Archive for the ‘Rhinoplasty’ Category« Older Entries
Friday, April 26th, 2013
It has been noted by a few patients that I see that we do not publish a gallery of before and after photos, I felt is was appropriate to explain why.
To be honest I really feel it is a breach of patient confidentiality, the couple we have were specifically for a media piece and we asked special permission for the publication. As a Father of a daughter I am very protective over a patients rights and I have made a decision on behalf of all patients we see not to embarrass them or pressure them into placing their private photo’s on the web. In a situation where for example a 21 year old female saying yes to a surgeon asking her to place the photos for publication I feel it is a moral question of if the patient really wants his or her photos on the Internet for eternity, where future partners, friends and employers can plainly view part of their medical history. We have plenty of before and afters in the rooms that can be shown on request. Secondly I think placing my best ten results on the web doesn’t really convey to a patient our breadth of skill in difficult rhinoplasty. Lastly I believe a guide to the photographs is necessary to show what the patient had, what they wanted, their computer imaging and their final result.
Please feel free to ask for before and after photos specifically matched to your issue and we can go through them during our consultation or with our specialist cosmetic nurses.
Friday, February 8th, 2013
I often get asked what the correct credentials are for performing rhinoplasty and it is very difficult for the patient and potential rhinoplasty candidate to separate the truth from the media hype and surgeon marketing machine.
Quite simply rhinoplasty is a difficult procedure, many procedures such as liposuction or breast augmentation are technically straightforward and that is why so many surgeons, cosmetic, plastic and even non surgeons offer these procedures. Often the difference between a good result and great result for these procedures is down to the surgeons aesthetic eye and their own preferences. Rhinoplasty is a different operation, it is a very technically demanding operation with very little room for error and tolerance for adverse outcome. at the end of the day breasts and tummies can be covered with clothes and the face cannot. Therefore a skilled rhinoplasty surgeon not only requires the skill required to perform the surgery but also needs that aesthetic eye and creative attention to detail and personally I believe should strive for a natural appearing outcome.
Australian training programs offer some exposure to rhinoplasty as it is often required to improve breathing after trauma or congenital defect (such as cleft palate), many years ago when I was training Rhinoplasty was still performed through the public system but not in large numbers. I was lucky enough to be exposed to many rhinoplasty cases as an Australian trainee but that is still not enough to be considered as a rhinoplasty expert. A surgeon (FRACS) which means they are a fellow of the royal Australasian college of surgeons is simply a must. There is lots of argument between ENT surgeons and Plastic surgeons about who is better to perform the operation but this mostly relates to historical issues and bears no relevance today. Plastic surgery of the face is a recognised part of an ENT surgeons training and a Plastic surgeon obviously covers it in their training as well. It is the post-fellowship training (training undertaken after Australian training) that is where the skills necessary are learned. many people just visit a surgeon for 6 weeks and call this a fellowship, this is not a fellowship it is an observer-ship and does not substitute for a proper training program designed to focus on facial plastic surgery.
The USA is the only country with a formal well organised training program that focuses in this area, Europe is starting one but it only takes 1-2 people per year and is only open to Europeans.
I was very privileged to apply for and accept and complete a facial plastic surgical fellowship in the United States as part of the AAFPS (American academy of facial plastic surgery). This training program in the USA only accepts around 35 applicants per year and only a few overseas trainees. It is extremely competitive and takes many years of planning and travel and exams and preparations to be able to complete it. It is governed by the ABFPRS (American board of facial plastic and reconstructive surgery) and the AAFPRS (American Academy of facial plastic and reconstructive surgery). It is open to both ENT surgeons and Plastic surgeons. No other surgical disciplines are allowed to apply. At the end of this tarining program (12 months) an exam is sat both written and oral and once the training program and exam is completed you can apply for membership. To give international standards in Facial Plastic surgery the IFFPSS website http://www.iffpss.org/ (International federation facial plastic societies) was formed, this ensures that anyone that is a member must have met certain criteria. Either a) have completed a facial plastic fellowship and passed the exam OR b) been in practice as a facial plastic surgeon or plastic surgeon and met a minimum number of cases AND passed the exam.
I hope this helps people in their research for a surgeon, remember it is your face and the best chance at a great result is the first operation.
Sunday, February 3rd, 2013
sorry for the break in posts, but unfortunately we have been very busy with not only performing rhinoplasty but the renovation of the bella vista office and the move from darling point to double bay which is due to be finished in about a months time.
Rhinoplasty is becoming more popular than ever with some sources now citing it as the most commonly performed procedure performed world wide.
As always surgeon choice is a very important decision and we encourage patients to do their research before committing to surgery. Most of our most difficult revision cases are for patients that just didn’t do their research and had a primary operation by someone who was simply not qualified to perform this difficult surgery.
Times have changed and the procedure is vastly more advanced with more predictable outcomes and better functional results than previous times. I recommend anybody considering this procedure see an ENT (ear nose and throat) surgeon with additional qualifications in facial plastic surgery or a plastic surgeon with an interest in facial plastic surgery.
What makes a great rhinoplasty surgeon? In my opinion many factors but the main ones are qualifications and “post-fellowship” training as Australian graduates are trained through the public system there is simply not enough cosmetic cases to give them enough experience. exposure to multiple cases, revision cases and a natural aesthetic eye are essential. dont be afraid to ask the surgeon how many of these surgeries he/she has has done and what their additional training is, if the surgeon is evasive or gets upset with the question then the answer is fairly obvious. Finally for this post I strongly recommend to not travel overseas as the lack of follow up rules it out as an option. You need ready access to your surgeon post-operatively and this simply cannot occur if you are in another country. Close and good post-operative care is just as important as the surgery.
to enquire about rhinoplasty surgery please call +61 2 88833699 or locally 02 88833699, we have a good follow up program for people based in Australia and are travelling interstate but please tell the reception staff as additional time needs to be booked for these appointments.
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Posted in Functional Rhinoplasty, Rhinoplasty, Uncategorized | No Comments »
Friday, November 11th, 2011
One of the most common causes of concern after rhinoplasty is a rough dorsum or palpable ridges. These are common after dorsal humpectomy and osteotomies, particularly in thin skinned individuals. I have been using a new product whch is a collagen matrix which acts as a very thin spacer between the bone and skin with excellent results. This product (Integra) prevents and treats dorsal irregularity and is a fantastic addition to the armamentarium of the modern Rhinoplasty surgeon.
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Saturday, September 10th, 2011
It is an unfortunate reality that there are many people that are unhappy with the results of their cosmetic surgery. Often these patients have seen Cosmetic Surgeons that are not appropriately qualified or had “overseas” cosmetic surgery holidays. There are many reasons that this is not a great idea but for patients that have already had the surgery and are unhappy with the results this advice may come a little late.
Surgery that has been performed may be able to be completely or partially reversed or certainly improved. Patients seeking Facial Plastic/Cosmetic procedure reversal or revision should make an appointment to see Dr Pincock at Sydney Facial Plastics at 02 88833699 or for overseas patients +61 2 88833699
For patients seeking revision or reversal of a body procedure they should make arrangements to see Dr Tavakoli – please visit his webpage by pasting the following address in your browser http://www.drtavakoli.com.au
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Posted in Blepharoplasty, Breast and Body Cosmetic Surgery, Facelift, Otoplasty (Ear Reshaping), Rhinoplasty, Uncategorized | No Comments »
Saturday, September 3rd, 2011
As I have mentioned before, Revision rhinoplasty is a challenging procedure for both the patient and the surgeon. For the patient because its often an emotional experience to go through another surgical procedure when they had hoped the first procedure would yield the perfect result and also for the surgeon because a) Revision rhinoplasty is a technically demanding procedure and b) managing the patients expectations and anxiety about a second procedure.
First and foremost it is extremely important that the patient wait an appropriate time between their primary procedure and a secondary or revision rhinoplasty. It is surprising despite how many times I inform patients about the time taken for subtle swelling to settle down, many patients will ask within the first month after a rhinoplasty if the nose is still swollen – of course ! I also get many second opinions from patients who have recently undergone surgery with another surgeon and are unhappy with the results and are disbelieving of the surgeon that the nose is still swollen. It is imperative that the patient understand that the healing process takes time and although most of the swelling settles by 3 months very subtle changes continue for up to 18-24 months.
If a patient seeks a revision or secondary rhinoplasty, as always it is important to make sure patient and surgeon “are on the same page” as far as desired outcome and whether that is a realistic outcome.
common revision rhinoplasty problems and the approach to correction
- further change to nasal shape – usually the result of surgeon wanting to be conservative or patient stating they did not want a major change when in fact they did. It is important to use computer imaging here to make sure both parties are aware what the desired outcome is and whether it is achievable. in particular patients will often feel their nose is over-projected after surgery. It can take some time for the nose to settle after surgery.
- asymmetry – if it is bony it is fairly straight forward and can be approached by an endo-nasal approach. if it is tip asymmetry this is more complex and will require an external approach. tip asymmetry within the first 12 months of surgery can still be related to differential rates of tip oedema resolution. Bony asymmetry can be addressed early if obvious, tip asymmetry should be delayed till at least 12 months after initial surgery unless its clear it will not resolve
- irregularity of underlying bone – this can be a common cause for patients to seek a referral or be concerned post-operatively. it is very common after surgery for there to be irregularity at the sites of bony osteotomy. These settle with time. It only needs to be addressed in the case of osteoma formation or if the irregularity is visible
- over-resection of nose – fake appearing nasal shape – this is unfortunately still a common occurence, the nose is small, very upturned and often blocked. This is almost always the result of a closed rhinoplasty technique with over-resection of lower lateral cartilages or “cephalic trim”. This needs to be corrected via an external approach rhinoplasty with an alternate source of cartilage stock. either ear or rib cartilage. Surprisingly I do occasionally get asked to achieve this look for some patients, in this situation most people will realise its not a desirable appearance after some explanation.
- post rhinoplasty nasal obstruction – very rare when performed by an ENT trained facial plastic surgeon, and most general plastic surgeons specialising in rhinoplasty recognise the at-risk patient prior to surgery. most rhinoplasty involved making the nose smaller and this can reduce airflow in a patient with a marginal nasal airway. This can be corrected quite easily by an ENT (ear, nose and throat surgeon) and does not require an external incision.
Undergoing rhinoplasty can be an extremely positive experience. It is imperative that a patient choose their rhinoplasty surgeon wisely. Visit http://www.rhinoplastysydney.net.au or call us at Sydney Facial Plastics on 02 88833699 if in Australia or +61 288833699 from overseas for more information about making a consultation regarding rhinoplasty.
Sunday, August 14th, 2011
Anyone that has had a bad cold or flu knows how frustrating nasal obstruction can be. Human beings are obligate nasal breathers which means that breathing through the mouth is possible but not preferable which is why nasal blockage is so annoying. There are five main reasons a nose may be blocked
1) deviation of the nasal septum
2) turbinate enlargement
3) nasal mucosal lining inflammation
4) adenoidal enlargement (most commonly in children)
5) external nasal deformity (including alar and tip collapse)
It is imperative that a correct diagnosis is made for your nasal obstruction as treatment needs to be directed at the exact problem. For example. performing septal surgery on someone with bad hay fever/allergic rhinitis is a waste of time. Similarly giving nasal steroid spray to someone that has an extreme septal deviation is not going to work.
An examination of the nose must be performed initially to assess the cause of nasal obstruction. Mucosal irritation can be treated with nasal sprays, immunotherapy or UV light therapy (rhinolight). Anatomical abnormalities such as adenoid enlargement, deviated nasal septum, turbinate hypertrophy pr external nasal issues are all treated surgically.
I often see desperate patients who have had 3 operations on their septum that clearly have unaddressed mucosal disease or an external nasal deformity such as alar collapse that is easily rectified.
I am dedicated to correctly diagnosing the cause of a patients nasal obstruction and treating it appropriately. Please call 02 88835368 to book a consultation for nasal obstruction. For any cosmetic disorders of the nose please call 02 88833699 or visit htttp://www.sydneyrhinoplastyexpert.com
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Thursday, July 7th, 2011
The dorsal hump or “high nasal bridge” is the most common developmental deformity that brings people to seek rhinoplasty. Many times potential rhinoplasty patients feel that it is relatively easy to just “shave it off”. Removal of a dorsal hump is actually quite easy to do, but making it look natural and smooth is the challenge. This is particularly the case in thin skinned individuals where any irregularity can be seen through the often paper thin skin that covers the dorsal hump.
Dorsal humps can be either bony or cartilaginous but most often are a combination of both. My technique is to expose the hump completely and then take it down by shaving it about 1/2 mm at a time. I think this a good way to make sure not too much is removed which results in a very artificial overdone appearance.
So what is the ideal dorsum?, well it differs for everyone and is a combination of several factors including skin type, facial bone structure, cultural background and personal preference. This is where computer imaging is very beneficial as many patients think they want a certain profile but realise it does not suit them after seeing the imaged profile. Personally I think a straight or very slightly convex dorsum is desirable in a male and a straight or very gentle concavity is desirable in a female.
It is very important to identify a low nasal takeoff or nasal radix on initial assessment as this can lead to over aggressive dorsal humpectomy if not recognised. In these cases a small radix graft with crushed cartilage and a conservative rasping of the dorsal hump yields a very natural result. This is especially true in asian rhinoplasty where the nasal take off point is often very shallow.
To discuss the possibility of dorsal hump surgery you should see a trained rhinoplasty surgeon, which is either an ENT surgeon with specialised training in facial plastic surgery or a general plastic surgeon with an interest in facial surgery. Make sure your surgeon has an FRACS qualification.
please visit http://www.rhinoplastysydney.net.au for more detailed information on rhinoplasty.
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Saturday, June 25th, 2011
Dr Pincock has always travelled to Wollongong in the Illawarra to consult patients in a combined clinic with Dr Stuart Mackay of Illawarra ENT and Head and Neck. He has recently extended his commitment to the Illawarra region by seeing patients at least once per fortnight and operating on patients at either one of two excellent medical institutions in the area, either Wollongong day surgery or Figtree Private Hospital. For more information on making an appointment to see Dr Pincock in the Illawarra region please paste the following address in your browser: http://www.illawarraent.com.au/ or visit www.illawarraent.com.au
Appointments can be made by calling Sydney Facial Plastics on 02 88833699 or calling Illawarra ENT, Head and Neck on 02 42261055
Dr Pincock has a pure facial plastic and reconstructive practice in the Illawarra and therefore only see’s patients for the following issues there
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Posted in Blepharoplasty, Botox, Facelift, Facial Implants, Fillers, Functional Rhinoplasty, Necklift, Otoplasty (Ear Reshaping), Rhinoplasty, Skin resurfacing | No Comments »
Friday, June 3rd, 2011
In Revision or secondary rhinoplasty, often the end result is a harsh look with significant asymmetry, this can be particularly evident in thin skinned individuals. Crushed or diced cartilage can be used to soften the nose and create a more natural look, asymmetry can also be addressed. It can also be used to gain projection, and achieve up or down rotation. It is particularly advantageous in the nasal tip.
Dr Pincock uses this technique in all rhinoplasty operations but it is a critical manoeuvre during revision or secondary rhinoplasty. Because he is a fully trained ENT (Ear, Nose and Throat) Surgeon his ability to locate and remove cartilage from the inside of the nose and ear is very useful for revision rhinoplasty.
For more information on revision Rhinoplasty please visit www.rhinoplastysydney.net.au
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