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I use a combination of the following techniques for Rhinoplasty/Septorhinoplasty

Piezo

Piezo, also known as ultrasonic Rhinoplasty, involves the use of piezoelectric instruments to perform precise bone cutting (osteotomy), removal (ostectomy) and reshaping (osteoplasty). The main advantage of piezo rhinoplasty is its ability to selectively cut bone, while preserving soft tissue structures, compared to traditional hammer and chisel techniques. This can lead to faster recovery times, less post-operative discomfort, and better outcomes. I feel strongly that Piezo allows a huge increase in variety and Rhinoplasty surgical options and that is why I use it for all my surgeries.

Open

I undertake exclusively open Rhinoplasty. Open Rhinoplasty is a surgical procedure performed to alter the shape, size, or structure/function of the nose. It is called "open" because during the surgery, I make an incision on the strip of skin between the nostrils (the columella), in addition to incisions inside the nostrils. This allows me  better access and visibility to the underlying nasal structures, such as bone and cartilage. The advantage of open Rhinoplasty is that it offers the a clearest view of the nasal anatomy, allowing me to make precise adjustments. The scar heals well and becomes barely noticeable over time.

Structural

Structural Rhinoplasty is a surgical technique focused on addressing the underlying structure of the nose, including the bone and cartilage framework. This approach is often employed to correct functional issues with the nose, such as breathing difficulties due to a deviated septum, as well as aesthetic concerns related to the shape and symmetry of the nose.

In structural Rhinoplasty, the nasal bones and cartilage are manipulated from on-top (the dorsum) to achieve the desired outcome. This can involve techniques such as osteotomy (controlled bone cuts), septoplasty (straightening of the nasal septum), and grafting (using tissue from another part of the body or materials to support or augment the nasal structure).

The goal of structural Rhinoplasty is to create a nose that not only looks aesthetically pleasing but also functions properly. This approach requires meticulous planning and precise surgical techniques to achieve optimal results while maintaining or improving nasal function. I perform a tailored surgical approach for each patient and their anatomy, using a combination of structural and preservation techniques.

Preservation

Preservation Rhinoplasty, is a surgical method that maintains the natural support structures of the nose, especially the dorsum, preserving as much as possible, to maintain or restore the nasal shape, structure, and function. Preservation Rhinoplasty has gained popularity in recent years as it offers several potential benefits, including reduced risk of complications, faster recovery times, and more natural-looking results. However, not all patients may be suitable candidates for preservation Rhinoplasty, and the appropriateness of this approach, depends on factors such as your nasal anatomy, aesthetic goals, and functional concerns. It's essential that if you are considering Rhinoplasty, you consult to determine the most appropriate surgical approach for your specific needs. I perform a tailored surgical approach for each patient and their anatomy, using a combination of structural and preservation techniques.

Secondary

Revision Rhinoplasty, also known as secondary Rhinoplasty, is performed to correct or revise the results of a previous Rhinoplasty surgery. It is typically undertaken when the initial Rhinoplasty did not achieve the desired outcome or resulted in complications that require correction, or following a septoplasty procedure that has left a change to the function or aesthetics of the nose.

Revision Rhinoplasty is generally more challenging than primary Rhinoplasty due to alterations made during the initial surgery and changes in the nasal anatomy caused by scar tissue. It requires a thorough evaluation of  nasal structure, previous surgical techniques used, and desired outcomes. During revision Rhinoplasty, its often neccessary to create structural support, using additional tissue scaffolds such as rib cartilage or facia lata (see below).

Rib and Fascia Lata

During secondary (revision) Rhinoplasty it is often neccessary to add structural strength to resupport the nose, following cartilage removal during the first procedure. It is difficult to predict what cartilage was removed during the initial surgery and what structural support might be left to work with. 

It is common for me to use donated rib cartilage and facia lata (tissue over the thigh muscle) to resupport and restore the support structures of the nose. This tissue provides a cartilage and tissue structure and is fully tested and treated to make sure it is safe to use. I have used these tissues in many patients with good success. These types of surgeries are more time consuming than primary Rhinoplasty and therefore require a higher charge/cost as a result, due to the requirements for tissue implants and increased theatre operating time. Using donor cartilage and tissue saves the pain and potential complications of harvesting these tissues from your own body.

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