Rhinoplasty
Professor Mark Ashton
MB., BS. MD. FRACS (Plas)
Specialist Plastic Surgeon
Professor Mark Ashton is a Melbourne-based plastic surgeon who specialises in rhinoplasty procedures. He is chair of plastic and reconstructive surgery at Epworth Freemasons Hospital, and former Head of plastic and reconstructive surgery at Royal Melbourne Hospital (2001 – 2016) and Royal Women’s Hospital (2000 – 2016).
The following information is designed to help you understand our process for rhinoplasty, including assessment and suitability, and will emphasise essential information to consider before proceeding with surgery.
AHPRA registration number – MED0001135718
Rhinoplasty Melbourne
What is Rhinoplasty Surgery?
Rhinoplasty surgery alters the shape of your nose and may improve your nasal breathing. The decision to undergo rhinoplasty is an extremely personal choice.
CONSULTATIONS
Our aim is to provide a comprehensive, informative and personalised patient experience. During the initial consultation process, you will have the opportunity to meet Prof Ashton, our dedicated nursing and administration staff, and our practice manager.
We encourage every patient to seek a second opinion with a qualified specialist plastic surgeon, before proceeding with any surgical procedures.
INITIAL CONSULTATION
Your initial consultation with Prof Ashton will require a valid referral from your general practitioner (GP), or other qualified healthcare provider. It is preferable that your referral is from your usual GP, as they will ensure all relevant medical history is included in your referral.
During your consultation, you and Prof Ashton will discuss your treatment objectives, and with your written consent, clinical photos will likely be taken for medical purposes. Mark will assess your medical history to ensure that all suitable and relevant treatment options are thoroughly discussed with you.
In addition, we use Vectra imaging to assess your nose shape in 3D, and digitally augment the images to show potential surgical results.
Our nursing staff and practice manager will also provide additional information regarding the procedure discussed, to ensure you are well-informed and you understand your choices. You will be afforded adequate opportunity to address any remaining questions prior to leaving our rooms, we are always happy to answer questions you may have.
SECOND CONSULTATION
If you decide to progress with your surgery, after having reviewed the information provided to you during your initial consultation, you will then have a second consultation with Prof Ashton for further discussion. During your second appointment, you will also meet with one of our nurses again to discuss the necessary surgical documentation, including the initial preoperative and postoperative care instructions.
Whilst you may be enthusiastic to schedule your surgery as soon as possible following your second consultation, if your procedure is determined as purely cosmetic – thus not eligible for an item number, a mandatory 7-day cooling off period must be satisfied in accordance with the current AHPRA guidelines. Following this cooling off period, you will have the ability to secure a surgical date and pay the required deposit.
COMMUNICATION
Communication is one of the most important aspects of your rhinoplasty consultation process and surgical planning. It allows you and your surgeon the ability to ensure your concerns and the related surgical options have been adequately discussed.
Our bodies are all unique and no two people will have the same results. In our practice, we find most patients invariably have a pre-determined result in mind. Therefore, it is critical you are always afforded a platform to openly and clearly communicate with your plastic surgeon, to ensure they understand the results you are hoping to achieve, prior to your surgery.
We find one of the most effective tools to communicate your wishes is via images. We encourage you to bring screenshots or photos to your initial consultation to articulate this.
WHAT YOU MUST KNOW BEFORE CONSIDERING RHINOPLASTY SURGERY
POTENTIAL RISKS
It is important to understand the risks involved with any surgery. The choice to undergo any surgical procedure, elective or urgent, should be based on the comparison of the potential risks to the potential benefits. Although most patients do not experience severe surgical complications, you must always discuss the risks versus the benefits with your surgeon, to ensure you understand all the possible consequences of your planned surgery.
There are risks associated with any surgery, and rhinoplasty is not immune to these risks. Some risks are common to all forms of plastic surgery, and others are specific to rhinoplasty. If any complications arise, it may be necessary to bring you back to theatre to address and resolve these concerns.
Some of the potential risks relating to rhinoplasty surgery are:
- Keloid or hypertrophic scars
- Slow healing; most likely to occur in smokers and people with diabetes
- Numbness of the nose, or change in feeling that continues after the swelling has resolved
- Asymmetry of the nose
- Visible swelling that persists for weeks and sometimes months; in some cases, 12 months may pass before the swelling resolves and the final result can be seen
FURTHER RISKS
INFECTION
The risk of infection can occur despite using antibiotics in the post-operative period. It appears to be more common in patients who continue to smoke post operatively, or who have comorbidities such as diabetes. There are other specific risks associated with surgery that you should always discuss with your surgeon prior to consenting to any surgery.
GENERAL ANAESTHESIA
General anaesthesia is commonly used, however, there is an array of potential complications which can occur during or after general anaesthesia. These complications can be as major as death or brain damage, or as minor as muscle soreness or pain at the site of your cannula. The most common complications are nausea, vomiting and sore throats, and all specialist anaesthetists are trained to avoid and manage complications as they arise.
One of our anaesthetists will be in contact with you the week prior to your surgery to confirm your health status, and answer any questions you may have regarding the anaesthetic and post operative pain management.
SMOKING
As cigarette smoke constricts the small blood vessels within the tissue, smokers have a higher incidence of wound healing problems. In particular, smokers are much more likely to develop wound breakdown and infection. For this reason, it is critical to stop smoking 2 weeks prior to surgery and for 6 weeks postoperatively.
DEEP VENOUS THROMBOSIS AND PULMONARY EMBOLISM
During surgery, there is a risk that blood may accumulate in the veins of the lower legs. Post-surgery, these clots can dislodge from the vein walls of the calves and travel to the lungs, resulting in a pulmonary embolism causing problems with breathing or even death.
Some medications can increase the risk of deep venous thrombosis. It is essential you discuss your current medications with your surgeon and your anaesthetist prior to surgery.
Please be aware this is not an exhaustive list of potential risks. Every patient responds differently to general anaesthesia and surgery. Please ensure you always discuss the surgical risks with your surgeon prior to moving forward with any surgery.
IF I DECIDE TO PROCEED, WHAT CAN I EXPECT WHEN I UNDERGO RHINOPLASTY SURGERY?
HOSPITAL AND ADMISSION
We perform all our surgeries at Epworth Freemasons Private Hospital in East Melbourne.
Each of our patients have a private room with an ensuite, and at Epworth Freemasons there are 12 state-of-the-art operating theatres with the latest anaesthetic machines and theatre equipment. There is also 24 hour onsite medical emergency care, with an onsite Intensive Care Unit.
You will need to fast prior to your surgery, usually from midnight the night prior. Your admission paperwork will be provided to you a minimum of 3 to 4 weeks prior to your operation so that any questions you may have can be answered well before your admission.
SURGICAL PROCEDURE
Rhinoplasty Surgery is only performed on our patients by Professor Ashton, a qualified specialist plastic surgeon, and is carried out under the administration of general anaesthesia by one of our accredited specialist anaesthetists.
In addition to your general anaesthesia, local anaesthetic is infiltrated to the surgical area, which aids in minimising blood loss, and ensures you will be as comfortable as possible following your surgery.
POSTOPERATIVE CARE
Following rhinoplasty surgery, you will spend time in the Post Anaesthetic Recovery Unit until you are wide awake and your pain is adequately managed, at which time you will be transferred to your room for the night.
You will be reviewed by Prof Ashton prior to being discharged from hospital, and the nursing staff will ensure your dressings are intact, and your discharge medications, usually antibiotics and pain medications, are ready for you.
You will be provided an information bag to take home which contains our afterhours details, as well as the dates and times for your follow up appointments with our nursing team and Prof Ashton. During your post-operative period, we will monitor your recovery and progress, and provide precise guidance on the level of activity or exercise you should engage with during your recovery.
Recognising each patient’s healing process is unique, our post-surgical care is tailored to accommodate individual needs. We will address any concerns you or we may have, and you will receive thorough post-surgical care from Prof Ashton and our dedicated team throughout your recovery.
What is involved with rhinoplasty surgery?
Professor Ashton usually uses an “open” technique, ‘open tip rhinoplasty’, involving a small incision at the base of the columella, the junction where the lip meets the nose, followed by small incisions made inside the nostrils. This enables access to the structural tissues of the nose, facilitating adjustments to the internal tissues and the bridge of your nose, to address any asymmetry. An eternal splint may be applied, and will remain in place until we confirm healing.
Recovery From Rhinoplasty Surgery
The use of local anaesthetic during surgery will assist to minimise your discomfort when you wake following surgery. As the effects of the local anaesthetic gradually subside, which is typically over the period of 8 to 12 hours, you will be provided with appropriate pain relief.
It is important to allow your body time to rest and recover during this initial postoperative period, meaning you should refrain from engaging in any strenuous activities or exercises.
Furthermore, we recommend you avoid exposure to excessive heat, such as steam baths or saunas, or any intensely heated environments involving high temperatures.
Things You Must Know About This Surgical Procedure:
A thermoplastic splint is applied to your nose, and must be left intact until your first post-operative appointment. It is critical that you keep the splint and your nose clean and dry.
The sutures and your nasal splint will be removed by our nurse during your first post-operative appointment, approximately 7 days following surgery.
Following rhinoplasty surgery, it is important to be aware that your nose will experience significant swelling as a direct result of the procedure. It takes approximately 6 to 8 weeks for the initial swelling to subside.
It is common for the swelling to continue reducing for up to 12 months following surgery, making it important to have realistic expectations, and an understanding that it may take up 12 months to evaluate the final outcome.
You may experience some bruising or swelling around the eyes after surgery, however, this will usually resolve by approximately day 10.
We advise you to avoid running, exercise or strenuous activity for a minimum of 6 weeks post-surgery. It is critical you also avoid any contact sports for a minimum of 12 weeks following surgery.
Interested In Rhinoplasty?
