Posts Tagged ‘Rhinoplasty’
« Older EntriesSydney Rhinoplasty Surgeon Dr Tobias Pincock – Modern Day Revision Rhinoplasty Techniques
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.
Tags: revsion rhinoplasty, Rhinoplasty, rhinoplasty expert, rhinoplasty specialist, rhinoplasty sydney, secondary rhinoplasty, sydney rhinoplasty
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Dorsal Hump surgery – Rhinoplasty Surgery in Sydney
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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Diced or Crushed Cartilage graft in Revision Rhinoplasty
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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Rhinoplasty Specialist in Sydney
Sunday, May 29th, 2011
Rhinoplasty is an operation that should only be performed by a rhinoplasty expert or rhinoplasty specialist. Most ENT (ear, nose and throat) surgeons and Plastic surgeons have little or no experience with cosmetic rhinoplasty in Sydney due to the training schemes being largely based on the public hospital system. ENT trainee’s will get exposure to rhinoplasty procedures through the septorhinoplasty procedure for nasal breathing as cosmesis is corrected as well and rotation through private hospitals and plastic trainees will get exposure through de-gloving injuries and rotation through private hospital attachments. Therefore when seeking a rhinoplasty in Australia or Sydney you simply have to look past the doctor’s basic qualifications. FRACS is a start which means they are a qualified surgeon and being a member of ASOHNS or ASPS is better meaning they are an ENT surgeon or a plastic surgeon. However this is still not enough, your surgeon should be a facial plastic surgeon or a plastic surgeon with specialty training in rhinoplasty.
If you have any sinus disease or nasal obstruction you simply have to see an ENT surgeon with Facial Plastic Training.
Dr Pincock is a rhinoplasty expert and has dedicated a large part of his training to be a rhinoplasty specialist in Sydney. He completed a coveted fellowship in the US in facial plastic surgery and sat the US board exams in Facial Plastic Surgery, gaining him acceptance into the International Federation of Facial Plastic Surgeons, this Federation currently at the time of this post has only 3 Australian members. Dr Pincock is simply higher trained in this procedure than most other surgeons offering this procedure and that means that as a specialist in rhinoplasty he is able to offer a more natural, more aesthetically pleasing nose than most other surgeons and is able to address your nasal obstruction and sinus disease simultaneously.
For more info please cut and paste this address in your browser: www.rhinoplastysydney.net.au or visit http://www.sydneyfacialplastics.com.au/cosmetic.html#rhinoplasty
External Rinoplasty in Male 3 weeks after
External Rinoplasty in Female 8 weeks after Surgery
Dr Pincock is an expert in rhinoplasty and rhinoplasty Specialist. to make an appointment please call 02 88833699.
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What is a nosejob, nose job, rhinoplasty anyway ?
Friday, May 27th, 2011
what some people refer to as a nosejob or nose job is more correctly called a rhinoplasty.
A rhinoplasty is to change the underlying structure and therefore the shape and function of the nose.
A rhinoplasty in sydney is performed by a surgeon who is qualified to perform rhinoplasty procedures, this is usually an ear, nose and throat surgeon with appropriate facial plastic training or a plastic surgeon with a particular interest in rhinoplasty. The cost of rhinoplasty in Sydney depends on the complexity of the nasal procedure and whether it is a complete reconstructive rhinoplasty, revision or secondary rhinoplasty or primary rhinoplasty.
Rhinoplasty may be cosmetic or functional.
Rhinoplasty is also called nasal reshaping, nasal sculpting or nasal cosmetic surgery
http://www.sydneyfacialplastics.com.au/cosmetic.html#rhinoplasty
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Revision Rhinoplasty in Sydney
Monday, August 16th, 2010
Revision rhinoplasty is one of the most difficult facial reconstructive procedures. Often a secondary, tertiary or quaternary rhinoplasty has already been performed leaving the nasal cartilaginous framework ravaged and the skin overlying it scarred and abnormal.
This is one reason to get your rhinoplasty performed in Sydney by a well qualified rhinoplasty expert. This is either an ENT trained Facial Plastic Surgeon such as Dr Pincock or a Plastic surgeon who specialises in the face.
If you have already had a primary rhinoplasty and are unhappy with the results its always best to discuss this with your original surgeon first. You should not be embarrassed or reluctant to bring up certain issues with your rhinoplasty. The best rhinoplasty surgeon in the world has revision rhinoplasty patients and it is therefore not a reflection on your surgeon if you have an issue BUT how he deals with it.
If you are unhappy with seeing your primary surgeon again or have lost rapport, then seeing another surgeon may be necessary.
Remember although choosing your surgeon wisely for a first time rhinoplasty is important it is imperative that you do your research before seeing someone for a secondary rhinoplasty.
Your secondary rhinoplasty surgeon should not be contradictory to your original surgeon or make disparaging comments about your original surgery. It is impossible for the second surgeon to have an understanding of all the factors that led to the issue or have a complete understanding of the conditions of the original surgery.
Revision surgery may simply involve taking down a dorsal hump down a little further or filing down some unevenness from the osteotomies OR it may require a full reconstructive rhinoplasty requiring ear cartilage grafts, rib or even artificial material.
Remember that the nose is not just for looking good so at any stage of rhinoplasty, maintenance of a good nasal airway should be a primary goal for all rhinoplasty surgeons. If you get a blocked nose from a rhinoplasty it will drive you crazy!!!, luckily nasal obstruction following rhinoplasty or “post rhinoplasty nasal obstruction” is relatively easy for an Ear, Nose and Throat surgeon to correct.
For more information please visit www.rhinoplasty.org.au or
http://www.sydneyfacialplastics.com.au/reconstructive_surgery.html#revision
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Cheek Implants
Monday, February 1st, 2010
As we age the normal cheek volume descends downwards producing two classic characteristics of ageing.
Firstly the loss of normal cheekbone volume and definition and secondly deeper nasolabial folds
this can be addressed temporarily by fillers – in particular the new voluma from the juvederm range
http://www.sydneyfacialplastics.com.au/injectables.html
for a permanent result patients may opt for cheek implants, these are similar to chin implants but are designed to sit over the cheekbone giving a more prominent cheekbone. They are inserted through a tiny incision on the inside of the cheek and give an amazing result.
for more detailed information see this link: http://emedicine.medscape.com/article/843020-overview
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Blepharoplasty-Eyelift-Eyelid Surgery
Saturday, January 30th, 2010
Blepharoplasty is a fantastic way to rejuvenate the face. Over the years the fat pad that the eyeball sits on to cushion it in the skull can herniate out from under the eye causing a puffy appearance or bags on the lower eyelid. On the upper eyelid skin can hang down making a person look tired and even obstruct vision.
http://www.sydneyfacialplastics.com.au/cosmetic.html#blepharoplasty
Upper and lower blepharoplasty can be undertaken at the same time and in combination with other procedures, it is a very powerful technique to rejuvenate the face and turn back the clock.
Dr Pincock offers the latest techniques in this surgery that he learned overseas and has brought to Sydney. For more information see this website
http://www.eafps.org/index.php?option=com_content&view=article&id=47&Itemid=45
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Chin Implant Surgery in Sydney
Friday, January 29th, 2010
Chin position on profile is a very important determinant of facial harmony. A strong chin denotes a powerful confident man and an attractive beautiful woman. This is often found in cartoons and caricature’s which depict superhero’s with strong jawlines and weak people with a receding chin. A weak chin can be easily corrected by a chin implant with or without rhinoplasty to address a patients overall facial harmony www.sydneyfacialplastics.com.au/cosmetic.html#chin
A chin implant can be placed through an external or internal incision and is a day stay procedure.
for more information see this website http://emedicine.medscape.com/article/842915-overview
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What is a Facial Plastic Surgeon ?
Friday, January 29th, 2010
A Facial Plastic Surgeon is a qualified surgeon who has chosen to super specialise in cosmetic and reconstructive surgery of the facial region. Most Facial plastic surgeons have training in ENT, Head and Neck surgery and then undergo further training to enhance their expertise in this region, although some general plastic surgeons also decide to specialise in the facial region only. for more info visit www.aafps.com.au/html/about/about.htm
or http://www.abfprs.org/about/about.cfm
Dr Pincock has undertaken all the steps necessary to achieve the highest possible qualifications for facial plastic surgery. He completed his Australian college of Surgeons training in Otolaryngology. Head and Neck Surgery and then was given the privelege of a formal facial plastics and reconstructive fellowship at the University of Washington under the guidance of Wayne F Larrabee , who is a world expert in ageing face and rhinoplasty surgery www.larrabeecenter.com
for more info on Dr Pincocks credentials for performing Facial cosmetic surgery please click here www.sydneyfacialplastics.com.au/surgeon.html
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