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Rhinoplasty Surgery / Surgeons – Nose Job Surgery

Dr Kourosh Tavakoli Member Of Australian Society Of Plastic Surgeons, International Society of Aesthetic Plastic Surgery, Australasian Society of Aesthetic Plastic Surgery, UNSW Australia, Fellow of the Royal Australasian College of Surgeons

Dr Tavakoli's Philosophy on Rhinoplasty

The trend in rhinoplasty surgery is all about the “natural” look away from the 80′s “operated look” seen in so many Hollywood stars. Surgery of the nose is one of the most common of all plastic and cosmetic surgery procedures. The best candidates for a rhinoplasty are those people who are looking for an improvement in the way they look, not those searching for perfection. Rhinoplasty can be performed on its own, or commonly combined with breast augmentation in younger patients or Facelift/eyelift surgery in more mature patients.

Dr Tavakoli is a Renowned Specialist Plastic Surgeon with an interest in Rhinoplasty for cosmetic and functional purposes. He has performed around 850 cosmetic Rhinoplasty cases. Dr Tavakoli performs both cosmetic Rhinoplasty and also functional Septoplasty and Turbinoplasty for breathing problems.

The ideal age for Rhinoplasty is between 20-40. Between the ages of 16-20 the surgeon needs to make an assessment based on physical and psychological maturity. After the age of 40 the Rhinoplasty surgeon needs to take the patient's skin quality into account as the cosmetic result can be affected by excess nasal tip swelling especially if the patient has very thick, oily and sebaceous skin.

Rhinoplasty / Nose Surgery: Modern Approach

Rhinoplasty: (Greek: Rhinos, “Nose” + Plassein, “to shape”) or “nose job” is cosmetic surgery of the nose and one of the most common of all plastic surgery operations. In fact Rhinoplasty is amongst the first cosmetic plastic surgery operations ever performed way back in 1898.

Dr Tavakoli prioritises the “natural” look that suits the patient facial features and ethnicity over the “upturned” and “pixie” look of the 1980’s. However, it is important to communicate clearly with Dr Tavakoli at the time of your nose surgery consultation the look you would like to achieve.

Rhinoplasty / Nose Job Surgery

Rhinoplasty surgery side by side1. Remove the hump or the bump over the bridge of the nose.

2. Improve the crooked nose by re-aligning the nasal bones. Improve the angle between the nose and the upper lip.

3. Shorten or lengthen the length of the nose.

4. Increase or decrease nasal tip projection.

5. Narrow the nostrils if required. Straighten the deviated septum hence improving breathing.

6. Reduce the bulk of air filters (turbinates) hence improving breathing even further.

Septoplasty & Turbinoplasty

Straighten the deviated septum hence improving breathing. Reduce the bulk of air
filters (turbinates) hence improving breathing even further.

  • Suitable Candidate for Rhinoplasty
    The best candidates for Rhinoplasty are those people who are looking for an improvement in the way they look, not those searching for absolute perfection. In fact patients completely obsessed with the appearance of their nose to the extent that it interferes with their daily living should perhaps seek counselling prior to consulting a plastic surgeon. Well-meaning friends and family members are not a good source of information. This includes information about Rhinoplasty, expectations on recovery from nose surgery and nose job cost overall. Find out as much information as you can about your Rhinoplasty operation before proceeding with nose surgery – a well-informed patient is a happy patient. Rhinoplasty surgery when performed on the right candidate by an experienced surgeon can produce profoundly positive transformation to ones face. Nose jobs have the potential to make the person undergoing nose surgery more attractive and in most cases look younger. Primary Rhinoplasty usually takes two hours, although more complicated nose surgery procedures may take longer. Revisional surgery takes longer and patients need to have different level of expectations.
  • Understanding Ethnicity & Nasal Shape
    Different ethnicities have different requirements in rhinoplasty. An anglo-saxon girl has different requirements to say a girl of Lebanese extraction. There are many rhinoplasty surgeons that produce the same “ski-jump” look for all their patients. Your surgeon must be mindful of this point and also the shape of your face, its proportions especially the aesthetic lines from the eyebrows to nose to the lips and chin.
  • Rhinoplasty Surgeon
    Rhinoplasty is one of the most difficult operations in cosmetic surgery. In Australia Rhinoplasty is performed by a few different group of doctors. Therefore your decision making process in undergoing nose surgery should heavily rely on word of mouth and personal research about rhinoplasty. This should also include prior cost estimations of Sydney Rhinoplasty by Dr Tavakoli. Please research your chosen surgeon thoroughly and specifically for Cosmetic Rhinoplasty.
  • Test Required
    In order to get the most from your nose job consultation, please obtain a CT-scan (NOT X-ray) of your nose and sinuses. Your GP should be able to organise this for you if you suffer from any of these conditions:
    • Breathing problems
    • Previous injury to the nose
    • Previous surgery of the nose
    • Hay fever or sinusitis
  • Preoperative Consultation
    The nose surgery consultation is where you need to convey your aesthetic wishes and goals clearly to Dr Tavakoli. A great deal of time will be needed to establish a rapport so all aspects of Rhinoplasty surgery can be thoroughly discussed. A minimum two consultations are required prior to the nose surgery and in some special cases three or four visits may be needed before proceeding with the Rhinoplasty surgery. Dr Tavakoli’s Sydney Rhinoplasty practice has the latest digital imaging system available at your disposal. Marketwise Professional will enable you and Dr Tavakoli to communicate to each other the desired cosmetic goals about the nose job on a large computer screen. Although useful, the imaging system should be used ONLY as a guide for the nose job and not be a guarantee of outcome. Patients need to realise the limitations of rhinoplasty based on ones Anatomy & Facial aesthetics. Not all pretty noses will look pretty on different faces. All rhinoplasty procedures require differing techniques to produce a great result and the end nose cannot be simply chosen from looking at a Model or Celebrity’s nose. Communication is the best means of establishing your aesthetic goals with Dr Tavakoli to ensure a great outcome.
  • The Rhinoplasty Operation
    Cosmetic and functional surgery (Rhino-septoplasty) of the nose takes approximately two to three hours and for your safety it is performed under a General Anaesthetic in a fully accredited Day Surgery or Private Hospital. Most incisions are placed inside the nostrils (Closed Rhinoplasty), but a small incision may be made in the columella (Open Rhinoplasty). Columella is the skin dividing the nostrils. These incisions heal quickly and leave scars that are almost invisible. PHILOSOPHY – Generally speaking Closed rhinoplasty is out of favour by most rhinoplasty experts around the world. Closed rhinoplasty does not adequately address many problems in rhinoplasty. Also the end result is often a pinched, upturned nose with too much nostril show. Open technique is designed to address all aspects of nasal deformity including safeguarding against the “the operated look”. Rhinoplasty surgery starts with the skin of the nose being separated from its supporting framework of the bone and cartilage, which is then sculpted to the desired shape. The skin is then re-draped over the new framework. Cartilage grafts from septum need to be used as Spreader grafts to maintain Internal Valve for breathing plus Columellar strut grafts to maintain tip projection. In addition Osteotomies are performed to re-align the nasal bones. Tip sutures and transection techniques utilised for increasing and decreasing projection and bulk (roundness). In some cases tip grafts are used for length and projection. Alar rim grafts are used in some cases for uneven nostrils. Alar base reductions are performed in patients with wide or flared alae. Septoplasty is performed if needed to straighten any deviation in the septum and/or harvest cartilage graft for nasal re-shaping. Turbinoplasty is performed if these air filtering structures are unusually enlarged. They usually go back to their normal size after corrective septoplasty. Turbinoplasty can cause excessive nose bleed and also create dry nose syndrome. Therefore not all patients require to have this procedure. At the end of the Rhinoplasty operation, an aluminium cast will be placed on your nose. The external splint will stay on for 10-14 days. If Septoplasty is also performed for airway correction, internal plastic tubes may be inserted in the nostrils for up to 7 days after the Rhinoplasty Septoplasty. Consultation Preparation: Before attending your consultation with Dr Tavakoli please have a CT scan of the nose, bring the films and report with you to the consultation, see image below: septum-300x265 non-surgical-rhinoplasty-at-Suite-1-Level-1-376-New-South-Head-Road-Double-Bay-NSW-20281rhinoplasty-sydney-in-Double-Bay-NSW-2028nose-job-located-at-Double-Bay-NSW-2028 rhinoplasty-specialist-at-Suite-1-Level-1-376-New-South-Head-Road-Double-Bay-NSW-2028nose-surgery-in-sydney-NSW-2028    
  • Recovery From The Rhinoplasty Procedure
    During the first two to three days after Rhinoplasty surgery, the face will feel puffy, the nose may ache, and you may experience a dull headache. You should plan on resting with your head elevated for the first couple of days. There will be swelling and bruising around the eyes, reaching a peak after four days. Some patients also get very swollen lips and cheeks including difficulty smiling. All these symptoms will subside within 3 weeks of the nose procedure. By the end of one week all nasal packing, dressings, internal and external splints and stitches from the Rhinoplasty should be removed. You will feel substantially better in your second week of recovery. The most uncomfortable part of the recovery after the Rhinoplasty operations is the inability to breathe through the nose for several days due to swelling. This usually improves within four weeks of undergoing the nose job procedure. Expect some swelling around your eyes for several weeks. As the swelling subsides, you will start to see the improvements from your nose surgery. Rhinoplasty healing is divided in 2 phases. The initial surgical recovery outlined above followed by a slow process of healing and scar modulation that can take up to 2 years in some patients.
  • Activities
    A few special precautions are required during your recovery from the Rhinoplasty operation. Bending or lifting can prolong swelling, so this is not recommended for three weeks after surgery. Running, cycling, or aerobics should not resume for four weeks. Contact sports (footy, rugby) should be avoided for eight weeks, as it takes that long for the bones to fully heal. You may drive when the swelling subsides enough not to interfere with vision, and you may fly two to three weeks after surgery. Follow-up visits to Dr Tavakoli’s Sydney Rhinoplasty practice are needed for 12 months following completion of nose surgery.
  • Immediate Risks
    Nose Bleed: Mild bleeding is expected. Moderate bleeding is usually seen in septoplasty cases. Need to keep your head up and spray Drixine. Severe bleeding contact Dr Tavakoli’s Emergency Mobile Number or present to any Hospital Emergency Department. Mild Infection: This can occur despite oral antibiotics. More common in secondary Rhinoplasty cases. Please ensure the nostrils are impeccably kept clean and scab free after the nose job procedure. The prescribed antibiotic ointment must be used on a regular basis. Breathing Issues: This is a very common issue after Rhinoplasty. It usually a result of swelling and congestion of internal lining of the nose. Keep up the use of FESS (salt water) spray during the first month after nose the surgery and breathing will improve within 2 months.
  • Long Term Issues
    Prolonged Swelling of the Tip: 6-12 months post-surgery. This is not a complication but variable prolonged response to surgical inflammation and trauma. This is far more common in Men and Women with thick oily (sebaceous) skin. Nostril size discrepancy present prior to Rhinoplasty may become more evident once the nasal tip is lifted. Achieving perfect nostrils may not always be possible. Bent or crooked Nose: If you having a crooked (bent) nose corrected at the time of your Rhinoplasty please note that making such noses dead straight is impossible. Most of the population have some degree of bend in their noses which goes unnoticed. Secondary or Revisional surgery may need to be performed in order to finalise the outcome of Rhinoplasty. This is far more common in Men and Women with thick oily (sebaceous) skin. The best time to perform this is around 12-18 months after the first operation. Revisional surgery is complex and requires extremely experienced surgeon. The problems that can be addressed include:
    1. Excessive nasal length
    2. Round tip & Polybeak deformity
    3. Supratip scarring
    4. Residual hump or Excessive hump removal
    5. Crooked nose
      There are many inherent issues with secondary or tertiary nasal revision. The success of this operation is dependent of what the primary surgeon has done to the structure of the nose. If the damage done in the first operation is great then the result of revisional surgery can be limited. In some cases the surgeon will use Ear cartilage or cartilage from the Rib in order to build all the structures destroyed by the primary surgeon. Bone use is no longer recommended in revisional surgery. dr-tavakoli-performing-rhinoplasty-surgery-at-Suite-1-Level-1-376-New-South-Head-Road-Double-Bay-NSW-2028

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