Nose Re-shaping (Rhinoplasty)
Written by Dr. Julian De Silva
Dr. Julian de Silva, selected as a Top Doctor 2013-2016
“As the nose forms the very center of the face it is also is key to facial harmony and balance. Nose reshaping to give a natural looking result requires harmony of the nose to both a patient’s face and to their body type.” Dr. De Silva has found that sculpting his patient’s nose to harmonize their face can make a huge difference to making his patient’s look and feel better about themself. Nose reshaping, termed rhinoplasty is an operation of finesse and millimeters make the difference between a natural looking result and one that has the trademarks of surgery. “I focus my attention on utilizing specialized techniques through open or closed (hidden incision, also known as endo-nasal) surgery to improve the nasal aesthetics. I consider the key to natural looking nose reshaping is delicacy and subtlety, less is usually more when it comes to the nose”. Dr. De Silva is a London based Oculo-Facial Plastic surgeon who performs multiple rhinoplasty procedures every week. Approximately 20% of all the rhinoplasty Dr. De Silva completes is revision surgery from elsewhere. “With the increasing complexity of facial procedures and modern technology, it is better to perform a few facial plastic procedures very well than to do all types of body plastic surgery only well.” Dr. De Silva specializes only in facial plastic surgery and performs no body surgery. Rhinoplasty surgery is as much an art as it is a science and with nose re-shaping millimetres make the difference, Dr. De Silva allows additional time for each surgery, and asks patients if they cannot get an appointment right away and there is a waiting list for surgery to be patient. Dr. De Silva likes to give every patient the time they need, and for some patients, surgery may not be the answer and he advises all patients not to rush into surgery.
Dr. De Silva believes that reshaping the nose to give a natural looking result requires a delicate balance between the size, shape, contours and definition of the nasal bridge and tip. Cultural variation is a very important consideration in rhinoplasty, different types of noses such as Caucasian, East European, Middle Eastern, Afro-Caribbean, South Asian and East Asian presents unique anatomy that requires specialist techniques to ensure a good looking result. Dr. De Silva is obsessive about the detailed sculpting of the nose from his years of experience in microsurgery. In order to reshape the nose to a style that is both natural while maintaining functional normal breathing requires attention to detail. In order to discuss and plan surgery with each of his patients, Dr. De Silva utilizes state-of-the are computerized digital imaging in the majority of his consultations to ensure that his patient’s expectations and the surgeon’s natural looking aesthetic are in agreement.
Dr. De Silva utilizes the most advanced contemporary innovational techniques from American colleagues in Los Angeles and New York. In approximately 20% of his patients, side profile may reveal facial imbalance with a small chin, Dr. De Silva may advise the use of a chin implant to restore balance to make a good result into a fantastic result. Rhinoplasty is considered technically the most challenging cosmetic surgery of the entire body, a great looking rhinoplasty requires a balance of patients genetic make up and healing, surgical technical excellence and the surgeon’s artistic talent.
Dr. De Silva is a facial cosmetic surgeon specializing in the face only, he does not perform body plastic surgery. He is known for natural looking results and uses the most innovative and contemporary techniques from Beverley Hills and Manhattan. Although rhinoplasty is the third most common cosmetic surgery, it is considered to be technically the most difficult, which is why some cosmetic and plastic surgeons do not perform rhinoplasty. The most common reasons people seek rhinoplasty is for reshaping of the nose, a high dorsal hump, lack of tip definition, a large or wide size of their nose. Patients may also describe of functional difficulty in breathing commonly caused by deviation of the nasal septum, allergic enlargement of the lining of the nose turbinates or middle nose narrowing. Dr. De Silva specializes in the fine detail of facial cosmetic surgery, having trained in microscopic surgery where fractions of millimeters define success. He worked in the NHS for over 10-years before working in Beverley Hills and New York, bringing the most innovative techniques to his practice in London. Dr. De Silva has presented at international meetings, won prizes and led teaching programs on surgical practice and quality of care.
Many patients who come to see Dr. De Silva are concerned about recovery after surgery and downtime. Dr. De Silva advises his patients, 1-week off work is all that is required, for some patients 2-weeks is preferred as by this point the majority of swelling has gone down. Dr. De Silva uses fine micro-surgical techniques to preserve the nasal cartilages and ensure minimal disruption to the natural anatomy of the nose to reduce swelling and bruising. Most of Dr. De Silva’s patients have minimal or no bruising after surgery and most do not require analgesia after surgery.
Rhinoplasty is usually an outpatient procedure performed under local anaesthesia with sedation or general anaesthesia. The procedure may be performed as an open (small skin incision under the nose) or closed (internal incisions) approach. The procedure takes between 1-2 hours and afterwards a splint is placed on the nose that remains for 1-week. Sculpting and reshaping the nose is a challenging procedure as every nose is unique in skin type and thickness, strength and size of the underlying cartilages and boney support. In addition each nose presents different functional breathing issues, commonly with deviated septum and enlarged turbinates. Dr. De Silva uses both open and closed techniques, although the closed technique is preferred as there are no incisions in the skin. For some noses, particularly where delicate surgery of the tip that requires millimeter refinement, the open technique is preferred as this gives the best long-term result. Dr. De Silva uses suture and micro-refinement techniques to maximize tip refinement, uses the most innovative facial plastic surgery techniques to maintain functional breathing that may involve the use of fine grafts that support the airway of the nose preventing collapse. Dr. De Silva is currently editing a new cosmetic surgery book that features rhinoplasty tips and techniques.
“Natural Looking” Rhinoplasty
A natural appearance of a person’s nose is one that is harmony with a person’s facial characteristics that does not look out of place or out of character. A pinched or pointy tip, a scooped bridge or a nose that looks too small are some signs of a rhinoplasty that looks surgical. Dr. De Silva’s aesthetic is a natural appearance where except for close family and friends most people will not be able to tell that you have undergone surgery. Rhinoplasty is an artistic surgery as there is no black and white definition for the final result, it requires an artistic eye to interpret facial characteristics and balance that with surgical technique in order to give a natural looking result. There an recognised contours in the nose shape, angles between the nose and facial characteristics that should be taken into account with nose reshaping.
Consultation with Dr. Julian De Silva
Your initial consultation will consist of a review of your medical history, clinical assessment and a discussion of your expectations and concerns. In some patients the use of computer modeling is used to give a visual representation of the results of cosmetic surgery. The nature of any proposed treatment will be explained in detail including the procedure itself, recovery time and anticipated result along with any potential risks of the operationDr. Julian De Silva is an artist and takes meticulous care to evaluate your facial characteristics, discuss your expectations and customise your surgery to you, this takes time and cannot be rushed. Dr. De Silva is not able to offer free consultations as he personally spends time with every patient discussing your individual and unique needs, your expectations from surgery and how to achieve a fast recovery and the most natural looking results. Dr. De Silva has treated patients from all walks of life including celebrities, actors, actresses, models, fellow physicians, professionals from every walk of life and from every continent, all patients need time and information to make an informed decision, with discretion and anonymity.
Recovery after Rhinoplasty
Many patients who come to see Dr. De Silva are concerned about recovery after surgery and downtime. Dr. De Silva advises his patients, 1-week off work is all that is required, for some patients 2-weeks is preferred as by this point the majority of swelling has gone down. Dr. De Silva uses fine micro-surgical techniques to preserve the nasal cartilages and ensure minimal disruption to the natural anatomy of the nose to reduce swelling and bruising. For some patient additional techniques the use of 3-D telescopic cameras may be used. Most of Dr. De Silva’s patients are surprised at the relative speed of healing with most patients having minimal if any bruising and no need for pain relief medicine.
Revision rhinoplasty is the terminology for undergoing a rhinoplasty after having a previous procedure on the nose. The previous procedure includes a primary rhinoplasty, septoplasty to improve breathing or substantial trauma to the nose. Revision rhinoplasty is a more complex procedure with the presence of scarring and a change in the natural anatomy of the nose, and often requires additional specialist techniques to improve the aesthetic result. Often supportive graft materials are required to improve the final result which often takes additional time and resources to complete. Some patients have functional breathing issues in addition, and this can require additional techniques to open up the airway and improve breathing. For some patients Dr. De Silva imports specialist graft material from the US to improve the final result for some patients, and other techniques may be required such as the use of patient’s ear cartilage to support a long-lasting result. As a consequence of having a previous procedure on your nose, the recovery after revision rhinoplasty can be longer as swelling can longer to resolve, for some patients the use of anti-swelling medicine after surgery can be a powerful tool to speed up recovery after surgery.
Commonly patients come to see Dr. De Silva to improve both their breathing and the cosmetic appearance of their nose. To assess breathing requires an assessment in person and cannot be completed with photographs or imaging alone. For specific patients further tests may be required to evaluate the cause of their reduced breathing and including a CT (computerised tomography) scan. Dr. De Silva often improves breathing at the same time as rhinoplasty with a combination of septoplasty and nasal airway surgery. There are limitations with rhinoplasty, the lining of your nose cannot be changed with surgery and patients who are prone to allergies such as hay fever will continue to have symptoms after rhinoplasty.
A non-surgical rhinoplasty utilises a filler material to alter the shape and position of the nose thereby avoiding surgery. The principal advantage of the technique is that it avoids a surgical procedure, however by definition the treatment is not permanent. A non-surgical nose job can be effectively used to correct specific nasal appearances: a nose with a small hump, nose that has a depression or irregularity along the bridge, very mild droopy. A non-surgical nose job can be used to improve certain features of a patient’s nose, who is not yet ready for a surgical rhinoplasty. Filler can also be sometimes used to smoothen a minor contour irregularity following previous rhinoplasty.
Caution is required in non-surgical rhinoplasty, as the nose is an intricate structure with important anatomy that can be damaged with filler techniques. There are important blood vessels in the nose that need to be avoided with non-surgical rhinoplasty as the implications for damage to these vessels include scarring of the skin (termed necrosis), damage to vision (even blindness) and scarring making surgical rhinoplasty more challenging. For these reasons it is important that non-surgical rhinoplasty should be performed by a clinician who is familiar with the underlying anatomy. Caution is also required to ensure a sterile environment is used to maximise rapid recovery and reduce the risk of infection. The most common filler used is a type of hyaluronic acid that naturally dissipates, most results typically last up for over one year.
Precautions are required in non-surgical rhinoplasty, as the nose is an intricate structure with important anatomy that must be preserved. There are important blood vessels in the nose that need to be avoided with non-surgical rhinoplasty and these techniques should ideally be performed by a surgeon who is also experienced in surgical rhinoplasty with knowledge of the underlying anatomy. Caution is also required to ensure a sterile environment is used to maximise rapid recovery and reduce the risk of infection. The most common filler used is a type of hyaluronic acid that naturally dissipates, most results typically last up for over one year.
Professional membership organizations that focus on Rhinoplasty Surgery