Septoplasty

This procedure is known as a tip rhinoplasty. It involves adusting the size and shape of the cartilaginous skeleton that has a major and important influence on the size and shape of the nasal tip. The procedure can either be carried out as a “closed operation” which involves scarring inside the nostril but often an open approach is used which results in a small scar on the collumellar (the bridge of delicate skin between the nostril).

Most certainly! During consultation I am happy to share before and after photos with you of people who have had the same procedure(s) you are considering. By doing this during the consultation, and in person, I have the opportunity to relate the example specifically to your situation, highlighting outcomes and helping with expectations.

A decision to move forward with surgery following a consultation forms the basis of a contract between surgeon and patient; if you are not comfortable with your medical professional in this process then you certainly must seek out a second opinion. I am happy to provide a consultation for someone who has already had a consultation with another cosmetic surgeon. The process is the same as any initial consultation and I will likely ask many of the same questions but this is necessary for me to make a decision about suitability, outcomes and potential risks.

The question whether a rhinoplasty would help really depends on the patient’s insight into what they feels is wrong. However, to judge the possible outcome of a rhinoplasty it is necessary to have a good idea of the true proportions of the face. This includes the vertical and horizontal relationships between the lower middle and upper thirds of the face with the apparent length of the nose from the tip to its root at the base of the forehead. The relationship of the position of the eyes as well as the width of the eyelids and the position of the eyes in relationship to the width of the nose are also important features to analyse. It is very difficult to accurately ascertain this information from photographs and to give truly objective advice, hence the reason an in-person consultation is always recommended. Wide angle photographs can distort the position of the eyes and make the size of the chin appear small. With all rhinoplasty procedures one has to be very careful in reducing the size of the nose in terms of the width of the area between the eyes and also the length because by doing this there is a chance of accentuating other features of the face unintentionally. The eyes may look further apart and because the chin is small the nose may still appear large post operatively. Perhaps the shape of the tip can be altered but only after assessment clinically by an experienced clinician who can look at your features accurately as well as the state of your health, skin and psychology that can greatly affect outcome of any surgery. With all rhinoplasty and septorhinoplasty procedures, the surgeon can concentrate on aspects of the nose which are troubling you as well as excluding any functional problems such as airway disturbance.

I think that the position of the jaw can sometimes have a significant effect on the out come of rhinoplasty. It is always important to assess the proportions of the whole face before planning any surgery that may alter the dimensions of a nose. I believe that it is wise to make sure nasal asymmetry or apparent size is not due to disproportion elsewhere in the face. For example, the nose may appear large or protruding because of a small recessed chin or an upper jaw, which is disproportionately backward in relationship to the lower jaw. The prominence of the cheeks, or the lack of, can also influence the planning of rhinoplasty especially when determining any change in projection. The surgeon should also check that a bend in the nose is true and not apparent. Abnormal neck positions, known as torticollis, can give the optical illusion that the nose is bent. Sometimes the nasal deviation is part of rare craniofacial conditions such as plagiocephaly, when the twist to the nose is part of a larger facial deformity. Lastly, the position of the eye sockets (orbits) can greatly influence the apparent shape and size of the nose. If the orbits are slightly positioned wider apart then noses can appear smaller therefore decreasing the width of the nose can accentuate the characteristic of the widely placed eyes. In conclusion, part of the planning for a rhinoplasty must include an experienced assessment of the whole craniofacial skeleton in order to advise the patient about predicted outcomes.