Rhinoplasty – aka nose job – is the second most popular cosmetic surgery procedure searched for in Australia.
It comes behind breast augmentation and ahead of tummy tucks, facelifts and so-called mummy makeovers in that order, according to data from a 2016 RealSelf study collected from 650,000 Australians (79% female and 21% male).
“While rhinoplasty is one of the most popular cosmetic surgery procedures, this does not mean it comes without risks,” says Dr George Marcells, one of Australia’s leading rhinoplasty anD facial surgeons.
“These risks are minimised when the surgery is performed by a highly skilled, experienced and trained facial plastic surgeon.
“As such a surgeon, my work focuses on all areas of the face, including the deep plane facelift, eye area rejuvenation and rhinoplasty.
“Rhinoplasty is the most popular procedure – 50-60% of my practice. A successful rhinoplasty procedure can have a positive impact on addressing breathing issues as well as restoring harmony to appearance.”
SPA+CLINIC gets the lowdown from Dr Marcells what you and your clients should know before proceeding with nose surgery.
S+C: What have been the major changes to rhinoplasty techniques over the last five years?
GM: Surgical techniques are always evolving. To be able to address the needs of patients, a surgeon needs to stay abreast of developments. Many of these are subtle but by understanding and applying the nuances it can make a big difference to the outcome. There is a better understanding, for instance, of how to use rib cartilage for augmentation.
S+C: Could you describe the different techniques?
GM: Broadly speaking, surgical augmentation involves placement by an open or closed approach of augmentation material. This usually involves the patient’s own cartilage harvested from the septum, ear or rib. Implants such as silicone and Goretex may be used but run the risk of infection or extrusion.
The open structure techniques, which I favour, require more training and experience to perform, but ultimately deliver a more satisfying and longer lasting result.
S+C: What qualifications does a surgeon need to be able to perform the procedure?
GM: As ear, nose and throat (ENT) and facial plastic surgeons, our work focuses entirely on the face. I would recommend this advanced level of facial anatomical knowledge as the benchmark.
S+C: Who is a good candidate for rhinoplasty?
GM: Anyone who has concerns about the shape of their nose or who has breathing difficulties.
S+C: Tell us about non-surgical rhinoplasty.
GM: Non-surgical augmentation involves injection of a dermal filler material, usually a hyaluronic acid.
Again, in-depth knowledge of facial anatomy and an understanding of the nuances of different dermal filler substances are the keys to success.
S+C: Who is a good candidate?
Non-surgical rhinoplasty may be useful to the patient who is not ready for surgery but wants to assess the difference a subtle change to the appearance of their nose can make. It may also be useful for patients that want their nose made larger.
S+C: How long do results last?
GM: Performed well, revisions are rarely needed following rhinoplasty with open approach.
S+C: What are the limitations of non-surgical approach to nose jobs?
GM: It cannot address breathing difficulties. As well, the results are not long lasting. They cannot make a large nose smaller. There is a risk of infection, inflammation and possibly skin loss and scarring.
S+C: What are the benefits?
GM: It’s a less invasive approach that may be suited to the patient who seeks a subtle change.
S+C: How popular is the treatment?
GM: Non-surgical rejuvenation is gaining popularity as patients become more accepting and aware of what can be achieved with fillers. However, the surgical option is still more popular for anyone wanting lasting changes to their nose.
S+C: Please describe the patient experience, starting with their initial consultation.
GM: My first role is to listen to the patient – to hear their concerns both functional and appearance-wise. Next I perform thorough physical examinations to assess breathing and suitability for surgery. I use computer imagery in the consultation to help communicate what may be possible to achieve with surgery. The prospective patient is more readily able to assess if the outcome achievable matches their desire with this visual representation. But we always stress that the computer image is a guide only.
The consultation is vital as it establishes a trusted relationship, providing an opportunity for the prospective patient to have their questions answered, be fully informed, coming to an agreement about the kind of nose that will best suit them and meet their expectations and so ultimately feel comfortable with their decision.
It’s crucial to have agreement and, for this reason, we do not rush things.
Following the consultation and after a recommended time frame for the patient to fully assess things, preparation is made for the surgery.
S+C: Do you still see a lot of patients who want the same shaped nose as an admired celebrity, even if it’s entirely wrong for their face? How do you deal with this?
GM: The idea of what makes a beautiful nose is very individual. With celebrities upheld in mainstream media as icons of our time, we do have patients who come to us with photos of their favourites and ask us to replicate.
This is only ever the starting point of a conversation in close consultation. From here, we take measurements of the person in front of us and compare with what the celebrity nose is like. Patient education is critical.
We utilise computer imaging to highlight the changes that would be most in harmony with the individual in front of us…. mindful to accentuate their positive qualities.
In these cases we take extra care to ensure there is an evolution in understanding what is best for them is to be themselves, not someone else.
S+C: What is the patient downtime after rhinoplasty?
GM: After surgery, ideally two weeks rest is recommended. We maintain close supervision of patients in follow-up consultations and after care.
S+C What are the hallmarks of a successful rhinoplasty?
The person feels more confident with their appearance and can breathe better. There should furthermore be no telltale signs of the surgery having been performed – the nose after surgery is in harmony with the face. Features such as the eyes and lips are more [attractively] prominent when the nose is in harmony.
The positive feedback we receive from clients, and in many cases from family members of our clients, is one of the most rewarding aspects of our work. Sometimes breathing issues include snoring and disrupted sleep… when this is improved, it impacts positively on many lives.
S+C: What happens when rhinoplasty is performed badly?
GM: It impacts negatively on a person’s appearance and also can make their breathing issues worse. A collapsed septum or deformities in shape are examples of unsatisfactory outcomes.