Rhinology — Dr. med. Florian Bast
Highly skilled London-based ENT surgeon with a specialist interest in rhinology and facial plastic surgery. Working at Guy’s and St. Thomas´ Hospital and Harley Street London and main work is Rhinoplasties.
Florian Bast, FCRS, Otolaryngology, Rhinology, Facial Plastic Surgery, Rhinoplasty, Septorhinoplasty, Nasal Surgery, Septal perforation, Balloon Sinuplasty, Balloon Dilation, Eustachian Balloon Dilation. Sinus surgery, Chronic Sinusitis, Snoring, Sleep Apnoea, Blepharoplasty, Otoplasty, Pinnaplasty, Scar correction, Filler, Injectables, Harley Street, Harley Street Nose Clinic, quality, German
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Rhinoplasty Procedures

 

Mr. Florian Bast M.D. FRCS is a leading ENT in the UK, specialising in facial plastic surgery with a focus on cosmetic and reconstructive rhinoplasty procedures. 

 

Initial consultations for rhinoplasty procedures are offered at our consulting rooms in 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 our care. Most surgical procedures are carried out at the world-leading Weymouth Hospital in London.

 

To learn more about your treatment options and care with us, please contact us here.

 

Rhinoplasty

Correction of Form and Function of the Nose

Dr. med. Florian Bast

The main reasons for nose surgery are: improvement of nasal breathing (septoplasty); 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 and visible scars are avoided. 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.

Differences between open and closed rhinoplasty.

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; the advantage of open rhinoplasty is better intraoperative views and access. The choice of procedure is always based on the patient’s needs. Prior to 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 anesthesia. In some cases, 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. There is a risk of haematoma (collection of blood), after surgery, particularly in the area under the eyes. This risk can be reduced by the operating technique itself and by applying regular cooling packs to the area, which also helps to alleviate discomfort. A strict regime of self-care of the nose is required following surgery to ensure optimal healing. Patients will receive individual recommendations and check-ups.

Functional, Endoscopic Nose and Sinus Surgery

Including Endonasale Tear Duct Surgery

Dr. med. Florian Bast

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 in 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 sence 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; and a decline in general well-being.

I will offer a medical or surgical plan of treatment depending on the patient’s needs following a thorough history and 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 the majority of 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 and endoscopic approach (DacryoCystoRhinostomy DCR).

Functional Surgery of the Nasal Septum Including Septal Perforation Closures

Dr. med. Florian Bast

Obstruction to breathing through the nose may 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 anesthesia. A small incision is made in the mucosa of the nasal septum, excess material such as ridges and spurs are removed, and uneven areas straightened. At the end of the surgery, the wound is closed with dissolvable sutures. I 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 will be in instructed in an after-care regime including salt water rinses, inhalation treatment, nasal ointment and decongestant nose drops.

It is most likely that at the time of the septoplasty, I will reduce the size of the inferior turbinates as well. 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 change in the shape of the nose. If topical therapy does not relieve the symptoms, surgical closure and if needed aesthetic reconstruction can be considered. This can be done via and open or closed approach; same incisions that are used 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.

At the end of the 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 extremely important not to blow the nose for several weeks.

Balloon dilation for Eustachian Tube Dysfunction

Dr. med. Florian Bast

Overview

Eustachian tubes are small tubes that run between the middle ears and the post nasal space. They are responsible for equalising ear pressure as well as draining and protecting the middle ear. The eustachian tubes are usually closed except when chewing, swallowing, or yawning.

These passageways are small in size and can become plugged for a variety of reasons. Blocked eustachian tubes can cause pain, hearing difficulties, a feeling of fullness in the ears, dizziness, popping sounds and tinnitus.  Such a phenomenon is referred to as Eustachian Tube Dysfunction (ETD).

ETD is a relatively common condition.  Depending on the cause, it may resolve independently, or through simple at-home treatment measures.  Severe, recurring and chronic cases may require a visit to the doctor.

The length of time that ETD symptoms last depends on the initial cause. Symptoms from altitude changes, for example, may resolve once you return to the altitude with which you are acclimatised whereas illness and other causes of ETD may result in longer-lasting symptoms.

The most common causes of ETD are allergies, chronic rhinosinusitis and the common cold. These conditions may cause your eustachian tubes to become inflamed or clogged with mucous.

Activities such as traveling at high altitude, flying on a plane, scuba diving, and simply taking an elevator or riding the underground train,  all of which involve a change in altitude, may elicite symptoms of ETD.

Endoscopic balloon dilation for ETD is the first technique that truly treats the cause of the symptoms experienced, and recent studies have demonstrated superior symptom improvement compared with medical treatment (0% complication rate).

I performed the first endoscopic balloon dilation for Eustachian Tube Dysfunction in 2011 in Germany shortly after the device was approved for the German market.

The treatment may be performed under general anaesthetic, or local anaesthetic +/- sedation.

I am happy to explain the procedure and the diagnostic pathway in details in person.

More Information

Balloon Dilation for Sinus Problems

Dr. med. Florian Bast

Overview

Balloon sinus dilation is a minimally invasive technique for selected patients with chronic rhinosinusitis and barosinusitis.
The aims of balloon sinus dilation are:
• to provide relief from uncomfortable and painful sinusitis symptoms
• to unblock sinuses without invasive surgery

The treatment may be performed under general anaesthetic, or local anaesthetic +/- sedation.
Tiny balloons are carefully directed into the blocked sinus openings.
Once the correct position is confirmed, the balloon is inflated to high pressures to stretch the narrow channels.
The whole procedure takes only a few minutes. When performed under local anaesthetsia patients should only feel slight discomfort when the balloon is inflated.

What is barosinusitis?

Barotrauma of the paranasal sinuses is a risk factor for anyone exposed to ambient pressure changes.  These pressure changes most often result from travel through mountainous regions, flying, or diving.  Barosinusitis is characterised by inflammation of one or more of the paranasal sinuses. Inflammation is caused by a pressure gradient, almost always negative, between the sinus cavity and the surrounding ambient environment.

More Information