Rhinoplasty can be performed to address a number of concerns with your nasal shape and function. These include a general dissatisfaction with the appearance of your nose - a nose that does not ‘fit the face’ whether due to genetics, injury or disease can greatly affect your overall appearance and self-confidence. Rhinoplasty can also be used to correct particular breathing problems which may be pre-existing or have resulted from trauma. Rhinoplasty is usually performed with Septoplasty (straightening or reshaping of the central cartilage and bony internal framework of the nose).
It may even be necessary to address your sinuses during rhinoplasty (Endoscopic Sinus Surgery). Both form and function must be addressed to achieve an aesthetically pleasing and functional nose. Dr Imani's extensive training in both Facial Plastic Surgery and Otorhinolaryngology (Ear, Nose and Throat Surgery) makes him one of only a few specialists in Perth expert enough to deal with rhinoplasty surgery. Dr Imani has spent many years specialising in addressing all aspects of nasal surgery, and he has a particular interest in rhinoplasty - an area known to be the most challenging in facial plastic surgery. Nasal surgery requires attention to detail and precision in execution, making it a highly specialised field.
Dr Imani strives for a natural appearance in performing all his facial procedures. A conservative approach is the key to his success using time-tested techniques to help avoid complications and an unnatural look. Many changes are achievable with a carefully selected rhinoplasty approach. The nose can be made smaller or larger and the shape, size and relation of the tip can be changed.
Dr Imani's rhinoplasty philosophy emphasizes strong nasal support to ensure a predictable long-term outcome. Rhinoplasty is difficult because every nose is different and the anatomy varies from patient to patient. As the anatomy varies so must the techniques used for correction. Dr Imani performs a precise and complete nasal analysis to spot all of the aesthetic and functional deformities. He then formulates a surgical plan that is conceived to correct the specific deformities.
Dr Imani does not have a standard aesthetic goal in nasal reshaping. He considers the person’s age, racial origins, height, and most importantly their desires about their looks before formulating a surgical plan.
Click here to contact IMANI Facial Plastic Surgery and Cosmetic Specialists for a consultation for your nose rhinoplasty surgery in Perth or see below for more information about the following:
What is involved?
Dr Imani utilises techniques, which preserve the nasal structure with minimal excision of supporting tissues. Excessive removal of supporting structures results in an operated look that frequently exhibits a pinched, upturned tip, with nasal obstruction. These problems can be avoided through the use of specialized operative techniques.
Dr Imani considers nasal function to be as important as the aesthetic outcome. Dr Imani will not compromise nasal function to give a patient a smaller nose. In fact, most of his patients breathe better after surgery and have improved nasal function over the long term. Even if the patient denies nasal obstruction, Dr Imani will maximize the nasal airway to avoid nasal obstruction as they age. There is no need to compromise nasal function for a better-looking nose. All patients presenting with nasal obstruction undergo special nasal function testing to determine the degree of nasal obstruction and the improvements gained after surgery.
Dr Imani believes that a nose should be in harmony with the other facial structures. In patients with a weak chin, chin augmentation is important to help balance the nose with the weak chin. The cheeks play an important role in nasal aesthetics, often a full cheek or malar eminence hides the length of an over projected large nose. In patients with small, underdeveloped or aging cheeks, dermal fillers or surgical cheek augmentation with implants will produce amazing results when combined with rhinoplasty.
In patients who have had a rhinoplasty performed years ago, revision rhinoplasty may be required if for example, the cosmetic portion of the procedure compromised the functional portion causing a secondary breathing problem. These patients must undergo construction of a new supporting structure that will provide the proper shape. Performing such major reconstructions requires an accurate understanding of three-dimensional nasal contours. When a patient undergoes rhinoplasty, scar tissue develops which may complicate subsequent reconstructions. There is tremendous variability in revision rhinoplasty deformities and some patients have problems that are much more difficult to correct. Dr Imani's highly specialised training allows him to deal with complex revision rhinoplasty surgery.
How do I plan surgery?
At the initial consultation, you will be discussing the features of your nose that you are unhappy with. Dr Imani will examine you and then discuss the improvements that he feels are realistically achievable. Photographs of your face are taken and analysed. Whilst you may find it useful to bring photographs of a nose/face that you like and you will be able to view results of previous patients of Dr Imani's, bear in mind that it is not possible to exactly replicate a face or nose. The proportions of your tissues (cartilage, bone, skin) and the rest of your face are unique and will always be a little bit different to anyone else.
Dr Imani will also discuss with you the steps involved with the procedure and the possible risks involved. Our staff will provide you with an idea of the costs and information to read on the surgery. You may be able to claim a portion of the cost of your surgery from Medicare and your private health fund. This is particularly likely to be true if you have breathing problems related to your nose or if you have a history of trauma to your nose or a birth defect. Dr Imani will usually see you a second time prior to any surgery.
If you live outside the Perth metro area, please contact the office in advance so that the relevant information is sent to you ahead of time. You will be more fully informed at the first consultation and any delays before surgery can be reduced.
Are there risks involved?
Yes. There are risks involved in all medical procedures. Dr Imani will gladly discuss and disclose all possible risks, benefits and alternatives involved at the time of consultation. Our practice staff will provide you with procedure specific information sheets after your consultation.
Preparation for your surgery
Please read the preoperative information sheets provided to you two weeks before surgery. You should avoid all herbal preparations, Vitamin E, Fish oil, Aspirin, Nurofen and similar non steroidal anti inflammatory drugs for two weeks before surgery. Dr Imani will discuss your usual medication intake at the time of preoperative consultation.
Anaesthesia:
General anaesthesia or local anaesthetic with sedation.
In/Outpatient:
Inpatient short stay/overnight or outpatient/same day.
Length of Surgery:
2-6 hours.
After Surgery:
If performed correctly, Rhinoplasty is associated with minimal pain and discomfort. You may experience a dull headache and a congested feeling inside your nose in the first 24 hours after surgery. Simple painkillers will be supplied and should be enough to control your pain. You should rest quietly with your head elevated with two to three pillows, and pillows on either side of your head so that you do not roll over onto your face. You should do this for seven days. You should use the nasal sprays and nasal saline douches as prescribed for you after your discharge. It is important to clear your nostrils with hydrogen peroxide (3%) and apply the antibiotic ointment supplied regularly. Swelling and bruising under the eyes is not uncommon but resolves within one week. It is normal to feel congested and even down and depressed for a few days after surgery. The splint on your nose will be removed seven days after surgery. Avoid blowing your nose forcefully for approximately six weeks however with the aid of your nasal sprays, you may blow out of your nose gently.
Pain Score:
Minimal pain, relieved with simple painkiller.
Nasal Packing:
Dr Imani almost never uses a pack inside the nose, so you can breathe through your nose when you wake up from your anaesthetic or sedation. The key is to wash the inside of your nose with saline douches to clear clots and the absorbable gels that Dr Imani places in the nose.
Recovery and getting back to work:
Back to work: 1-2 weeks.
Normal social, recreational, travel activities: 2-3 weeks.
Activities that are more strenuous: 2-3 weeks.
Avoid more strenuous impact exercises or activities and direct sun exposure: 6-8 weeks.
The new you:
You will be able to see the improved shape of your nose immediately after the splint is removed, however, you will not see the long-term results for quite some months (6-24 months). Small degrees of swelling persist for three to six months and subtle changes in the shape of the cartilage and shrinkage of the skin can take up to a year or two. If there is something about your nose that alarms you, feel free to inform Dr Imani and his staff. It may just be a passing phase, as much of the reshaping of the nose continues to occur in the months after surgery. A few of our patients (less than 1%) may require a second touch up procedure or revision surgery. This is usually performed a year after surgery when the tissues have settled and are much easier to work with.
Duration of Results:
Long-term.
Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified surgeon.
Cost of Rhinoplasty:
The cost of rhinoplasty in Perth is varied depending on your particular needs, the nature of your problem and the experience and the expertise of the rhinoplasty specialist you see.
The price for rhinoplasty or nose job in Perth with Dr Imani ranges from:
$5000-$30000
Pre Rhinoplasty Instructions:
Common to all types of surgery, you will need to stop eating and drinking fluids for a set amount of time the evening prior to your surgery, most often this will be midnight (at least 6 hours from the time of the actual anaesthesia). We will confirm this with you. However if in doubt, its best to fast from midnight before surgery. Eat and drink plenty the night before, refrain from eating heavy fatty meals.
In some cases, defined by Dr Imani, you may need to take certain medications with a small sip of water. Dr Imani or the designated anaesthetist will advise you of this. You may take your usual medication, which needs to be taken on a daily basis. Please advise us of all medications and supplements that you are taking.
In order to give you the least possible chance for infection, shower with an anti-microbial soap and shampoo the evening before. This removes and discourages the growth of bacteria on the surface of your skin. Try not to cause too much irritation of the face, specifically the nose, while scrubbing. Repeat this process the morning before the procedure. Shampoos or liquid soaps containing tee tree oil or Chlorhexidine or Cetramide are sufficient.
Don’t wear nasal or any facial piercing to the hospital. We don’t want them to get lost, and they may be a source of infection as they have bacteria on their surface. Trim your nasal hairs with a pair scissors or trimmers the day prior to surgery.
In the two weeks before and after surgery observe the following general rules:
Start using IMANI Specialised Skin Care Regime to optimise your skin for healing, apply the following to your face
a. Exfoliating enzyme cleanser twice a day (2-3 drops) - face
b. Conditioning enhancer with each serum application (2 sprays) - face
c. Clearing serum II (2 drops), at night 1 hour prior to going to bed - nose
d. Enzymatic firming mask twice a week (2-3 drops spread over the nose, leave on skin and wash after 15-30 minutes) face
e. L-Hyaluronic Hydrating Moisturiser (2-3 drops in the morning) face
f. Hydrating TiO2 Sun Protection when heading out in the sun face day of the surgery:
Wash your face and hair
Do not consume any food or water when you wake up.
Take your usual regular medication with a small sip of water, unless instructed otherwise by Dr Imani or your anaesthetist
Remove all make up
Men-shave the morning of the surgery
Do not wear contact lenses
Leave all valuable at home
Arrange for a lift to from the hospital when you are discharged the same or the next day. You will need adult supervision for 24 hours post anaesthetic. You cannot drive back home yourself.
Do not sign or contemplate any important legal documents or business matters in the 24- 48 hour period after anaesthesia. Medications may alter your judgment. This will be a longer period if you are taking painkillers after surgery.
Immediate Post Procedure Instructions:
Inform the attending nurse if you begin to experience pain or nausea (this is rare) in the recovery room. The nurse will be able to administer medications to correct the nuisance quickly. The anaesthetist will prescribe you prescription pain, nausea, and anti-inflammatory medications for your recovery period.
Prevent injury to your nose. Minimise all activities and be very careful not raise your heart rate and blood pressure by exercising.
Avoid blowing your nose for 2 weeks. If you sneeze, try to keep your mouth open. Wipe/dab your nose very gently around the nostrils with a clean soft tissue paper. Avoid rubbing or abrading the small stitches/sutures under the nose with tissue paper.
To cleanse the crusts around the nostrils, use a clean cotton wool tip dipped in 3% hydrogen peroxide (purchase from the chemist)– be gentle and do not rub off the sutures/stitches for the first 7 days, after day 7 you can start scrubbing the suture lines with 3% hydrogen peroxide. Moisten the stitches/suture line with antibiotic ointment (Kenacomb) using a clean cotton wool tip four times a day. The incisions should be kept moist at all times.
Wash your nose with Sinus FLO high volume washes (see YouTube video) 4-6 times a day. You can expect clots and a bloody discharge in the first 7 days after surgery. It is very important to wash your nose regularly to clear away the blood debris for optimal healing
Use the prescribed decongestants: Flo rapid relief to decongest your nose for a maximum of 5 days after surgery. You can use 1-3 sprays twice a day to decongest your nose or to stop your nose from bleeding. Take you antibiotics as prescribed. Eat a cool diet (Cold food and icy drinks) for 7 days. Sleep with your head elevated at 30-45 degrees for two weeks
Do not sleep on your side. Do not bend your head below your waist level
Change the dressing (if you have one) under the nose as needed.
Take laxatives (prunes/Coloxyl and Senna) if you feel constipated
Avoid extreme physical activity. Strive for more rest than usual and avoid exertion. Gentle exercise and walking can resume at two weeks. Brush your teeth gently with a soft toothbrush only. Avoid manipulating your upper lip, which helps keep your nose at rest.
Avoid smiling or excessive facial movements for 1-2 weeks.
Wear clothing that fastens in front or back for 1 week. Avoid slipover sweaters, tight t-shirts, and turtlenecks. Avoid foods that require prolonged chewing. This is the only dietary restriction related to the rhinoplasty. You may wash your face but avoid getting the nasal cast wet. Do not wash your hair for 1 week unless someone can do it for you.
Do not get your nasal dressing wet, if it gets wet use the blow drier on cold cycle to dry it again. Absolutely avoid tanning for 6 weeks after surgery. Avoid sun exposure for 6 weeks after surgery. Do not wear regular glasses or sunglasses that rest on the bridge of the nose for at least 6 weeks. You may tape the glasses to your forehead.
After Dr Imani removes your nasal silicone cast, the skin of the nose may be cleansed gently with a mild soap or a hypoallergenic or mild skin lotion
For optimal results you can use IMANI Specialised Skin Care two weeks prior to surgery and one week after surgery to alleviate excess swelling and clear the black heads and blocked pores on your nose. It is best to start these skin treatments prior to surgery. The expected skin regime is:
Exfoliating enzyme cleanser twice a day
Conditioning enhancer with each serum application (2 sprays)
Clearing serum II apply to your nose, at night 1 hour prior to going to bed
Enzymatic firming mask twice a week (2-3 drops spread over the nose, leave on skin and wash after 15-30 minutes)
L-Hyaluronic Hydrating Moisturiser (2-3 drops in the morning)
Hydrating TiO2 Sun Protection when heading out in the sun
Dr Imani does not use any internal nasal packing and there is usually a good reason if he has used packing after surgery (if you are likely to bleed excessively- this happens once every two years!). In addition, Dr. Imani will place a silicone splint on the exterior of your nose (top of your nose) to hold the nose in place. This may stay on your nose for 7-14 days.
All sutures used are absorbable and will dissolve in time. Avoid pulling on them, instead moisturise them with the antibiotic ointment (this will be prescribed to you on the day of the surgery) as often as you can to keep them moist. Prior to application of antibiotic ointment cleanse the suture line with 3% Hydrogen Peroxide soaked cotton wool tip.
The day after your procedure, if there is packing (this is a very rare event) in the nose it will be removed from your nose. You can request some pain medication 30 minutes prior to pack removal.
There may be prominent bruising and swelling of the face and nose. You may see red, swollen eyes, or bruising around the eyelids from the procedure. Take all medications as directed by Dr Imani and the anaesthetist. This remains especially important for any steroids and anti-biotic medications. This prevents the nose from becoming infected or swelling beyond expectations.
In order to prevent the formation of blood clots, walk around several times each day for a minimum of ten minutes. In addition to fighting off blood clots, this promotes the circulation and healing of tissues. Don’t bend or exert yourself physically until cleared by Dr Imani.
Although the stitches will be tiny, they still have the potential to break from extensive activity.
Things to monitor and report to Dr Imani after surgery
Elevated temperature. Buy a small thermometer to check your temperature every six to eight hours. The first sign of infection will be an increase in temperature and discomfort in your nose or generally feeling off.
Uncontrollable increasing pain or headaches.
Excessive redness and heat beyond expectations.
Seven to 14 days after your surgery (Average 10 days after rhinoplasty):
1. Dr Imani will see you in his office and remove the nasal splint (silicone dressing over the nose)
2. Take a shower prior to coming to the office to wet the dressing thoroughly and wash your face on the day of the review
3. Dr Imani will use adhesive tape removal fluid on a cotton wool tip to remove the splint, this is like removing a plaster tape.
4. New tapes may be applied without the splint to your nose for another 10 days
5. You will need to remove these tapes in 7 days: wet the dressing in the shower, use a cotton wool tip soaked in olive oil or baby oil, or any mineral oil. Work the Q tip under the dressing to loosen and lift off
6. Begin nose massage: perform 4 times a day 5 minutes each time, massage the tip towards the face and the bridge or dorsum of the nose towards your eye brows. Simply start at the tip and massage towards the upper lip and again start at the tip and massage towards the middle of the brows, then push down any lumps or bumps that may be visible. This is a lymphatic massage to drain the excess fluid and swelling towards your face away from the nose and it help in healing. Make sure your hands are clean.
7. Continue to wash the inside of your nose with FLO 4 – 6 times a day until your nose feels normal (breathing)
8. Continue to apply Kenacomb/Bactroban ointment to the suture lines for two weeks at night, continue to use 3% Hydrogen peroxide on the suture lines if they sutures are persisting.
9. Ignore swelling and numbness – this is normal, however report excessive sudden swelling or redness to Dr Imani
10. Avoid heavy exercise for 6 weeks, you may start light exercise like walking and stretching
11. Continue to rest head up for 6 weeks if you can tolerate it. You may sleep on your side
12. Avoid wearing glasses for 6 weeks after surgery