine both operations with an ENT colleague who will help open the sinuses and airway. So while Dr Moradi performs the cosmetic enhancement the ENT will take care of the breathing, the perfect outcome for the patient.

Reasons people choose Rhinoplasty?

There are many reasons to get a rhinoplasty, such as:

  • Oversized nose
  • Bump on the bridge of the nose
  • Drooping at the tip of the nose
  • Deviated septum
  • Broken nose

What is a rib graft rhinoplasty?

This technique is used for revision cases where we need extra cartilage for support and contour.

Dr Moradi will harvest the rib from the patient, ideally, he will use the nasal septum for cartilage but this is inadequate in revision cases as it has already been used up in the initial surgery.

Using ear cartilage is not as viable as a rib graft because of the lack of strength and support it provides.

When do you do a closed vs open rhinoplasty?

Different surgeons have different approaches. If you only need a hump reduction, Dr Moradi uses a closed approach.

Otherwise, Dr Moradi uses an open approach as it provides the best access and most accuracy in creating shape.

If I have broken my nose, when is the best time to straighten it?

The best time is within 2 weeks before the nasal bones set.

However, if it is longer than this you will need a formal rhinoplasty to re-break the bone and straighten it. Which always involves straightening the septum at the same time.

Do I need to break my nose for surgery?

Generally, yes, when you have a hump reduction, Dr Moradi will need to narrow the base width of the nose or if he needs to straighten the nose.

How small can you make a nose?

Not very. We are limited by the skin quality and the bony and cartilaginous framework.

Dr Moradi will also need to keep the relationship with the mid and lower face. Too small a nose, makes the chin look too large.

Male Rhinoplasty vs. Female Rhinoplasty

Around 20% of my rhinoplasty patients are men. Most have surgery for correction after trauma, but some also have it to make subtle changes to their appearance. Either way, the surgery is always customised to their wishes and goals.

When performing male rhinoplasty, the profile goals should be a straight dorsum with no 'supratip' break, unlike a female rhinoplasty that needs that small "kick" up at the tip.

How much does a Rhinoplasty cost?

Rhinoplasty surgery is covered by most private health insurance. Review your policy carefully to determine what is covered.

Costs associated with a rhinoplasty vary on a number of factors, however, this will be discussed during your consultation:

  • Anaesthetist's fees
  • Private hospital or day surgical facility fees
  • Your level of private insurance cover
  • Need for other facial plastic surgical procedures, such as eyelid rejuvenation, facelift, neck lift or brow lift.
  • Surgical assistant's fee

Medicare

Rhinoplasty 45641. This number can only be used for functional breathing issues and not for cosmetic improvement. You can perform functional surgery with aesthetic enhancement, but the latter portion is charged to the patient directly. Rhinoplasty, total, including correction of all bony and cartilaginous elements of the external nose, with or without autogenous cartilage or bone graft from a local site (nasal), if:

the indication for surgery is:

  • Airway obstruction and the patient has a self-reported NOSE Scale score of greater than 45 or
  • Significant acquired, congenital or developmental deformity; and
  • Photographic and or NOSE Scale evidence demonstrating the clinical need for this service is documented in the patient notes.

Rhinoplasty Results

Can I predict these results?

In terms of seeing the final result after rhinoplasty, it is best to break the recovery of the nose into three parts; the upper third, the middle third and the lower third. The upper two thirds will take about six weeks to get the final result. The tip, which requires more refinement, will take between 6 - 12 months for the final result to show. In the first 10 days, you will have stitches and a splint on your nose. Once that is removed, you will have swelling and black eyes which will gradually fade. The swelling will also slowly move down into your cheeks as gravity tries to get rid of it.

Immediately after the operation, both you and Dr Moradi will be aware that there is swelling in the tip of your nose, but no one else will because people simply do not pay that much attention to your face. At three months, you will think that the swelling is gone but the doctor will be able to notice the smaller signs of swelling. Finally, after 12 months, the swelling will be entirely gone and your nose will be as it should.

Just like in breast surgery where the crease support and control is paramount to predictable results. Same with a nose, tip projection support is critical to long term success.

With breasts, I always reconstruct the crease with supportive sutures or internal bra and with noses I maintain projection with a combination of extension grafts and tip grafts. Never rely on natural cartilage to support the nose.

I support the tip using a number of techniques, and often combination of them all.

Tongue in Groove

This is a technique where the tip cartilage footplates are secured to the caudal septum allowing a platform and stability to the tip cartilages.
I use this to control and support tip projection. 100% of the time, I combine this with a columellar strut

Columellar Strut

This is a technique to support the tip cartilage. I use the tongue in groove to position my tip cartilages, but I also need the columellar strut cartilage to provide support and stability.

Think of it like a bent tree, the strut is like a stake in the ground which you tie the tree to to provide support.

This is one of the reasons the tip of the nose is so stiff for a few months. Like any broken bone, You need stability before mobility.

Caudal Extension Grafts

Caudal Extension Grafts help tip support, projection and rotation.

Summarised Recovery

Rhinoplasty surgery is performed under general anaesthetic either as a day case or with an overnight stay. Patients will usually take one or two weeks off work. During the healing process, you will wear a splint down the length of the nose -- this is done to support the new shape of your nose. If there is any work done to the septum, internal splints are also placed. In the immediate post-operative period, Dr Moradi will prescribe nasal sprays to help with the inflammation and also to prevent drying up of the mucosal lining over the days after surgery.

Stages of Recovery

  1. Physical recovery - around 2-4 days before you feel normal after surgery
  2. Social recovery - 2-4 weeks before all the bandages and splints are off and the bruising isn't obvious
  3. Results recovery - Upper 2/3rds of the nose takes 2-4months. The tip of the nose takes 6-12months

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Dr Pouria Moradi - Your Sydney Specialist Plastic Surgeon

"I am a consultant plastic, reconstructive and aesthetic surgeon working as a visiting medical officer at Prince of Wales, Royal Women's and Sydney Children's Hospitals, and an associate lecturer at UNSW Medical School.

Having studied medicine at UNSW as a Sam Cracknell Sport and Academic Scholar, I was then awarded Membership of the Royal College of Surgeons of England in 2005 and Fellowship of the Royal Australasian College of Surgeons in Plastic, Reconstructive and Aesthetic surgery."