Rhinoplasty, colloquially known as a ‘nose job’, is a surgical procedure to alter the nose's shape, size or structure. This procedure is carried out under general anaesthesia for either cosmetic or medical reasons, to improve breathing, for example. The upper portion of the structure of the nose is bone, and the lower portion is cartilage. Rhinoplasty can change bone, cartilage, skin or all three depending on needs and requirements.
Florian Bast is a leading expert in delivering these surgeries for patients across some of London’s most prestigious hospitals.
Initial consultations for rhinoplasty procedures are offered at our consulting rooms at 9 Harley Street. Your appointment can be booked at a time to suit you. During your consultation, Mr Florian Bast will discuss all concerns and suitable treatment options with you.
Full pre-op and post-operative care are managed by your consultant with the support of a wider team of expert health practitioners; this is standard for patients under supervision. Most surgical procedures are carried out at the world-leading Weymouth Hospital in London.
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Rhinoplasty procedures can deliver essential improvements in the functionality of the nose, breathing and sense of smell. For many, however, it is an opportunity to improve the appearance of the nose and boost confidence
Surgeries related to the nose have different names and include those for the improvement of nasal breathing (septoplasty), or modification of the shape of the nose (rhinoplasty) or a combination of both procedures (functional septorhinoplasty). Possible reasons for a rhinoplasty include:
Fracture of the nasal bone or another nasal trauma
Hump or saddle nose
Bent or buckled nose structure
Nose too long or too short
There are two main rhinoplasty techniques: closed and open rhinoplasty.
Closed rhinoplasty corrects the structures through an incision inside the nose; this avoids visible scars. In open-rhinoplasty the nose is operated on through an incision at the area between the nostrils (columella), combined with incisions on the inside of the nostrils. The skin of the nose tip is carefully lifted, and the nasal cartilages and bones are surgically corrected. At the end of the surgery, the incisions are closed with fine suture material. The small incisions usually heal very well and in most cases, are barely noticeable after a few months.
Most experts agree that excellent results can be accomplished with open as well as closed rhinoplasty.
One advantage of closed rhinoplasty is the absence of visible scars; open rhinoplasty offers better intraoperative views and access. The choice of procedure is always based on the patient’s needs. Before surgery, morphed photographs will be used during the consultation process to ensure we agree on the best approach to surgery.
The surgery takes place under general anaesthesia. Sometimes, small silicone wedges are sewn into the nose at the end of surgery for stabilisation and removed after 7-10 days. A nose plaster is also removed after 7-10 days. No tamponades are used. As with many surgeries, there are some risks, for example, bruising. This risk can be reduced by the operating technique and by applying regular cooling packs to the area, which also helps alleviate discomfort. Following a thorough consultation, this will be clearly outlined and will depend on the treatment approach chosen and your particular physiology.
The sinuses are air-filled cavities connected to the main nasal cavity. These include the maxillary sinus, ethmoidal sinuses, frontal sinus and the sphenoid bone. Acute and chronic paranasal sinusitis can occur due to an obstruction in the outflow of the sinuses. The chronic form has become more prevalent these past decades and is considered one of the most common conditions in Western industrialised countries.
Typical symptoms include: Frequent sinus infections. Excessive secretions at the back of the throat. Loss of sense of smell. Nasal discharge. A compulsion to clear one’s throat. Morning expectoration. A swelling sensation in the nose. A feeling of pressure above the sinuses. A decline in general well-being.
I will offer a medical or surgical treatment plan depending on the patient’s needs following a thorough history, clinical examination, and CT scan.
If surgery is required, this is usually functional endoscopic sinus surgery (FESS). The infected material is rinsed out of the sinuses, and the blocked passageways are opened. Healthy tissue is preserved so that the nose and sinuses may continue to function normally.
Most patients describe this process as painless. Nasal tamponades, still frequently used in some practices, are not necessary in most cases. Review and care of the mucous membrane is required in an outpatient setting, and the patient will have nasal spray, rinses, and balms to apply at home.
I work alongside an ophthalmologist in cases where there is narrowing and obstruction of the tear ducts to open them up via an endoscopic approach (DacryoCystoRhinostomy DCR).
Obstruction to breathing through the nose can be caused by a deviation of the nasal septum, septal deformity with bony protrusions, or enlarged nasal conchae. In most cases, there are various pathologies. Surgical correction of the nasal septum to improve nasal breathing may be an option for those with chronically obstructed nasal breathing or following failed medical therapy.
Rarer causes for obstructed nasal breathing are foreign matter (mostly unilateral and in children), deformity of the nose, polyps, tumours, trauma and pharmaceutical side effects.
Surgery, so-called Septoplasty, is performed under general anaesthesia. A small incision is made in the mucosa of the nasal septum, excess material such as ridges and spurs are removed, and uneven areas are straightened. At the end of the surgery, the wound is closed with dissolvable sutures. In rare cases, small foils are sewn onto both sides of the nasal septum that remain in the nose for 5-to-7 days. No nasal tamponades are required. Following surgery, you'll be given an after-care regime including saltwater rinses, inhalation treatment, nasal ointment and decongestant nose drops
It is most likely that at the time of the Septoplasty, I will also reduce the size of the inferior turbinates. This is done with a very gentle, non-cutting technique.
Obstruction to nasal breathing may also be caused by a perforation of the nasal septum. Other symptoms of septal perforations can also be recurrent nasal bleeding, discharge, crusting, loss of sense of smell or even a change in the shape of the nose. If topical therapy does not relieve the symptoms, a surgical closure is needed, and aesthetic reconstruction can be considered. This can be done via an open or closed approach, using the same incisions for cosmetic septal or rhinology surgery. In some cases, tissue such as ear cartilage, muscle fascia or biologically designed tissue is needed to close the perforation. This is always preceded by individual consultation and surgical planning.
Following surgery, small foils are sewn on both sides of the nasal septum, which will remain in the nose for 10 to 14 days. No nasal tamponades are required. After surgery, you will be instructed in an after-care regime including salt water rinses, inhalation treatment, nasal ointment and decongestant nose drops. It is crucial not to blow the nose for several weeks.
Do you have more questions about the procedures? Get in touch with us to learn more or book a consultation.