Rhinoplasty is a major potentially life changing surgery, in order to safeguard your health it is crucial to select the right surgeon. Asking the correct questions will provide you with valuable information regarding the skills and overall competence of the surgeon. This list of questions will assist you in your decision. Always ensure that all your doubts are addressed before proceeding with the surgery.
1. Are you a Certified Surgeon With Accredited Specialist Training?
Dr Rodrigo Teixeira is a qualified Specialist Plastic Surgeon, fellow of the Royal Australasian College of Surgeons (FRACS). He specialises in Aesthetic Surgery, Rhinoplasty and Facial Surgery. He is the head of the Plastic Surgery unit at the Northern Hospital (TNH) and is a consultant plastic surgeon at the Royal Children’s Hospital of Melbourne (RCH). He is also an honorary senior lecturer of the University of Melbourne.
In private practice, Dr Teixeira is a member of the Melbourne Institute of Plastic Surgeons (MIPS) in Richmond. He operates in reputable and accredited facilities in Melbourne such as, Epworth Freemasons, Warringal Private Hospital, St Vincent’s Private East Melbourne and Stonnington Day Surgery.
2. Do you have additional fellowship training relevant to Rhinoplasty?
Dr Teixeira has fellowship training in Aesthetic Plastic Surgery, including facelifts, rhinoplasty, breast augmentation, breast reduction, breast lift, abdominoplasty, liposuction and others.
Additionally, he has completed fellowship training in Craniofacial and Cleft Surgery, including treatment of congenital, developmental and traumatic nasal deformities.
3. What are my responsibilities in order to have a successful rhinoplasty?
- Understanding your anatomy assists in gauging the possibilities of the surgery. Keep in mind that previous trauma or previous surgery, thick skin, thin skin, fillers, and many other factors could become limiting factors.
- Have realistic expectations for the surgical outcome which are based on your circumstances, are relevant to your anatomy and safe to be performed.
- The motivation to seek surgery should arise from your own reasons and should not be governed by the opinion of another person.
- Avoid comparisons with Instagram models and friends. Everyone has a different aesthetic which is unique to them, what works on someone else’s face may not work on yours.
- Wait until you completely understand the treatment, the recovery and the risks. Never rush your decision. You must be comfortable and feel safe to proceed.
- It is very important to follow the instructions given by your surgeon. Often complications arise when patients do not adhere to given directives. Read any booklets given to you, take notes if necessary and ask questions until all your doubts are addressed.
- Maintain good communication with your surgeon and their team. Be straightforward about any accidents and mishappens so they can assist you in the best way possible. Avoid keeping things to yourself, if you have any concerns, share them with your surgeon, this will mitigate anxiety. Your surgeon and their team must be ready to assist you regarding all issues related to your treatment.
- Recovery is essential to a successful surgery. Give yourself sufficient time for recovery, refrain from rushing your recovery or or put yourself through unnecessary or avoidable risk.
- Attend all appointments as planned by your doctor. If you can’t attend an appointment, call in advance to reschedule. If you think that you need an extra appointment, please ask for it.
4. Am I a good candidate for a Rhinoplasty?
Wait for growth and skeletal maturity, avoid rhinoplasty under the age of16, unless it is critically necessary. There is no age limit for patients who are older as long as you are healthy, do not smoke, do not have comorbidities or take medications that add significant risk.
- Medical History
Inform your surgeon about issues such previous trauma, nasal fractures, rhinoplasty operations, injectables and fillers, threads, implants, drug use, smoking, alcohol consumption, medications, allergies, nasal congestion, sinusitis, hay fever, etc, as they may be relevant to your treatment and outcome. Have a list of your entire medical history prepared before you go for your consultation.Medical History
Inform your surgeon about issues such previous trauma, nasal fractures, rhinoplasty operations, injectables and fillers, threads, implants, drug use, smoking, alcohol consumption, medications, allergies, nasal congestion, sinusitis, hay fever, etc, as they may be relevant to your treatment and outcome. Have a list of your entire medical history prepared before you go for your consultation.
- Realistic Expectations
Commonly, patients seek an improvement in function and aesthetics and are happy to have an assessment and listen to medical advice. You should be able to communicate your main concerns clearly and objectively. Vague concerns can lead to breakdown in communication between you and your surgeon. In addition, ignoring warnings, anatomic limitations or seeking for a result that is not natural or suitable to your circumstances can lead to unhappiness and dissatisfaction.
You should be seeking treatment for yourself. Do not seek care because a partner, a family member or a friend wants you to do so.
Your surgeon should provide you with a cost estimate. As the name implies, it is an estimate and the final costs may vary depending on factors such as the choice of hospital, choice of doctor and anaesthetist, length of surgery (theatre is charged per hour, sometimes per 15 min blocks), length of admission in hospital, need for extra treatments (intensive care, return to theatre, re-admission, other specialist referral), additional investigations (blood tests, radiology), special medications and materials, etc. It is important to have spare funds available for the event of a complication or revision surgery. Ask your surgeon if procedure insurance is available.
5. What surgical technique will you use?
- Structural Rhinoplasty
Structural rhinoplasty consists of removing excessive tissue and adding missing tissue to replace, reshape and reinforce the nose where it is needed. It is mostly commonly carried out as an open rhinoplasty but there are exceptions. Generally, pen rhinoplasty allows better exposure and access to nasal tip surgery, with or without cartilage grafting, to achieve a desired contour of the nose.
- Excisional Rhinoplasty
Excisional rhinoplasty involves removal of a substantial amount of bone or cartilage from the nose and is mostly carried out as closed rhinoplasty. However, there is a greater risk of an undesirable outcome as this technique may weaken the structure of your nose.
- Preservation Rhinoplasty
Preservation rhinoplasty focuses on preserving tissues and ligaments of the nose. Your surgeon will preserve tissue on the nasal dorsum and release or remove tissue from other areas to allow reposition and reshaping of the nose. In terms of results, it is a choice for patients that want to improve the appearance of their nose, yet still wish to preserve its natural aesthetics.
- Functional Rhinoplasty
Functional rhinoplasty describes the type of rhinoplasty aimed to improve or maintain the function of the nose, particularly to enhance the patient’s breathing. Functional rhinoplasty is best indicated for those who experience difficulty breathing due to having a severely blocked nose, a deviated septum, or any other complications that impede their ability to breathe freely.
6. How long of a recovery period can I expect? Will I need time off work?
Recovery is an important element of a successful surgery. There are a number of factors and steps you need to keep in mind. Here is a breakdown of the recovery timeline:
Week 1: Nasal stent and splint are removed. Bruising and swelling is still prevalent.
Week 2: Facial swelling subsides and bruising begins to vanish.
Week 4: Early swelling has subsided and breathing will improve.
Week 6: Bone healing is advanced and high intensity workouts can be resumed.
Month 6: Nose starts showing refinement. Abnormal sensations have subsided.
Year 1+: Late swelling subsides and the final shape of the nose is now visible.
7. What are the risks and most common complications?
In general, postoperative bleeding will be mild and can be controlled by elevating the head to 60 degrees, applying ice packs to cheeks and gentle nostril pressure for 15 minutes. This should be followed by spraying each nostril with nasal decongestant. If these measures fail, the patient should be seen by the surgeon. Cauterisation with silver nitrate, anterior/posterior nasal packing, operative exploration and cauterisation, and angiographic embolisation (rare) may be required.
Infection following rhinoplasty is very rare. Early signs of infection are typical of cellulitis and include tenderness, redness, and warmth. Early cellulitis usually responds appropriately to antibiotics but internal packing or internal splints may need to be removed at this time. Purulent collections require drainage and irrigation.
- Persistent Swelling
Edema should be considered in two distinct postoperative phases: Early and Late. Early edema occurs within the first 4 weeks. Minimising early edema is best addressed by prevention using cold compresses, head elevation, taping, and avoiding salt laden foods. Late edema is present over the following several months to the first postoperative year (or longer following secondary rhinoplasty) and actually represents scar remodeling. Persistent swelling will resolve on its own. In certain situations steroid injections may be helpful to control the production of the excessive scar tissue that may occur in some areas of the nose, masking the result. The most common indication is the attenuation or loss of the supratip break, which is caused by the proliferation of scar tissue in the dead space between the skin and underlying cartilages. It is more common in revision rhinoplasty and in men with thick skin.
- Dorsal Irregularity/Deviation
Occasionally, dorsal irregularities or deviations will occur in the postoperative period. The patient is examined to determine the cause and severity. Palpation of the dorsal irregularity may reveal displacement of cartilage, bone or grafts and it may be possible to correct this with digital repositioning of the structure. Minor fullness may develop over the nasal dorsum in the first few weeks following rhinoplasty and may be due to a periosteal inflammatory reaction. In this case, the patient is instructed to massage the area in a very controlled manner to help prevent the formation of scar tissue. Dorsal deviations are treated similarly. Deviations noted in the early postoperative period may be corrected with manual pressure. Significant deviations may require early operative intervention and late presenting deviations may need operative intervention after allowing 1 year for resolution of edema and scar maturation.
- Nasal Airway Obstruction
Nasal airway obstruction in the postoperative period is either secondary to edema or anatomic. Most patients have some degree of transient airway obstruction that will resolve over 2 to 3 weeks. In many instances, the patient will notice improvement of their symptoms by using saline nasal spray two or three times per day. Nasal decongestants and anti-allergics sprays or tablets may be used if symptoms are significant but should not be used for more than 1 week. Maximal recovery of nasal airflow should occur between 3 to 4 months after rhinoplasty. Anatomic obstruction may require surgical intervention but this should be delayed for at least 1 year to allow for scar tissue maturation. The most common anatomic cause is internal nasal valve collapse or scarring in the internal nasal valve area.
8. Can I see before and after photos of Rhinoplasty patients?
Your surgeon should be able to show you photos of other patients and it can be very helpful for you to access the skills of the surgeon. However, it is important to know that not all patients give consent for their photos to be shown. While considering if you should give consent and the levels of consent you are willing to give, please note that you are allowing your surgeon to show your photos to other patients, the same way someone else allowed your surgeon to show their photos to you.
9. Do you perform Rhinoplasty surgery often? Is it a big part of your practice?
Your surgeon should have specific training and experience in rhinoplasty surgery. Rhinoplasty is the most common treatment offered by Dr Rodrigo, other common procedures are facial surgery and cosmetic breast surgery. It is best that your surgeon performs rhinoplasty on a regular basis, including different types of rhinoplasty such as cosmetic, functional and reconstructive nose surgery.
10. What happens if I am not happy with the result of my surgery?
If you are not satisfied with the results or you think that the procedure was not carried out properly, you should first take up the matter with the practitioner. Don’t ignore your feelings. You may only need a little reassurance as the healing process varies between individuals and may take extra time for swelling, bruising or the appearance of scarring to subside.Explain your concerns and ask what options might be available to make the situation better. Try not to become too angry as the doctor will want to help you as much as possible.
If your concerns persist revision surgery may also be an option. There are situations where minor adjustments may be enough to resolve the complaint. However, there will be cases that require major revision. Despite your surgeon’s experience, the medical literature recognises that complications may occur even with the best surgical care.
About Dr Rodrigo Teixeira
Dr Rodrigo Teixeira, MD, FRACS is a Plastic Surgeon in Melbourne. He has significant experience in Cosmetic Surgery, Rhinoplasty and Facial Surgery. Dr Teixeira is a fellow of the Royal Australasian College of Surgeons (RACS), member of the Australian Society of Plastic Surgeons (ASPS) and Australasian Society of Aesthetic Plastic Surgeons (ASAPS). Internationally, he is a member of the American and the International Societies.