• If you feel your blocked nose is lowering your quality of life, it can be improved

WE ASK THE FOLLOWING QUESTIONS:

• Do you suffer from nasal congestion or stuffiness?
• Do you suffer nasal blockage or obstruction
• Do you have trouble breathing through your nose?
• Do you have trouble sleeping or snoring?
• Do you have trouble with exercise because of your nose?
• If these sound like problems you have, then it is worth beginning treatments to improve your situation.
• This does not always require surgery.

• A very big or very bent nose may be obvious to all, and may be a defining feature for the person

• Other concerns are more subtle, and quite subjective but can cause distress to the patient
• Before considering rhinoplasty surgery, the specific cosmetic and functional concerns must be very well defined, and understood between your surgeon and you.
• Changing the appearance of the nose is not to be undertaken lightly.
• Once you have decided that rhinoplasty is for you, you should be able to agree with your surgeon on a checklist of objective issues that you would like to address.

FOR EXAMPLE:

1. Improve left nasal blockage
2. Make nose smaller
3. Improve external bend
4. Improve profile
5. Refine nasal tip

• This approach in planning is far more useful than computer modelling, which in most cases does little to help patients understand what they can really expect after surgery.
• When the surgery addresses the issues on the checklist, the result will be a dramatic improvement in nasal function and appearance, giving a balanced and natural result.
• Dr Smith has an extensive experience in rhinoplasty surgery, an has operated on almost every conceivable type of nose.
• He will be able to show you pre and postoperative photos of a case just like yours, so that you know what you can expect.

• When we look at people from show business and the world of celebrity, we often see obvious evidence of rhinoplasty.
• Whilst these people are usually very attractive, it is a mistake to think that it is because of their nose. Despite this, many people would like to achieve a similar nasal appearance.
• The unnatural, post-surgical nose will often carry a “signature appearance”, being recognisable as the work of a particular surgeon.

• These “nose-jobs” will go out of fashion as the stars of the moment disappear from the front pages.

• Some stars and celebrities have had rhinoplasty, which even the most trained eye cannot easily detect.
• These noses will never go out of fashion.

They are:

• WELL PROPORTIONED
• STRAIGHT
• SYMMETRICAL
• SMOOTH…
• and
• …HAVE CLEAR AIRWAYS

• These ideal noses are really quite unremarkable, even average in appearance, and what we notice is the person’s eyes.
• Well-planned and well-performed rhinoplasty will give this result.

• Most patients that we see for these issues will already have a clear idea that they would like a rhinoplasty.
• In some cases, patients present with mainly breathing concerns. On reflection they may identify things about the nasal appearance they would like to change, whilst improving the airway.
• It is often possible to improve the nasal airway without out doing anything to the outside of the nose.
• In the most severe cases of nasal deformity, the external shape must be changed to give a good airway

• Dr Smith will spend time documenting the issues that worry you about your nose in terms of function and appearance
• A history of other related “sinus”, allergy and ENT symptoms will be gathered.
• We will identify what treatments have been undertaken to this point, and what effect they have had.
• We discuss the degree to which you feel your nose impacts your quality of life.
• A general medical history is taken.

• A detailed inspection of the inside outside of the nose.
• A detailed internal nasal examination including flexible nasal endoscopy.

• A local anesthetic spray with decongestant is applied to the nose.
• A fine endoscopic tube, usually with a camera attachment, is used.
• Sinusitis, and potential causes of blockage at the back of the nose can be diagnosed.
• The spray (COPHENYLCAINE)has a slightly unpleasant, bitter taste.
• The mouth and throat are numb for about half an hour.
• There is usually no other discomfort associated.

• Standard photography is taken from multiple views
• The views are: Front>profile (left and right)>oblique (left and right)> high basal>low basal
• Dynamic photos (eg smiling, deep nasal inspiration) are often taken
• The photos are essential to discuss what we can expect after surgery, and to document changes after surgery has been performed
• Rather than computer modelling which has little relevance in understanding the probable outcome of surgery, Dr Smith likes to :

• Low radiation CT scan is usually undertaken. This allows us to definitively exclude deeper causes of nasal obstruction. It also gives a great aid for explaining structural airway issues, and how they can be addressed.
• A referral for a blood test for allergy/ hayfever (RAST) is often made.

• This surgery should only be undertaken when you feel that you fully understand the issues and the surgical techniques to correct them.
• It is unusual to book surgery at the first consultation- we will have a detailed discussion about the relevant issues at that stage.
• It takes time to digest this information, and there are often further results which we are awaiting (eg CT scan).
• It is important to reflect and to discuss with close family members (parents/ partners) and friends.
• Clearly, this is never an urgent operation, and so you should never feel rushed when making a decision to have surgery.
• When you have decided to go ahead, Dr Smith can give a booking form for a local hospital (Kareena or St George Private Hospital are the main locations).
• Simone or Nardine (our practice mangers) can give a detailed breakdown of expected costs

• Depending on your level of coverage, your health fund is likely to cover hospital expenses, and a proportion of surgical and anaesthetic fees as long as it can be demonstrated that the surgery is largely for functional (breathing) issues, and not primarily cosmetic reasons.
• Medicare will also contribute a portion of the fees in this circumstance.
• There will be out of pocket expenses, which can be reliably predicted with the help of our office staff.
• If the rhinoplasty is primarily cosmetic, the fund will not cover any of the costs, and the entire process including hospital expenses will need to be covered in full by the patient

• This is a technically challenging operation, usually taking several hours (or more) to ensure the best results.
• A good result is evident from the earliest postoperative days, and once the patient is recovered they scarcely think about their nose again.
• A poor result can have devastating consequences for the patient’s physical and emotional wellbeing, and require ongoing treatment, despite which the nose may never be quite right.
• Our fees reflect Dr Smith’s expertise, and consistently demonstrated good results, whilst trying to remain reasonable for our typical patients.
• There are many surgeons in Sydney who are much more expensive. Whilst some of them are very skilled, this is not always the case. Often, very high prices are determined by factors other than the expertise of the surgeon or the expected quality of the treatment experience.
• If you are interested in a quote for rhinoplasty, feel free to contact Simone or Nardine in our office. It is impossible to exactly determine costs without seeing you in person, but it is likely to give a fairly accurate guide

• The most important thing is that your surgeon can demonstrate their rhinoplasty experience and ability to address both function and appearance of the nose, whether they be an ENT or a plastic surgeon.
• ENT surgeons have core training in functional nasal surgery and treatment of sinusitis. Cosmetic rhinoplasty is very well taught within the ENT subspecialty of facial plastic surgery.
• Dr Smith has extensive training and experience in functional and cosmetic nasal surgery, and performs rhinoplasty surgery on a frequent basis.
• He is able to definitively treat your nose, regardless of the contributing factors.
• Dr Smith also has extensive experience in revision rhinoplasty, improving the nose after unsuccessful surgery by other practitioners.

• If you live in the Sutherland Shire or St George areas, it is not necessary to leave the area for high quality rhinoplasty, as there are several very accomplished rhinoplasty surgeons locally.

• Dr Smith is able to see you in a local practice and operate in either Kareena, or St George Private Hospitals.